People’s Charter Pillar 10 (Improving Health Service Delivery): For Discussion
Readers are invited to consider and comment on what the Bainimarama Government has done —and what it has not yet done— towards the realization of these health objectives.
Critical Problems and Issues:
- Fiji’s overall progress towards the three health-related Millennium Development Goals (MDG) i.e. reduction in child mortality, maternal mortality and HIV/AIDS, is disappointing.
- Resources allocated for health service delivery, as a proportion of GDP, remains low by international standards including compared to countries such as Solomon Islands and Tonga.
The following key measures and actions must be taken with due priority and urgency :
- Increase financing as a proportion of GDP by 0.5% annually to 7% within the next 10 years.
- Strengthen institutional arrangements by centralising decision making and decentralising the delivery of health care.
- Expand private sector role in public health care delivery such as through outsourcing.
- Strengthen public and private sector coordination including with the medical professional organisations, to meet the manpower needs.
- Consider other options for health financing such as social health insurance in addition to tax financing.
- Establish a Health Policy Commission
To immediately improve the performance of the health sector, the formation of a Health Policy Commission has been recommended to oversee the administration of the Public Hospitals Act and to provide strategic direction on how health services should operate in the short, medium and longer term. The Commission will comprise leading community representatives including those from relevant Ministries and nongovernment stakeholders such as academics, practitioners, advocates and consumers. (Similar representation should also apply to the divisional and sub-divisional hospital boards with more clearly defined terms of reference.)
The health sector is severely underfunded and generating revenue by the ‘user pays’ system has always been subject to political backlash. The NCBBF agreed to recommend that Government increase all non-essential medical fees, ensure an improvement in fiduciary collections, and consider immediately implementing alternative means of health financing such as risk pooling through a social health insurance scheme.
To reduce costs the NCBBF also recommends outsourcing non-technical hospital services including: laundry; security; maintenance and cleaning services. The introduction of herbal medicine is also considered important in reducing pharmaceutical costs.
The migration of health professionals is now a widespread international phenomenon.
There are push and pull factors: while very little can be done to address pull factors, there is a need to concentrate on reducing push factors. This can be done by ensuring a rewarding, comfortable, safe, conducive and supportive working environment.
Concerns were also raised about the increasing incidence of communicable and non-communicable diseases (CDs and NCDs) in the community. The NCBBF strongly recommends that, while all efforts are being made to improve service delivery, communities should also take greater responsibility in improving their health. The quality of food sold in the markets — especially ‘fast’ foods — was also considered a major contributor to NCDs. Stringent controls are required and a greater awareness of what people consume and the implication of this consumption for their health.