The Fiji Health Sector Review 2024 which was launched last month provides an insightful yet drastic revelation about the state of Fiji’s healthcare system.

The report drew attention first to the decline in Fiji’s birth and infant mortality rates. It stated that this has resulted in a reduction in the share of young dependents, leading to an increase in the share of Fiji’s working-age population.

A greater component of the working-age population translates into a larger labour force pool and opens opportunities for Fiji to benefit from faster economic growth.

However, this economic potential can only be realised if we can ensure that our population remains healthy and educated, and is supported by conducive economic and labour policies, as well as access to financial systems.

The report indicated that this favourable population composition is projected to persist until around 2050.

Burden of NCDs

According to the Ministry of Health and Medical Services, NCDs are estimated to cost Fiji approximately $591m annually, which includes direct costs of treatment and prevention as well as indirect costs incurred by employees who exit the workforce to care for affected relatives, or who miss or under perform at work due to illness.

The report stated that women’s ability to participate in paid work is most affected given their caregiving responsibilities and if left in its current state, the growing NCDs burden coupled with an aging population is significantly likely to place enormous pressure on our public health spending.

The report cautions that this presents a risk, as without increased public spending, households will be compelled to pay more out-of-pocket or forgo care, leaving them vulnerable to both financial and health risks.

Challenges in health service delivery

There are significant gaps in the quality of NCDs services provided at primary healthcare facilities in Fiji. According to data from the recent STEPS survey, fewer than one-third of individuals with hypertension and diabetes have been diagnosed or are aware of their conditions according to the report.

Among those diagnosed, fewer than one-third of individuals with diabetes and fewer than one in seven with hypertension are adhering to a treatment regimen. Of those receiving treatment, less than 10 per cent have their blood sugar or blood pressure under control.

This reflects a situation where only a small proportion of Fijians with hypertension or diabetes are effectively managed, leaving a significant number at risk of hospitalisation due to inadequately managed chronic conditions at the outpatient level.

The report also revealed that recent studies in Fiji suggest that there are knowledge gaps among medical staff, including regarding adherence to clinical guidelines, in the management of patients with chronic conditions.

The issue is further compounded by the limited availability of drugs and diagnostic tests as well as low levels of patient adherence to treatment.

Inefficiency in resource utilisation in the health sector has also been highlighted by the report where an imbalance exists on where resources are being directed and how resources are being used.

For example, the report stated that 79 per cent of the government’s health spending was on hospitals in 2019 and this suggested that expenditure is predominantly allocated to outpatient services at major hospitals rather than primary health care facilities like health centres and nursing stations which are less costly to operate and more physically accessible to patients.

Running at close to maximum capacity is straining and putting pressure on Suva’s CWM and other major urban health facilities according to the report.

CWM for example consistently operates at full capacity and frequently needs to transfer patients to other care facilities.

The Valelevu Health Centre, serving a catchment population of 60,000 people, functions as one of CWM’s off-load facilities for both outpatient and inpatient care, despite not being classified or equipped as a hospital.

The report noted similar trends are seen at other urban health centres with large catchment areas, restricting their capacity to provide preventative care. This results in delayed disease diagnoses and preventable complications that ultimately require expensive treatment at higher levels of care. Additionally, it contributes to stress and burnout among healthcare staff.

In contrast, many rural hospitals in Fiji have very low utilization rates. Hospitals in the Northern Division average only 30 per cent bed occupancy, while those in the Eastern Division have an average of just 10 per cent bed occupancy. This indicates a limited provision of inpatient services compared to the investments made in the hospital sector in these divisions.

Areas for reform

Fiji’s health service structure needs a fundamental shift, moving from a hospital-centered, curative care system to one that emphasizes preventive care and disease management at the primary level. Primary healthcare-focused systems provide the most cost-effective, equitable, and accessible approach to improving population health.

Hospitalsations due to complications from diabetes and hypertension can often be avoided with early and proper management of these conditions. The goal is to reduce the number of patients with chronic conditions and related complications who require care at secondary and tertiary facilities.

While some of Fiji’s secondary and tertiary facilities have recently been upgraded, further investments are still needed to enhance healthcare services and safety at the country’s main referral hospital, CWM.

Fiji needs bold action to tackle its NCDs crisis, beyond what the health sector can do by itself. It needs to implement strategies that address lifestyle risk factors to delay the onset of NCDs and the development of multiple health conditions in those with NCDs.

The report states that while Fiji has introduced cost-effective policies and interventions, they are not bold enough to address the current crisis, and their implementation is weak. Fijian leaders can take stronger actions to match the scale of the NCDs crisis.

A new human resource model within the medical workforce, along with upgrades to primary healthcare, will improve access to care. Providing health promotion and preventive care close to people’s homes will require solutions that make the most of Fiji’s current healthcare staff and are tailored to the needs of the population they serve.

The private sector is increasingly contributing to Fiji’s health system.

With proper planning, it could be utilised to enhance health service delivery, including for underserved populations in urban areas, according to the report.

Current programs that buy services from the private sector could, with better monitoring, be turned into strategic opportunities for screening, preventive care, and health promotion.

The report stated that the government could build on its efforts to involve private general practitioners and healthcare providers in expanding NCDs prevention programs and evaluations are needed to determine the cost-effectiveness of current and future arrangements to ensure value for money.

Investments in health equal economic gains

Health improvements would lead to significant economic gains for Fiji.

Achieving the health outcomes of a typical upper-middle-income country by 2040 would increase Fiji’s annual real GDP per capita growth rate by 0.3 percentage points from 2024 to 2050, according to the report.

The World Bank estimates that catching up by 2050 would raise Fiji’s growth rate by 0.15 percentage points compared to the current trend.

Including the economic value of longer life expectancy, the annual economic gains of catching up by 2040 would rise to 0.90 percentage points from 2024 to 2050, or 0.55 percentage points if achieved by 2050.

The greatest benefits would come from health promotion, preventive care, and managing chronic NCDs effectively.