National Strategic Plan 2016-2020 Executive Version

Objectives

Fiji’s National Strategic Plan 2016-2020 provides a five-year framework for improving population health, aligned with government priorities, the Sustainable Development Goals, the Pacific Healthy Islands vision and Universal Health Coverage. Its long-term vision is a healthy population, and its mission is to empower people to take ownership of their health and achieve their full potential through quality preventive, curative and rehabilitative services within a caring and sustainable health-care system.[1][2][3]

• Deliver health services through Strategic Pillar 1, covering non-communicable diseases, nutrition, mental health and injuries; maternal, infant, child and adolescent health; and communicable diseases, environmental health, emergency preparedness, response and resilience.[3][4]
• Strengthen health-system performance through Strategic Pillar 2, with emphasis on primary health care and continuity of care, a productive workforce, evidence-based policy and planning, medicines, equipment and infrastructure, and sustainable financing.[5][6][7]
• Promote wellness through a whole-of-society, settings-based approach addressing the environments in which people live, work and play, supported by the National Wellness Policy and Health in All Policies approach.[4][8]
• Reduce premature morbidity and mortality from non-communicable diseases by tackling lifestyle risk factors, improving early detection, risk assessment, counselling, clinical management and rehabilitation, and integrating mental health into primary health care.[8][9]
• Improve maternal, newborn, child and adolescent outcomes by promoting first-trimester antenatal care, strengthening obstetric, postnatal, neonatal and infant services, maintaining immunisation coverage, reducing malnutrition and expanding services for adolescents aged 13 to 17 years.[10][9]
• Strengthen communicable disease prevention, surveillance, treatment, environmental health, risk reduction and emergency management.[11][12]
• Advance equity, integrity, respect for human dignity, responsiveness and customer focus, while ensuring accessible, affordable and non-discriminatory services.[3]

The plan uses a situation analysis of health needs, health-system constraints, contributing factors and expected impact to set priorities. It recognises that non-communicable diseases are an increasing burden as the population ages and that poor health affects household and government finances, labour supply, saving and economic development.[13][14]Gender perspectives are to be integrated across government and civil-society action, addressing gender norms, values and inequality that can impede health.[13][14]

Implementation

Implementation relies on Ministry of Health and Medical Services leadership, multisectoral collaboration and a reoriented primary health-care model under the Wellness Fiji approach. The Ministry is to work with other government bodies, civil society organisations, development partners, faith-based organisations, private-sector stakeholders and communities to deliver coordinated action.[1][15][13]

• Deliver primary health care through sub-divisional hospitals, health centres, nursing stations, national public-health programmes, multidisciplinary outreach teams and volunteer Community Health Workers.[16][10]
• Establish continuity of care through defined referral networks linking public and private providers, while decentralising appropriate outpatient workloads from central and divisional hospitals to major sub-divisional health centres.[10][17][6]
• Improve community access by training Community Health Workers, increasing zone-nurse community visits, extending facility opening hours where appropriate and developing services for urban, rural, remote and peri-urban populations.[8][18][19]
• Strengthen clinical quality and safety through systematic quality improvement, audits against clinical standards and guidelines, infection-control measures, service-efficiency monitoring and patient-focused care.[6][19][20]
• Develop the workforce through annual needs assessments, recruitment, deployment, retention, continuing professional development, occupational health and safety compliance, and collaboration with training institutions to match graduates to service needs.[6][21]
• Maintain reliable supply systems for essential medicines, regulated medicinal products, biomedical equipment and facility maintenance, using service standards and population needs to guide infrastructure planning.[7][22]

Governance and planning functions are coordinated through the Ministry. The Planning and Policy Development Unit leads policy development, National Health Accounts, donor coordination, departmental plans and medium- to long-term strategies in consultation with the Public Service Commission and Ministry of Finance.[23]Regulatory oversight is supported by bodies including the Fiji Medical Council, Fiji Dental Council, Fiji Pharmacy Profession Board, Fiji Nursing Council, Private Hospital Board and Rural Local Authorities.[23]The National Strategic Plan Secretariat provides guidance, facilitates consultations and consolidates stakeholder input.[15]

Health information, research and performance management support implementation. The Health Information, Research and Analysis Division manages health information, research, monitoring and evaluation of corporate and strategic plans, key performance indicators, epidemiological analysis and information technology services.[4]Operational measures include electronic patient-management systems, integrated surveillance and reporting, interoperable information systems, improved access to priority datasets, annual surveys and targeted research plans.[6][7][24][25]

The plan includes an indicator framework covering service access, quality, health outcomes, workforce capacity, policy and budgeting, health information, medicines, infrastructure and financing. Examples include institutional wellness-programme uptake, Community Health Worker coverage, zone-nurse outreach, customer and employee satisfaction, essential-medicine availability, health expenditure and household out-of-pocket payments.[8][18]It also specifies indicators with reporting frequencies and named sources for non-communicable diseases, maternal and child health, communicable diseases and health-system performance, although some baselines and targets remained to be confirmed.[26][27][28][12][29]

Financing is mainly derived from general taxation, supplemented by private spending and donor support.[17]The approach calls for long-term financing alternatives, rational resource allocation, cost-effective planning and budgeting, and a health-financing strategy that improves sustainability, equity, efficiency and financial risk protection.[17][7]No overall programme budget or detailed funding gap is specified, although the plan includes a ten-year costed health-financing assessment plan and targets an increase in general government health expenditure from 7.2% of total government expenditure in 2012 to 10% by 2020.[30][31]

Monitoring & Evaluation

The National Strategic Plan 2016-2020 establishes a broad monitoring, evaluation and accountability architecture for health-service delivery and health-systems strengthening, combining a national indicator annex, routine information systems, surveillance, audits, surveys, performance reviews and regulatory oversight.[32][4][33]

• Use carefully selected indicators to track progress, assess whether interventions contribute to intended outcomes, and identify when interventions require improvement.[15]
• Apply defined indicator frameworks across priority areas, including 16 indicators for non-communicable diseases and 28 for maternal, infant, child and adolescent health.[8]
• Monitor outcomes through annual, quarterly, six-monthly and periodic reporting, using baseline values, 2020 targets, named data sources and specified reporting frequencies.[26][27][34][28][35][36]
• Track non-communicable disease outcomes, including premature mortality, tobacco use, cervical cancer screening, diabetes-service standards, mental-health service adherence, injuries and institutional wellness-programme adoption.[26][27]
• Monitor maternal, child, adolescent, environmental-health, emergency-preparedness and communicable-disease outcomes, including immunisation, infant mortality, adolescent birth rates, vector surveillance, case fatality rates and preparedness standards.[34][28][35][36]
• Strengthen communicable-disease surveillance through the National Notifiable Disease Surveillance System, syndromic surveillance, hospital-based active surveillance, laboratory-confirmed reporting and immunisation-related surveillance.[12][37]
• Review surveillance timeliness and completeness quarterly, including routine, laboratory-confirmed and vaccine-preventable disease reporting.[12]
• Integrate electronic patient-management systems, communicable-disease surveillance and reporting, interoperable information systems, surveys and applied research into annual planning and performance management.[6][7]
• Monitor health-system performance through indicators on outpatient access, facility operating hours, discharge summaries, community health workers, service capacity, infection control, quality of care, readmissions and clinical audits.[19][20]
• Measure workforce performance through staffing ratios, recruitment time, vacancy rates, occupational health and safety compliance, continuing professional development, attrition and training-programme accreditation.[21]
• Track governance and information-system capacity using the Policy, Planning and Budgeting Index, Health Metrics Network Health Information Systems self-assessment, Clinical Information System maturity and implementation of PATISplus.[29][24][25]
• Monitor medicines, equipment and infrastructure through tracer-product availability, expiry wastage, medicine registration, equipment functionality, facility compliance, maintenance expenditure and capital-works maintenance allocations.[22][30]
• Assign corporate monitoring functions to the Health Information, Research and Analysis Division, which manages health information, research, strategic-plan monitoring and key performance indicators for corporate reporting.[4]
• Support accountability through professional and service regulatory bodies, alongside unit-level monitoring and evaluation standards, systematic quality improvement and results-based monitoring intended to inform organisational decisions.[23][6][7]
• Evaluate decentralisation of outpatient services before extending it across all divisions.[10][17]

Several indicators have baselines or targets still to be confirmed, and some entries in the supplied indicator extract appear corrupted.[26][27][34][28][35][20][21][29]The extracts do not provide a consolidated evaluation methodology, complete accountability framework, or all indicator definitions and responsible bodies.[3][16][33][12][37][19]

Costing & Financing

Sustainable health-system financing is a strategic priority, with an emphasis on equity, efficiency, financial risk protection, evidence-based budgeting, National Health Accounts and long-term financing reform.[3][4][18][7]Fiji's health system is mainly financed through general taxation, while private expenditure represents more than one third of total health expenditure and donors contribute an estimated 6% of total health spending.[15][17]

• Review the health-financing system in response to rising demand for services, particularly demand associated with non-communicable diseases.[15]
• Develop long-term financing alternatives to reduce dependence on government funds, improve efficiency and support cost-effective planning and budgeting.[17]
• Strengthen analytical capacity for strategic health financing and develop an appropriate health-financing strategy.[7]
• Apply rational resource allocation and budgeting to improve efficiency and cost-effectiveness.[6]
• Coordinate National Health Accounts, donor coordination and health-financing assessments through the Planning and Policy Development Unit in consultation with the Ministry of Finance and other stakeholders.[23][30][31]
• Monitor delivery of goods and services against agreed budgets through the Finance Accounts Unit.[23]
• Develop and annually update a ten-year costed plan of health-financing assessments to address priority policy issues.[31]
• Plan facilities, equipment, maintenance and health services according to common standards, population needs and service plans, recognising the major resource implications of the Clinical Services Plan.[15][2][17]
• Increase the maintenance allocation within the total capital works budget from 14% in 2014 to 30% by 2020.[22][30]
• Keep stock wastage due to expiry below 3% of the medicines budget.[22]

Current health expenditure was 299.3 Fijian dollars per capita in 2012; government health expenditure was 7.2% of total government expenditure, with a target of 10% by 2020; and household out-of-pocket payments represented 26.8% of current health expenditure in 2012.[30]Non-communicable diseases accounted for 40% of health-care costs for diseases in 2011 and were expected to impose increasing pressure on public and household finances and the wider economy.[13]The extracts do not specify an overall programme budget, programme-level allocations, quantified funding gap, detailed costing methodology or wider economic assumptions.[8][18][24][25][22][30][31]