National Strategic Plan 2016-2020 Executive Version

Objectives

Fiji’s National Strategic Plan 2016-2020 provides a five-year health-sector framework and a longer-term wellness vision of “A healthy population”. Its mission is to empower people to take ownership of their health and achieve their full health potential through quality preventive, curative and rehabilitative services delivered by a caring and sustainable health-care system.[1][2]The framework aligns with Fiji Government priorities, the post-2015 development agenda, Sustainable Development Goals, the Pacific Healthy Islands vision and Universal Health Coverage.[3][2]

• Promote population health, equity, dignity, responsiveness and affordable access to quality services without discrimination, using Health in All Policies and a wellness approach.[2][4]
• Address non-communicable diseases, nutrition, mental health and injuries as the first priority area under the pillar for preventive, curative and rehabilitative health services.[1][5]
• Reduce premature non-communicable disease morbidity and mortality by tackling lifestyle risks and underlying determinants including poverty, housing, food markets, education, transport, safety, social norms and gender inequality.[6][4]
• Strengthen settings-based wellness in places where people live, work and play, supported by multi-sectoral engagement, appropriate legislation and the National Wellness Policy.[3][5][4]
• Expand early detection, risk assessment, behaviour-change counselling, clinical management and rehabilitation for non-communicable diseases; integrate mental-health services into primary health care; and improve injury reporting related to violence, domestic abuse and road traffic incidents.[7]
• Improve maternal, infant, child and adolescent health; strengthen communicable-disease and environmental-health functions; and build resilience to health emergencies, climate change and natural disasters.[8][9]
• Advance health-system performance through effective, efficient, accountable, sustainable and equitable service delivery, encompassing primary care, workforce, governance, information, medicines, equipment, infrastructure and financing.[10][11][12]
• Provide financial risk protection and improve the sustainability, equity and efficiency of health-system financing, recognising resource gaps as a constraint on achieving the overall vision.[9][12]

Implementation

The Ministry of Health and Medical Services leads implementation, but the delivery model depends on whole-of-government, whole-of-society and community collaboration.[6][13][5]The plan combines population-level prevention and wellness promotion with accessible primary care, referral-based hospital and specialist services, early diagnosis, treatment, rehabilitation and health-systems strengthening.[14][7][11]

• Coordinate planning and policy through the Planning and Policy Development Unit, including National Health Accounts, donor coordination, departmental plans and medium- and long-term strategies, in consultation with the Public Service Commission and Ministry of Finance.[13]
• Deliver primary health care through sub-divisional hospitals, health centres, nursing stations and national public-health programmes, with community outreach, volunteer Community Health Workers and zone-nurse visits to improve rural, remote and urban access.[14][8][9]
• Strengthen continuity of care through defined referral networks between public and private providers, supported by policies, standards and protocols for safe, high-quality services.[8]
• Coordinate hospital, specialist, rehabilitation and mental-health services through divisional and specialist hospitals, clinical service networks and the Fiji Pharmaceutical and Biomedical Services Centre.[2]
• Develop services and infrastructure according to population projections, service requirements, common standards and clearly defined population needs, while linking facility, workforce and clinical-services planning.[15][1][4]
• Recruit, train, deploy, retain and motivate staff according to assessed need; undertake annual Workforce Indicator of Staffing Needs assessments; improve occupational health and safety; and strengthen professional development and training-programme accreditation.[13][16]
• Secure access to safe, effective medicines, biomedical equipment and other commodities through stronger procurement, supply-chain management, product standardisation and maintenance systems.[17][12][18]
• Engage government ministries, civil society, communities, local authorities, development partners, faith-based organisations, private providers, universities, professional associations and international partners in health action and service support.[17][19][20][21]
• Maintain regulatory oversight through legislated bodies, including the Central Board of Health and professional councils governing medical, dental, pharmacy, nursing and private-hospital functions.[14]
• Use health information, research and analysis functions to manage data systems, analyse health statistics and epidemiological information, monitor corporate and strategic plans, and oversee key performance indicators.[13]
• Monitor implementation through national strategic-plan indicators, including 16 indicators for the non-communicable disease priority area and 28 for maternal, infant, child and adolescent health.[4]
• Track indicators through surveys, facility and programme records, hospital discharge data, medical cause-of-death certificates, audits, surveillance systems and health-information platforms, with frequencies ranging from monthly and quarterly to annual and periodic measurement.[22][23][24][25]
• Strengthen performance accountability through unit-level monitoring and evaluation standards, integrated surveillance and reporting, interoperable information systems, applied research and annual planning cycles.[11][12][26]
• Improve financing through evidence-based budgeting, strategic health-financing analysis and development of an appropriate financing model, while considering long-term alternatives and potential outsourcing of non-technical services.[4][12]

Monitoring & Evaluation

The plan establishes a broad performance-management framework using indicators, routine data, surveillance, research, audits and periodic review to track progress across service delivery and health-system strengthening. The Health Information, Research and Analysis Division manages health information systems, compiles and analyses health statistics and epidemiological data, promotes research, monitors corporate and strategic plans, and oversees key performance indicators for corporate reporting.[13]

• Monitor priority areas through a national indicator annex, including 16 indicators for non-communicable diseases and 28 indicators for maternal, infant, child and adolescent health.[4]
• Track non-communicable disease outcomes and services through measures of premature mortality, diabetes, tobacco use, obesity, dental health, institutional wellness programmes, cardiovascular risk assessment, cervical-cancer screening, suicide, self-harm, mental-health service standards and injury reporting.[22][23]
• Use data sources including national surveys, medical cause-of-death certificates, hospital discharge data, health-facility and programme records, school-health records, oral-health surveys and quality-improvement audits.[22][23][24]
• Apply reporting intervals ranging from monthly and quarterly reporting to six-monthly, annual, periodic and survey-based measurement.[27][25][28]
• Strengthen communicable-disease surveillance by integrating surveillance, notification and reporting with laboratory, hospital and vaccine-preventable disease information, and by linking surveillance with research, public-health response and communications.[8][11][12]
• Measure service quality and accessibility through indicators on outpatient attendance, operating hours, decentralised outpatient care, discharge summaries, infection control, clinical audits, hospital readmissions, patient satisfaction and national clinical quality and safety standards.[29][30]
• Monitor workforce performance through staffing ratios, recruitment times, vacancy rates, occupational health and safety compliance, professional development, attrition and training-programme accreditation.[16]
• Improve data quality, interoperability and accountability by expanding use of PATISplus, developing integrated surveillance systems, applying national eHealth interoperability standards, recording mortality data for the Fiji Bureau of Statistics, and making approved datasets available through the National Data Repository.[16][26][31]
• Establish unit-level monitoring and evaluation standards, integrate surveys and applied research into annual planning, and use findings to assess performance and adjust implementation.[17][12]
• Maintain regulatory accountability through statutory bodies responsible for setting and enforcing standards across medical, dental, pharmaceutical, nursing, hospital and related health functions.[14]

Selected 2020 targets include reducing premature non-communicable-disease mortality from 40.7% in 2014 to 37%; reducing adult tobacco use from 17% to below 11%; increasing cervical-cancer screening coverage from 15.8% to 50%; and reducing suicide from 9.8 to below 7.8 per 100,000 population.[22][23]Workforce targets include 10 active doctors, 55 nurses, 16 midwives and 2.8 dentists or dental therapists per 10,000 population by 2020.[16]Several indicators retain baselines or targets marked as to be confirmed, developed or not established, and the extracts do not specify a single consolidated reporting schedule or formal performance-accountability process for all indicators.[22][23][24][32][33]

Costing & Financing

Sustainable financing is a dedicated health-systems-strengthening priority intended to improve the financial sustainability, equity and efficiency of the health system while protecting equitable access to quality care and reducing financial risk.[9][12]Health policy, planning and budgeting are to be based on evidence, efficiency and cost-effectiveness.[4]

• Maintain a predominantly publicly financed health system funded through general taxation, while recognising that private expenditure accounts for more than one third of total health expenditure and donors contribute an estimated 6% of total health spending.[4]
• Review financing arrangements in response to rising service demand, particularly from non-communicable diseases, which represented 40% of healthcare costs for diseases in 2011 and are expected to impose increasing pressure on government and household finances.[17][6]
• Strengthen National Health Accounts, donor coordination and financial monitoring of the timely and efficient delivery of goods and services against agreed budgets.[13]
• Develop an appropriate health-financing model, expand analytical capacity for strategic health financing, and consider long-term financing alternatives and outsourcing of non-technical services to reduce dependence on government funds.[4][12]
• Increase the share of the capital-works budget allocated to maintenance from 14% in 2014 to 30% by 2020, supporting facilities that are planned, equipped and maintained against service standards and population needs.[18]
• Develop a 10-year costed plan for health-financing assessments, first prepared in 2015 and updated annually.[34]

Current health expenditure was 299.3 Fiji dollars per capita in 2012.[18]General government expenditure on health represented 7.2% of total general government expenditure in 2012, with a 2020 target of 10%, while household out-of-pocket payments represented 26.8% of current health expenditure in 2012.[18][35]The Clinical Services Plan has major resource implications, and resource gaps are identified as a barrier to achieving the strategy’s vision.[1][9]However, the supplied material does not provide a total programme budget, programme-level allocations, quantified funding gaps, expenditure ceilings, detailed costing methodology or wider economic assumptions.[1][9][12][34]