Strategic Plan 2020-2025

Objectives

The 2020–25 Strategic Plan of Fiji’s Ministry of Health and Medical Services seeks to achieve universal health coverage through a one-system approach that links population health, patient-focused clinical services and efficient health-system management.[1][2]It aims to improve the health and well-being of all Fijians through integrated public health, a strengthened continuum of care and action on social determinants of health, with particular attention to vulnerable and marginalised people, isolated islands, disease hotspots, climate-affected communities and informal settlements.[1][2]

• Reform public health services towards a population-based approach to communicable and non-communicable diseases, mental health, environmental hazards, public health emergencies and the climate crisis.[3][4]
• Expand promotive, protective and preventive care across the life course, including integrated screening, detection and diagnosis from community to hospital level, healthier lifestyles and the Wellness Fiji approach to mental health, nutrition, physical activity and oral health.[4]
• Reduce communicable disease burdens, including leptospirosis, typhoid and dengue, while reducing non-communicable disease prevalence, premature mortality, obesity and related risk behaviours.[5]
• Strengthen climate resilience, water, sanitation and hygiene, food safety, emergency preparedness and compliance with the International Health Regulations.[5][6]
• Increase access to quality, safe and patient-focused clinical, rehabilitative and palliative services, including decentralised care for women, children, young people, older people and people with disabilities.[7][6][8]
• Improve patient outcomes, safety, quality and value through standardised clinical services, timely diagnosis, treatment and referral, integrated care and reduced avoidable hospital admissions.[8][9]
• Develop a skilled, diverse and inclusive workforce; strengthen supply chains, procurement, infrastructure, financial processes and digital health; and improve planning, governance and partnerships.[9][10][11]
• Align health action with Sustainable Development Goal 3, the Healthy Islands vision, the Astana Declaration and Fiji’s National Development Plan, including equitable access regardless of location, gender, ethnicity, disability or socio-economic status.[12]

Implementation

Implementation is structured through a rolling five-year Strategic Plan, annual operational plans, business plans for ministry units and individual work plans for health workers.[3][13]The delivery model integrates primary, secondary and tertiary care provided by government, private and traditional providers, and re-orients services towards care closer to people’s homes.[14][15]

• Decentralise selected outpatient, specialist, maternal, rehabilitative and clinical services to divisions, subdivisional hospitals, health centres, special outpatient departments and community outreach, supported by community health workers, maritime services, telehealth and specialist mobile clinics.[14][5][6][8]
• Integrate clinical and preventive services to detect disease earlier, reduce severe hospital presentations and ensure more consistent clinical standards nationwide.[15][5]
• Implement the World Health Organization Package of Essential Non-Communicable Disease Interventions in primary-care special outpatient departments to support early detection and management of cardiovascular disease, diabetes, chronic respiratory disease and cancers.[7]
• Integrate mental health, nutrition, physical activity and oral health into reproductive, maternal, newborn, child and adolescent health services, including antenatal, postnatal and immunisation contacts.[5]
• Strengthen patient-centred care through the 157 complaints hotline, queue-management pilots, waiting-time analysis, patient-satisfaction feedback and the Patient Charter.[7]
• Use clinical governance, competency frameworks, clinical practice guidance, auditing, the Role Delineation Plan and the Strategic Workforce Plan to standardise practice, address workforce shortages and develop leadership, management and supervision.[9]
• Reform the end-to-end supply chain, including procurement, warehousing, quality control, equipment maintenance, stockout measurement and more efficient distribution through Fiji Pharmaceutical and Biomedical Services.[16][10]
• Modernise health information and electronic medical record systems, including the Patient Information System, Human Resource Information System, pharmaceutical inventory system, Consolidated Monthly Return Information and National Notifiable Disease Surveillance System.[13][11]
• Strengthen financial management across 12 cost centres, develop a health financing strategy, produce annual National Health Accounts and maintain services free of charge or at very low cost, including the Free Medicine Policy for poorer households.[16][10]
• Coordinate delivery through the Ministry of Health and Medical Services with other ministries, private providers, civil society organisations, communities, religious institutions, research institutes, donors, United Nations agencies and development partners.[13][17]
• Use cross-government action on wellness, salt reduction, antimicrobial resistance, climate change, water and sanitation, sexual and gender-based violence and disability access.[2][17]
• Strengthen governance through standardised planning processes at national, divisional and facility levels, while exploring a Global Health Coordination Unit and a Programme Implementation Board.[11][17]
• Measure implementation through a monitoring, evaluation and learning plan, Strategic Plan outcomes and key performance indicators, Annual Operational Plans, workforce monitoring, stockout measurement, facility data, disease surveillance, clinical audits and National Health Accounts.[15][3][13][10][11]Individual indicator definitions, reporting frequency and formal accountability procedures are not specified in the supplied text.[3][11]

Monitoring & Evaluation

Monitoring, evaluation and learning are intended to link the 2020–25 Strategic Plan to annual operational plans, business plans, individual work plans and management decision-making, supported by outcomes and key performance indicators.[15][1][3][13][11]The supplied text does not provide a single consolidated indicator framework, indicator definitions, reporting timetable, evaluation design or formal strategy-wide accountability mechanism.[3][13][11]

• Measure progress through Strategic Plan outcomes and key performance indicators, with annual operational and business plans translating commitments into activities, outputs and cost-centre responsibilities.[3][13]
• Use health information systems to compile, analyse and apply evidence for clinical, operational and strategic decisions, including the Patient Information System, Human Resource Information System, Fiji Pharmaceutical and Biomedical Services inventory system, and Consolidated Monthly Return Information.[13]
• Collect facility service-use data through Consolidated Monthly Return Information and monitor priority communicable diseases through the National Notifiable Disease Surveillance System.[13]
• Track health outcomes, determinants and service provision through more than 50 internationally agreed Sustainable Development Goal indicators, covering maternal and child health, infectious diseases, non-communicable diseases, mental health, injuries, universal health coverage, environmental risks and outbreaks.[12]
• Assess 2025 progress against reduced communicable and non-communicable disease burdens, fewer inpatient presentations, lower schoolchild obesity, strengthened International Health Regulations capacity and improved facility emergency preparedness.[5][6]
• Monitor International Health Regulations capacity across workforce, surveillance, laboratory and response functions, including the planned upgrade of the Centre for Disease Control from Level 2 to Level 3.[6]
• Review climate-risk exposure among populations and locations, and count facilities meeting minimum emergency and disaster-preparedness standards.[6]
• Undertake continuous critical audits of maternal, neonatal, perinatal and child health services, using the Maternal and Newborn Health Service Initiative and perinatal audit tools to identify and implement improvements.[6]
• Monitor non-communicable disease prevention through systematic screening, early detection and treatment, tobacco use, obesity trends and premature mortality, particularly among people aged 45 to 59 years.[18][7]
• Use vaccination coverage benchmarks of 90 per cent for 2017–18 and 95 per cent by 2021.[14]
• Capture patient experience and service performance through the 157 complaints hotline, waiting-time analysis, queue-management pilots and patient-satisfaction surveys.[7]
• Apply clinical governance, competency monitoring, clinical guidance, auditing, staff-satisfaction monitoring and health-workforce analysis to improve quality, safety and service value.[9][10]
• Measure stockouts of essential medicines and commodities across nursing stations, health centres, subdivisional hospitals and divisional hospitals.[10]
• Publish National Health Accounts annually with the World Health Organization to track expenditure flows, out-of-pocket payments, financial protection and progress towards universal health coverage.[13][10]
• Require the Ministry of Health and Medical Services to communicate national priorities, provide partner progress updates and coordinate support to reduce duplication and disjointed implementation.[2]

Costing & Financing

Financing policy aims to maintain health services free of charge or at very low cost, strengthen financial management and financial protection, and monitor expenditure through annual National Health Accounts.[16][10]The Strategic Plan sections supplied do not specify a total budget, costed activities, detailed programme allocations, quantified funding gaps, financing targets or economic assumptions.[16][2][10]

• Maintain the Free Medicine Policy, which enables the poorest households to reclaim medicine costs.[16]
• Allocate financial management through 12 cost centres and improve expenditure efficiency, including better targeting of spending towards the bottom 40 per cent of earners.[16]
• Strengthen financial controls, processes and expenditure management across cost centres to improve use of taxpayers’ money.[10]
• Develop a health financing strategy, produce annual National Health Accounts and monitor out-of-pocket expenditure as part of universal health coverage commitments.[10]
• Recognise that clinical services across primary and secondary care receive the majority of the health budget and that the health workforce is the largest component of health expenditure.[14][7]
• Note that public health spending reached 3.1 per cent of gross domestic product and that hospital services received approximately 43 per cent of government health spending between 2011 and 2015.[16]
• Use business plans to set activities and budgets for each functional unit and cost centre under annual operational plans.[13]
• Explore contracting with civil society organisations and public-private partnerships for direct and support services where cost-benefit studies identify efficiencies, while recognising that further research on existing models is required.[10]
• Coordinate development-partner financial and technical support, which represents a small share of total health expenditure but may address critical domestic funding gaps and technical-capacity needs.[2]
• Reduce the cost of overseas patient referrals by improving access to specialist services within Fiji, although no monetary estimate is provided.[8]