Fiji is well advanced on disease transition, with noncommunicable
diseases (NCDs) now the main cause
of death. All sub-groups of the population appear to be
affected.
The Ministry of Health’s considerable efforts to tackle
NCDs include development of national NCD strategies
and increased funding and expansion of diabetes
services. This has been complemented by additional
resources from donors such as AusAID, and technical
support from a variety of organisations.
A newly developed tool (Robinson and Hort 2011)
was used to describe and assess Fiji’s health system
response to NCDs. Its four dimensions assessed
preparedness in building commitment, reorienting
policies, developing new service delivery models
and ensuring equity against four descriptive levels
of readiness. The piloting of this framework in Fiji is
reported here based on a desk review and informed by
consultation with selected individuals. An initial literature
search included regional and international reports from
the WHO and World Bank, MOH data and documents
from the Ministry of Health and Bureau of Statistics.
Following assessment of these, the framework was
used to assess Fiji’s progress.
The assessment showed inconsistent progress. In
building commitment and addressing health system
constraints, it showed strong progress, with high-level
commitment, efforts to secure sustainable funding and
strategic planning. There was slightly less progress in
public policy on population health promotion. Efforts
were found to use policy approaches outlined in
strategic plans, and to engage the community and
private sector.
Progress for service delivery models and equity was
very limited. No evidence was found of specific actions
to ensure equity of services or health-related financial
support structures for low-income households. In
the delivery of health services for NCDs, evidence of
progress against the framework indicators was absent,
although other actions were found. There appeared
to be limited consideration of how to integrate NCDs
into existing primary healthcare services. There was
little evidence of targeting high-risk groups or proactive
engagement with the private sector.
Expansion of indicators under the service delivery
element may be of value to increase the scope of
this assessment. It may also be valuable to consider
participatory approaches to completing this framework.