Health as an important issue in The Life of the Fiji Coalition Government- December,2023.

WHO bases its 6 building blocks or Pillars on how the organization can provide Scientific, Technical and Fiscal support to the various 194 Sovereign States. These are simply the rocks around the management of health systems in developed countries. Additionally, it assists developing States to source funding from multilateral / bilateral agencies, philanthropic organizations and UN organizations. The Six (6) blocks are sequentially identified for discussion and important directions/ priorities alluded to, as promised to be affected in the first 100 days of office by Fijis Coalition Government, however still unaddressed as we close 2023. 

1.    Executive Leadership: The Government as in prime minister and his health minister lead providing guidance, direction to the bureaucracy- Permanent Secretary and the management team. Oversight of Policy, Strategy and Program delivery to the people is supposedly time-lined and monitoring & evaluation, in real time warranted.

Leadership and Governance: The bureaucratic management ensures that meritocracy, accountability, transparency and access to the common citizens within all the resources are utilized. Delivery of services ensure that all human rights parameters are covered, within constraints of finance and within the constitutional framework.  The day to day running must be time-lined and efficient, responsive to the national needs and in concordance with any National Development Plan (short, medium and long term). The bureaucracy must continue functioning even around times of strife, around elections and transitions based on those developmental targets and not await new ministers’ directives when political change occurs. The following items have not seen the light of day yet. 

# Obtain all WHO /other specialist reports not released by PM office 2015-2022 or by PSH and his team.

(Irene Manueli report on Neonatal standards of care and why infants were dying in hospitals- not meeting MDG standards- 2016-17., remains lost in the PM's office.)

 # Why the Sahyadri, Indian Cardiac MOA was terminated in 2016 without any overlapping arrangements. Additionally in this matter, why has the Professor Stenson of the WHO sponsorship report not released since 2016?

 # The Aspen Agreement needs attention. I know Deputy PM, Professor Biman Prasad has reviewed this agreement but independent healthcare professionals also need to input on technical details. What is the delay?

# The involvement of MIOT Fiji/ Singapore/ India in Aspen operations needs clarification.  Persons of interest need to be questioned on fiscal outlays. Question of fiscal kickbacks on Heart Surgery for senior members of the previous government need to be provided to the public, at large.

 # Due consideration to decentralizing health care to Divisional levels with a lean HQ with benefits in service delivery with pandemics, climate change mitigative adaptations.

# Due consideration to establishment of a Health Commission to interlink Executive, Bureaucracy and Peoples representatives to prioritize healthcare as a whole of society priority cannot be underscored.

2.  Health Services: This area looks at the services, its development, modernization, improvement based on national needs. Its interphases with technology and manpower development. Ideally a 60/40 % ratio of financing to Clinical / Public Health is the international goal. We are far from this ratio currently. Under this heading we need to address the decadent IT system which needs urgent upgrades.

 # Reports must be submitted by section heads with forward plans, M&E,       

   Financial status.

 # Are MOH MS strategic and program targets being addressed or is the

    Health bureaucrats just rolling along with little foresight?  The dysfunction   

    in services lie with DMO/DHS level. Top/ Bottom not working in any synchrony.

   # Ministry and Government should not solely depend on the private sector for healthcare development but increase its abilities for the people who cannot afford exorbitant pricing structures. The PPP with the GP sector needs closer study.

# Start the process of inviting WHO to look at a National Health Insurance Scheme for all our people not just the privileged. One such study was undertaken in 2009-2014 era and recommended that with return of  political stability the situation should be reviewed. We are ready for this now!

3.    Human Resource and Manpower: Optimize ratio of patient/ doctor: patient / nurse: patient/ patient: allied health staff must be optimized to reduce work stress, burn out and fatigue to healthcare staff in face of increased work force losses of recent within a toxic work environment. This exercise needs right sizing within all areas, as in recruitment to graduation, ongoing and post graduate training leading to a right sized human resource base. Areas to include career planning, progression, financial returns to enable retention are long overdue.

 There are currently WHO parameters to assess "Client waiting times" in emergency departments, clinics, laboratories and radiology departments. These are not being used to determine service ideals.

# Reports on Manpower recruitment, training and progress with graduate studies to reduce attrition?

 # Re-assess current manpower needs by section heads.

# All employees must have a Position Descriptions or Job description from top / bottom. Unfortunately, this may not be the case even at HQ level in the health ministry.

 4.    Pharmaceutical and Medical Consumable Supply: Right size the national needs.

# Undertake an immediate assessment of population demographics viz a viz (where are the people), what diseases are in the community is an important step. This wide survey to be undertaken by Public Health Personnel almost immediately.

 # What medication is in use, modernize the supply with quality generics.

#  The Pharmaceutical storage must be decentralized to divisions in view of extreme weather conditions/ disaster management becoming commoner within the framework of climate change. Benefits will accrue with a better supply change, possibilities of improved inter-hospital supplies transfers, reducing outages and public outcries

# The Clinical services network and the Pharmaceutical oversight group must be proactive in ordering items coming of the “patency listing”.

 # Professional Pharmacists to be engaged in this division to optimize purchase of medications and medical supplies. Right size the distribution and ensure inter-facility transfers in times of shortage/ notification of supplies to alternatives in such times with due notification to local pharmacists /doctors.

 # The pharmaceutical Products decree must be fully implemented to prevent local wholesaler distributors (5) bring in substandard items which are harmful to human life. 

5.    Health Financing: This area ideally be fully scrutinized to right size the true needs: reduce wastage, increase efficient and set in motion improved service delivery. Priority setting is important.

# The essential drugs list must be rightsized. The price structure of medication reviewed by the Fiji Competition & Commerce Commission.  There is very little executive and Leadership /governance understanding in this area. i.e. Wastage is high and just too many unnecessary training exercises are undertaken in expensive hotels and useful funds are lost in this exercise. All facilities have conference rooms and can be used with local catering only for full day events.

 # Not having post warranty service agreements on expensive diagnostic machines in the laboratories, x-ray departments, ICU and CCU is not to be tolerated in future. In the past delays by “Biomedical teams in Health” and “Ministry of Economy” have failed despite budget allocations of one million annually to this exercise. That is why most machines are nearing the end of their life of 7-10 years now, needing replacement in the uncertain future. 

6.    Health Information and Technology remains under funded. $400,000 only. Savings from better managed health finances can be used to improve the IT man-power and networks to create paperless hospitals patient information systems in facilities and interconnect the public health and clinical networks, down to the sub-divisional levels.  Aspen Hospital Group has literally stolen all the senior IT manpower from Ministry of Health. 

 Dr. Neil Sharma. Suva