A new World Bank report is showing evidence of inefficiency in resource utilization in the Fijian health sector.

The report titled Fiji Health Sector Review, “Mo Bulabula, ka Bula Balavu” (Wishing You a Healthy Life and Long Life) launched today states that a resourcing imbalance between primary care and hospital care can have implications for both allocative efficiency and technical efficiency.

It highlights that spending on primary health care has increased in absolute terms but fallen as a share of current health expenditure.

While more than half of public health expenditure in Fiji is directed to primary health care, PHC, 79 percent of government health expenditure was on hospitals in 2019.

The report says that this suggests that PHC spending is predominantly allocated to outpatient services in hospital settings, rather than to ambulatory or preventative care providers at health centers or nursing stations which are a less costly alternative and are more physically accessible to patients.

The report says that Ministry of Health’s data on antenatal care visits suggest that more than half of all visits to hospitals are by pregnant women who are not deemed to be at risk, and thus could be managed by personnel at lower-level healthcare facilities.

Health Minister Dr. Atonio Lalabalavu agrees that the health system needs to evolve to respond to the current and future challenges.

“A key strategy will be flipping the health service delivery model – to move from waiting for our sick population to come to the tertiary facilities such as CWM into a setting where our primary health care systems interfaces with the population to prevent, diagnose and manage diseases at an early stage of illness when it is cost effective and impactful for the households.”

Dr. Lalabalavu stresses the importance of getting the basics right through transformative public healthcare focused on health promotion, prevention, and disease control.

“In building this strong foundation, of a robust PHC system, it reduces the number of patients with chronic conditions and associated complications who seek care in secondary and tertiary facilities which are more resource intensive.”

Dr. Lalabalavu stresses his Ministry has already started implementing policy recommendations, including a digital health strategy to improve service delivery and a people-centered primary healthcare strategy to strengthen the system.

He adds that the review provides evidence and a concrete action plan to develop a new PHC model for Fiji, which could serve as a reference model of care.