Healthcare Reform –Fiji 2009-2010.

Healthcare Reform –Fiji 2009-2010.



Introduction.

Healthcare reform is generally a policy and operational change to a health system. The recent US Healthcare bill has been endorsed allowing President Obama some well deserved leave.

Effectively this will mean an attempt at “universality” of health cover with an additional 31 million people receiving medical care. In a country which is held as most developed, over 47 million remain out of the range of medical cover, currently.

Healthcare also consumes 16% of the US GDP. Therein lays the difficulty to deal with cost control. Spiralling upwards “Cost” includes that of the health practitioners and newer technology which need urgent addressing simultaneously with “Universality” issues. The forces in play make health politics quite sick.

The anticipated timeline to implementation will be 2014 and will mean everybody needs to take out medical insurance as mandated or face fines. The issues of public versus public /private insurance also need addressing.

This brings to surface “individual choice”, Human rights.

Is health a right or is it a choice, remains debate-able?



Our health reform which took root in 2009 has its own issues which are being addressed according to our national needs without delay. With fewer than 3% of the GDP we have had universality of cover, unlike USA. Our cover needs to raise its standards several fold to be worthy of praise. The first steps have been undertaken.

However to spearhead a streamlined, efficient level of care ,along with strengthening the tier system of health delivery (primary care strengthening) we have taken the care to the people in 2009 (patient centeredness and specialist outreach).We have not waited but simultaneously advanced on new policy and operational redirection without the comfort of taskforces, scoping, strategising prior to operations.

There are competing financial and human resource demands in any country. Each subgroup has had their priorities.



The Public’s Demand.

At the outset the pharmaceutical lines were most pressing with outages of medication; consumables and the lead time to receive these essentials at the health outposts were matters which needed urgent streamlining. A revitalised system to procure, store and distribute these items had brought relief to both practitioners and patients alike. Sourcing generic pharmaceuticals and consumables have had their high points especially with the global recession.



The long waiting times at our Accident/Emergency units at base hospitals were a matter of concern. With extended hours at the peripheral health centres, the base hospitals felt the respite and started coping a little better. External Audits of Outpatient services have been conducted at the CWM Hospital, a sure sore point for many clients. Issues to address have included grumpy nurses and short fused doctors. Least of all the dirty toilets will be something of the past as $100,000 is being spent to refurbish the conveniences currently.



The Hospitals developed new facilities which are essential for tertiary units in the form of The Cardiac Catheterisation Laboratory and the Regional Pacific Eye Unit is taking shape at CWM hospital, Suva. The Eye Clinic is the recipient of the latest Laser machines and retinal cameras which are operational by our local experts. The Cardiac Laboratory has already undertaken Angiograms in just under 30 patients and is poised for progress onto Stenting by February 2010 and undertakes Balloon Angioplasty by June 2010.



The first Digital Radiology Unit in the South Pacific will be installed in late January 2010, along with modern updates including a Mammogram unit replacement.

Lautoka hospital will site a new Computerised Axial Tomogram (CAT) Scanner along with a Mammogram machine for the first time. Labasa Hospital will become operational with a CAT scanner.



Diabetic Hubs linked to The National Diabetic Centre will become operational at Lautoka and Labasa These centres will become one stop holistic centres dealing with Diabetes Mellitus, all linked by the latest computer software to analyse disease trends and statistics for meaningful interventions.



A new system of trauma intervention includes training for Emergency Ambulance crew, Disaster preparedness, field epidemiology are already in advanced stages of operationalisation. A new fleet of Ambulances are on order and arrive in April 2010.



The process of making healthcare delivery lean has seen the outsourcing of security services and will be followed by the Cleaning, Laundry, and the Food services.



Planned infrastructural developments will include refurbished A&E @ CWM Hospital, Sukuna Ward for management of Diabetes holistically and a total makeover to the West wing and Laundry.



Lautoka Hospital will shortly have a diabetic hub and a satellite health centre at Kamikamica Park. Plans to install their CAT scanner and Mammogram at in the pipeline. Infrastructural developments will be undertaken to accommodate student and staff of the University of the Fiji. A Cardiac Catheterisation Laboratory and a Hyperbaric Chamber are also on the radar.





The Medical/Nursing Demand.

The medical practitioner’s in the civil service requested that the technology was defunct and they were overworked. Literally tired of the bandaid they were providing.

The nurses likewise indicated their need for recognition for additional work support, promotions and technology.

These issues have been addressed with new technology being purchased direct from manufacturers and are being installed at all health locations, Fiji wide.

Legislation with respect to Radiation Health, Radiology Technology, Medical and Dental Practise, including General Practitioners, Child Welfare Decree has been taken to Cabinet.

The Mental Health decree, HIV promulgation, Codex on Infant feeding regulations is soon to be followed by the new Ambulance decree. The Stakeholders are currently reviewing the Nurses, Midwifes, Nurse Practitioner bill, Allied Health Practitioners and the Pharmacist decree.

These modern pieces of legislation will make the delivery of health safer for the people with annual registration based on ongoing continuing professional development programs.



The nurse’s staff establishment was optimised and the need for additional human resources identified with increased intake to counter the annual attrition rate.

Improved system of rostering has improved manpower placement in the wards with ongoing monitoring and evaluations.

Middle level courses were increased to train our public health, midwife and nurse practitioners and mental health nurses have been addressed. A serious attempt to promote all suitable personnel was undertaken with generally good results.

The concept of a professional Fiji College of Nursing to provide ongoing Nursing Professional Development activities has been well received in the profession.

Annual licensing will come into play in 2011 based on Continuing Nursing Education plans.



Laboratory Services.

The laboratory services will receive a shot in the arm shortly with Laboratory strengthening in the form of installation of a Laboratory Information System, training of Phebotomists, centralisation of stores, reagents, instrument/equipment upgrades and regular preventative maintenance of all equipment.

Audit and Situational Analysis of the services and facilities have been undertaken and the strengthening will be supported by World Health Organisation, Global Fund, South Pacific Commission and Fiji Health Sector Improvement Program. Other Allied health teams including Dieticians, Physiotherapists and environmental health officers and bio-technicians will also be dosed with human resource development programs in 2010.



Human Resource Development.

2010 will be the year where Healthcare delivery will blossom. A concerted effort to upgrade training of all cadres of personnel is to be undertaken. With the inbound high technology we will need to up skill our personnel. Local and overseas training will be undertaken in various formats. Formal and informal attachments, partnering with national, international alliances and Global initiatives will be considered.

Retension and eventual return migration of our professionals will be visions to consider.



Customer Focus.

2010 will be a target year to return pride to the profession. Our clients and patients should see a happier workforce under manageable stress.

This will mean more efficiency, empathy, compassion being demonstrated to the suffering patients of our country.





Dr Neil Sharma.

Minister of Health,

Suva, Fiji.