2025-05-06-世界银行-2024年斐济卫生部门回顾_投资于人（英）_155页_26mb

Fiji Health Sector Review 2024 Summary

Core Content

The Fiji Health Sector Review 2024 provides an in-depth analysis of the country's health system, highlighting its challenges and opportunities for improvement. The review is conducted by the World Bank at the request of the Ministry of Finance, Strategic Planning, National Development and Statistics (MFSPNDS), in close consultation with the Ministry of Health and Medical Services (MHMS). It assesses key areas including health financing, service delivery, human resources, and policy suggestions, with a focus on addressing the growing burden of non-communicable diseases (NCDs), improving access to healthcare, and ensuring equitable health financing.

Key Findings

1. Health Outcomes

• Life expectancy in Fiji is low compared to other upper middle-income countries (UMICs), currently at 68 years versus the UMIC average of 77 years.
• Healthy life expectancy (HALE) has seen limited gains compared to peers.
• Infant and under-five mortality rates have stagnated since 1995, despite earlier improvements.
• Non-communicable diseases (NCDs) are a major health challenge, with 85% of deaths in 2019 linked to NCDs, and 64% of these deaths occurring in the working-age population.
• NCDs are more burdensome in Fiji than in countries like Malaysia.
• Women face greater challenges in participating in paid work due to caregiving responsibilities, affecting their economic productivity.

2. Health Financing

• Public health spending is the primary source of health financing, accounting for 70% of total health expenditure.
• Out-of-pocket (OOP) expenditures are relatively low, but rising.
• Private health insurance is growing, yet loss ratios are very high, suggesting inefficiencies.
• Health spending is expected to increase significantly, reaching 7% of GDP by 2050 in real terms.
• Fiji is underinvesting in health compared to UMIC peers, with total health expenditure at 4.25% of GDP, below Jamaica (6.1%) and Belize (4.8%).

3. Health Service Organization and Delivery

• Primary health care (PHC) is under-resourced and underutilized, with 79% of government health spending directed to hospitals in 2019.
• Ambulatory care services are not adequately developed, leading to a high risk of hospitalization for conditions that could be managed in outpatient settings.
• NCD services in PHC facilities are limited, with only one-third of individuals with hypertension and diabetes being diagnosed or aware of their conditions.
• Healthcare facilities in rural areas have low bed occupancy rates, while urban hospitals are overburdened and often operate at near full capacity.
• Colonial War Memorial (CWM) Hospital is a key referral center but is frequently overused, leading to inefficiencies and burnout among staff.
• Antenatal care (ANC) is often delivered in hospitals, even for low-risk pregnancies, which could be managed at lower-level facilities.

4. Human Resources for Health

• Skilled health workers (SHWs) are present in sufficient numbers to meet the minimum threshold of 4.4 per 1,000 population.
• Doctors and nurses are predominantly in the public sector, but staffing shortages persist.
• Doctors have left the public sector in favor of private employment, while nurses have migrated to New Zealand post-COVID.
• Dentists and pharmacists are in short supply, and the number of students entering nutrition and rehabilitation fields is not meeting growing demands.
• Fiji National University (FNU) is a key producer of skilled health workers, contributing to the Pacific workforce.

5. Policy Suggestions and Programs

• Reorienting service delivery to emphasize preventative care and chronic disease management.
• Improving PHC facilities by enhancing diagnostic capabilities, equipment, and staffing.
• Strengthening health financing through prepayment mechanisms and pooling of resources to ensure financial protection.
• Enhancing public-private partnerships (PPPs) to improve service delivery and reduce the burden on the public system.
• Investing in infrastructure to support primary and secondary care and reduce reliance on tertiary care.
• Implementing targeted programs to address NCDs, including early diagnosis, treatment adherence, and community health worker (CHW) programs.
• Addressing supply chain management (SCM) challenges to ensure availability of essential medicines and diagnostic tools.
• Strengthening data systems to improve health policy planning and resource allocation.

Key Challenges

• Inefficient use of resources in the health sector, particularly between primary care and hospitals.
• High NCD burden and rising health costs threaten financial protection and economic growth.
• Inadequate diagnostic services and medicines in PHC facilities.
• Uneven distribution of health facilities and skilled workers, with urban areas overburdened and rural areas underutilized.
• Staff shortages and high attrition rates, especially among doctors and nurses.
• Limited access to preventive care and chronic disease management.

Opportunities for Improvement

• Leveraging the demographic dividend by ensuring a healthier and more productive working-age population.
• Reducing NCD burden through improved diagnosis, treatment, and prevention.
• Enhancing financial protection by promoting prepayment and social health insurance.
• Expanding community-based care and CHW roles to improve preventative care and health equity.
• Investing in primary care infrastructure and staffing to reduce the strain on hospitals.
• Improving SCM systems to ensure availability and affordability of essential medicines.
• Enhancing data collection and analysis to support evidence-based policy decisions.

Conclusion

The Fiji Health Sector Review 2024 underscores the urgent need for reform and investment in the health system to address inefficiencies, inequities, and the rising burden of NCDs. By improving preventative care, human resources, and health financing, Fiji can enhance health outcomes, economic productivity, and financial protection for its population. The report emphasizes the importance of strategic reorientation of service delivery and policy implementation to align with Sustainable Development Goals (SDGs) and economic development.