Wave Upon Wave

Abstract

Decentralization in the health sector has been widely implemented since the 1970s as a reform mechanism with mixed results. This study describes Fiji's 2 attempts at decentralizing its health sector and examines the implications they have had for the functions of planning, financing, and delivery of health services. The first wave attempted a major restructure by devolving Fiji's health system. Political instability, along with a lack of acceptance, stalled its implementation resulting in a delegated system. While the functions of planning and financing remained centralized, the function of delivery was delegated to geographic regions. The second wave was a more focused effort that targeted the deconcentration of outpatient services in one division. This attempt also decentralized the delivery function while keeping the other 2 functions centralized. Fiji's incremental approach to decentralization could provide lessons for Asia-Pacific countries that have had failed attempts in large scale decentralization efforts.

Governance Functions to Accelerate Progress toward Universal Health Coverage (UHC) in the Asia-Pacific Region

“…For example, Thailand, Australia, New Zealand, Singapore, Hong Kong SAR (China), the Philippines, China, and Malaysia use health technology assessments (HTAs) to inform policy and decision making. [34][35][36][37] Other countries, including Indonesia, India, and Myanmar, have begun to use HTAs, though in an unstructured and informal way. 21,34 HTAs have been used to develop the universal health benefit package and the National List of Essential Medicines in Thailand, and the National Health Security Office (NHSO) works with a large group of stakeholders in deliberative processes to foster legitimacy and transparency.…”

“…[34][35][36][37] Other countries, including Indonesia, India, and Myanmar, have begun to use HTAs, though in an unstructured and informal way. 21,34 HTAs have been used to develop the universal health benefit package and the National List of Essential Medicines in Thailand, and the National Health Security Office (NHSO) works with a large group of stakeholders in deliberative processes to foster legitimacy and transparency. 38,39 In Fiji, the health information system (which collects core public health data and clinical-level data via electronic patient records linked to a national health number) provides information that guides decision making in both clinical and management settings.…”

Decentralisation; The Question of Management Capacity: A Response to Recent Commentaries

“…Decentralisation initiatives may not fit neatly into analytical frameworks as illustrated in our analysis, and the use of alternative frameworks such as the arrows framework 7 to examine Fiji’s decentralisation initiative would increase understanding. Indeed, in a preceding study, 17 we examined both decentralisation initiatives in Fiji from a functional perspective. That analysis has led to a forthcoming publication, 18 where we explore some of the reasons why the current decentralisation initiative has been considered successful by the Fijian government.…”