MINISTRY OF HEALTH AND MEDICAL SERVICES

Annual Report 2015

August 2016

Hon Jone Usamate

The Minister for Health and Medical Services
Ministry of Health and Medical Services
Suva

Dear Hon Usamate,

I am pleased to submit the 2015 Annual Report in accordance with the Government‟s regulatory requirements.

Dr Josefa Koroivueta
Acting Permanent Secretary for Health and Medical Services

2
Contents
1. Permanent Secretary‟s Remarks ............................................................................................ 8
2. Ministry of Health and Medical Services Overview................................................................ 9
3. Ministry of Health and Medical Services Priorities ................................................................. 9
Key Cabinet Papers ........................................................................................................... 12
4. Reporting on RDSSED 2009-2015 ....................................................................................... 15
5. Hospital Services ............................................................................................................... 19
6. Fiji Pharmaceutical and Biomedical Services Centre (FPBSC) ................................................. 23
7. Divisional Report 2015 ..................................................................................................... 25
8. Public Health Services ....................................................................................................... 29
Wellness Centre .................................................................................................................... 29
Mental Health ...................................................................................................................... 29
Family Health ....................................................................................................................... 30
Communicable Diseases (CD) ................................................................................................. 33
Environmental Health (EH) ................................................................................................... 36
Dietetics and Nutrition .......................................................................................................... 37
Oral Health .......................................................................................................................... 40
National Health Emergency & Disaster Management Unit ......................................................... 41
Achievements ........................................................................................................................ 41
9. Administration and Finance ................................................................................................ 42
Training Unit ........................................................................................................................ 42
Personnel Unit ...................................................................................................................... 42
Industrial Relations................................................................................................................ 43
Post Processing Unit (PPU) ..................................................................................................... 43
Workforce Planning .............................................................................................................. 44
Human Resource Information System ..................................................................................... 45
Finance ................................................................................................................................ 45
Asset Management Unit (AMU) ............................................................................................. 46
10. Health Information Research and Analysis Division ............................................................. 47
11. Planning and Policy Development Unit (PPDU) .................................................................. 52
12. The Nursing Division ........................................................................................................ 54
14. Health Outcome Performance Report 2015 ........................................................................ 59
16. Health Statistics ................................................................................................................ 70
17. Overseas Patient Referral 2015 .......................................................................................... 78
18. Disease Trend Analysis 2000-2015 ..................................................................................... 79
19. Donor Assisted Programs/Projects 2015 .............................................................................. 85
20. MDG Progress Report ....................................................................................................... 86
21. Finance ............................................................................................................................ 88

3
List of Tables

Table 1: Key Cabinet Decision for 2015 ................................................................................. 12

Table 2: RDSSED Performance Indicators for 2014 and 2015 ................................................... 16
Table 3: RDSSED Performance Indicators for 2014 and 2015 .................................................. 17
Table 4: Government Health Facilities .................................................................................. 25
Table 5: Demography of Central/Eastern Division .................................................................. 26
Table 6: Demography of Western Division ............................................................................ 26
Table 7: Demography of Northern Division .......................................................................... 26
Table 8: Summary Population by Division ............................................................................. 27
Table 9: Dental Statistics ...................................................................................................... 41
Table 10: Personnel Activities 2015 ........................................................................................ 43
Table 11: Post Processing Activities 2015 ................................................................................ 44
Table 12: MoHMS Staff Establishment 2015 ............................................................................ 44
Table 13: Diabetes Cases by Facility 2015 ............................................................................... 59
Table 14: Top 5 Leading Cancer Sites by Sex and proportion distributions, Fiji .......................... 61
Table 15: Age Specific and Age Standardized Rates of all cancer sites. ...................................... 61
Table 16: Vital Statistics. ...................................................................................................... .70
Table 17: Life Expectancy – 2015 ........................................................................................ ...70
Table 18: Immunization Coverage 2015 ............................................................................. .....71
Table 19: Notifiable Diseases 2015 ................................................................................. ........72
Table 20: Health Service Utilization Statistics 2015 ........................................................ ...........73
Table 21: Morbidity and Mortality Statistics 2015 .................................................................. ..74
Table 22: Top ten causes of morbidity by disease cause group 2015 .......................................... 75
Table 23: Top ten causes of morbidity by disease 2015. ........................................................... 76
Table 24: Health Status Indicators 2014-2015 .......................................................................... 76
Table 25: Patient Referral by Medical Category, 2010-2015. ................................................... .78
Table 26: Patient Referral Costs by Category 2015 .................................................................. .78
Table 27: Donor Assist Programs.. ......................................................................................... 85
Table 28: MDG Performance ................................................................................................ 86
Table 29: Segregation of 2015 Budget ..................................................................................... 90
Table 30: Proportion of Ministry of Health Budget against National Budget and GDP ................ 90
Table 31: Statement of Receipts and Expenditure for the Year Ended 31st December 2015 .......... 91
Table 32: TMA Trading Account for the Year Ended 31st December 2015 .................................. 92
Table 33: TMA Profit and Loss Statement for the Year Ended 31st December 2015 ..................... 92
Table 34: TMA Balance Sheet for the Year Ended 31st December 2015. ................................... .93
Table 35: Appropriation Statement for the Year Ended 31st December 2015 ............................. .93
Table 36: List of Health Facilities ........................................................................................... .94

4
List of Figures

Figure 1: Ministry of Health and Medical Service Organisation Structure .................................. 15

Figure 2: Four Divisions within Fiji ........................................................................................ 25
Figure 3: ICO Performance trend 2011-2015 .......................................................................... 50
Figure 4: Diabetes Cases by Age Group 2015 ......................................................................... 59
Figure 5: New Diabetes Cases (Incidence) by Gender and Age Group 2015 .............................. 60
Figure 6: Leading 3 Cardiovascular Disease Conditions 2015 ................................................... 62
Figure 7: Typhoid Cases for 2015 by Month .......................................................................... 62
Figure 8: Dengue Cases for 2015 by Month............................................................................ 63
Figure 9: Leptospirosis Cases for 2015 by Month .................................................................... 63
Figure 10: New HIV Cases 1989- Sept 2015 ............................................................................. 64
Figure 11: Number of TB Cases (TB Notification) ..................................................................... 64
Figure 12: TB Case Detection Rate 2015 .................................................................................. 65
Figure 13: New Sputum Smear Positive TB – Treatment Success Rate ......................................... 65
Figure 14: Treatment Success Rate among bacteriologically confirmed cases .............................. 66
Figure 15: TB in children ........................................................................................................ 66
Figure 16: Under 5 Mortality Rate for Fiji 2000-2015............................................................... 67
Figure 16 (i): Maternal Mortality Ratio for Fiji 2000-2015 ............................................................ 67
Figure 16 (ii): Maternal Mortality Rate Rolling Average of 3 years.................................................. 68
Figure 17: Contraceptive Prevalence Rate for Fiji (per 1000 CBA) 2000-2015 ............................. 68
Figure 18: Percentage of 1 Year Olds Immunised against Measles 2000-2015 .............................. 69
Figure 19: Mortality Pyramid for 2015 .................................................................................... 71
Figure 20: Diabetes Cases 2000–2015 ...................................................................................... 79
Figure 21: Diabetes Cases 2013–2015 ...................................................................................... 79
Figure 22: Cancer Cases from 2000 – 2015 .............................................................................. 80
Figure 23: Sexually Transmitted Infection Cases 2000-2015 ....................................................... 80
Figure 24: Cardiac Related Cases 2000–2015 ........................................................................... 81
Figure 25: Depression Cases 2000–2015 .................................................................................. 81
Figure 26: Acute and Chronic Renal Failure Cases 2000-2015 .................................................... 82
Figure 27: Typhoid Cases 2011–2015 ....................................................................................... 82
Figure 28: Typhoid Cases by Divisions 2000-2015 .................................................................... 83
Figure 29: Dengue Fever Cases 2011 - 2015 .............................................................................. 83
Figure 30: Leptospirosis Cases 2011-2015 ................................................................................. 84
Figure 31: Auditors Report 2015 ............................................................................................. 88

5
Acronyms

ACBA Australian Coding Benchmark Audit

ACP Annual Corporate Plan
AHD Adolescent Health Development
ALOS Average Length of Stay
AMU Asset Management Unit
ARH Adolescent Reproductive Health
BFHI Baby Friendly Hospital Initiative
BP Business Plan
BOV Board of Visitors
CBA Child Bearing Age
CD Communicable Diseases
CMNHS College of Medicine, Nursing and Health Sciences
CPD Continuing Professional Development
CPG Clinical Practice Guidelines
CSN Clinical Service Network
CWMH Colonial War Memorial Hospital
DMFT Decayed Missing Filled Teeth
DNS Director of Nursing
DOTS Directly Observed Treatment Short-course
DPPDU Director Planning and Policy Development Unit
DSAF Deputy Secretary Administration and Finance
DSHS Deputy Secretary Hospital Services
DSPH Deputy Secretary Public Health
EH Environmental Health
EmNOC Emergency Obstetric and Newborn Care
EPI Expanded Program of Immunisation
ESKD End Stage Kidney Disease
FCCDC Fiji Centre for Communicable Disease Control
FHSSP Fiji Health Sector Support Program
FJPH Fiji Journal of Public Health
FNU Fiji National University
FPBS Fiji Pharmaceutical and Biomedical Services
GDP Gross Domestic Product
GF Global Fund
GMU Grant Management Unit
GO General Orders
GOPD General Outpatient Department
GSHS Global School-Based Health Survey
HC Health Centre
HCF Health Care Finance
HEADMAP Health and Emergencies Disaster Management Plan
HIU Health Information Unit
HIV/AIDS Human Immunodeficiency Virus /Acquired Immunodeficiency Syndrome
HPTSG Health Policy Technical Support Group
HQ Headquarters
HRP Health Research Portal
ICT Information Communication Technology
IMCI Integrated Management of Childhood Illnesses
JICA Japan International Cooperation Agency
KPI Key Performance Indicator
LIMS Laboratory Information System
MDA Mass Drug Administration
MDG Millennium Development Goals
MMR Maternal Mortality Ratio
MoHMS Ministry of Health and Medical Services

6
MR Measles and Rubella
MRI Magnetic resonance imaging
MVA Manual Vacuum Aspirator
NCD Non Communicable Diseases
NCHP National Centre for Health Promotion
NHA National Health Account
NHEC National Health Ethics Committee
NICU Neonatal Intensive-Care Unit
NIMS National Iron and Micronutrients Supplementation
NQSHL National Quality Standards for Health Laboratory
NRP Neonatal Resuscitation Programme
NSP National Strategic Plan
NTBD National Tooth Brushing Day
NTD Neglected Tropical Diseases
OPV Oral Polio Vaccine
PATIS Patient Information System
Pac ELF Pacific Programme to Eliminate Lymphatic Filariasis
PHIS Public Health Information System
PICU Paediatric Intensive Care Unit
PO Purchase Order
PPHSN Pacific Public Health Surveillance Network
PPTCT Prevention of Parent-to-Child Transmission
PPP Public Private Partnership
PPU Post Processing Unit
PR Principal Recipient
PSC Public Service Commission
PSHMS Permanent Secretary for Health and Medical Services
RCA Root Cause Analysis
RDSSED Road for Democracy, Sustainable Socio-Economic Development
RDQA Routine Quality Data Assessment
RHD Rheumatic Heart Disease
SDs Subdivisions
SOPD Special Outpatient Department
SHA System Health Account
SPC South Pacific Community
SP Strategic Plan
STI Sexually Transmitted Infections
TAS Transmission Assessment Survey
TB Tuberculosis
TISI Then India Sanmarga Ikya Sangam Fiji
UNFPA United Nations Population Fund
UNICEF United Nations Children Fund
USP University of the South Pacific
VCCT Voluntary Confidential Counselling Test
WDF World Diabetes Foundation
WHO World Health Organisation
WPRO Western Pacific Regional Office

7
1. Permanent Secretary‟s Remarks

The year 2015 has been an interesting and challenging one for the Ministry. The
Ministry reviewed its performance over the last 5 years and developed its
National Strategic Plan 2016-2020, which was launched in December 2015.

The Annual Report 2015 highlights the key achievements and challenges which
include a comprehensive health outcome report that demonstrates Ministry‟s
performance against key health indicators. There has been progress made in some
areas and the challenges faced in progressing in other areas are also
acknowledged, as health status is affected by many factors some of which are
beyond the health sector.

There is a need for a whole of society approach to address the growing burden of
NCDs and MoHMS has been promoting and strengthening the Wellness
Approach to health over the past year and will continue to do so. The Ministry continues to take a broader approach
to handling challenges and is continuously working on improving efficiency and engaging with key partners in
extending health service delivery.

Some of the key achievements for 2015 are highlighted below:

 Fiji hosted Pacific Health Ministers Meeting.
 Fiji received global award for Tobacco Control
 Minister was appointed the chair of the Regional Committee at the Civil Registration and Vital Statistics
meeting in Thailand.
 New Nursing Station opened in Nayavuira.
 Vatukarasa health Centre, Sigatoka Maternity and Cuvu Health Centre opened.
 The relocated Nagatagata Nursing station
 Ministry hosted Pacific Public Health Surveillance Network Meeting.
 Fiji introduced new vaccine to eradicate polio disease.
 Ministry launched Sexual & Reproductive Health Manual to address reproductive health issues.
 New cervical cancer policy launched
 Health Ministry launched new data repository for easy access of information by the public on the internet.
 New mobile eye clinic launched to provide services to the people in the remote areas.
 Phase two and phase three of the CWM hospital Operating Theatre project completed.
 CWM hospital received new (trauma) equipment.
 Fiji won global prize for 2nd best cooking demonstration book, this was designed for healthy meal
preparation.
 New NCD mobile wellness bus for the Northern Division for outreach programs in the rural areas launched

The above highlights some key initiatives taken to further improve service delivery as well as improve collaboration
regionally on key health issues. There have been ongoing efforts to improve the performance of the health system in
meeting the needs of the population, including effectiveness, efficiency, equitable access, accountability, and
sustainability.
I would like to conclude by thanking all our partners and MoHMS team for their ongoing commitment towards
improving the health of the population.

Dr Josefa Koroivueta
Acting Permanent Secretary for Health and Medical Services

8
2. Ministry of Health and Medical Services Overview

The Ministry of Health and Medical Services acknowledges that it is the right of every citizen of Fiji, irrespective of race,
gender, creed or socioeconomic status, to have access to a national health system that provides high quality health
services, the principal function of which is to provide accessible, affordable, efficient and high quality health care and
strengthen community development leading to improved quality of life.

3. Ministry of Health and Medical Services Priorities

Strategic Pillar 1: Preventive, curative, and rehabilitative health services
1. Non-communicable diseases, including nutrition, mental health and injuries
2. Maternal, infant, child and adolescent health
3. Communicable diseases, environmental health and health emergency preparedness, response and resilience

1 Diagram note: the canoe represents

the MoHMS initiative to promote
health and wellness in the Fiji
population

2 3

4 5

6 7

8
Strategic Pillar 2: Health systems strengthening
4. Primary health care, with an emphasis on continuum of care and improved quality and safety
5. Productive, motivated health workforce with a focus on patient rights and customer satisfaction
6. Evidence-based policy, planning, implementation and assessment
7. Medicinal products, equipment and infrastructure
8. Sustainable financing of the health system

9
Guiding Principles

The Guiding Principles for Ministry of Health and Medical Services are,

Vision

A Healthy population

Mission

To empower people to take ownership of their health

To assist people to achieve their full health potential by providing quality preventative, curative and rehabilitative
services through a caring sustainable health care system.

Equity

Respect
for
Human Intergrity
Dignity
Values

Responsive Customer
-ness Focus

General Principles

1. Health in all Policies approach

2. Healthy Islands concept
3. Sustainable Development Goals (SDG)
4. WHO Health Systems Building Blocks
 Leadership/governance
 Health care financing
 Health Workforce
 Medical products, technologies
 Health information and research
 Service delivery
5. Universal Health Coverage

10
Legislation for which this portfolio is responsible,

No Description
1 Constitution of the Republic of Fiji 2013
2 Fiji National Provident Fund Decree 2011
3 Fiji Procurement Act 2010
4 Financial Administration Decree 2009
5 Financial Instructions 2005
6 Financial Management Act 2004
7 Financial Manual 2014
8 Occupational Health and Safety at Work Act 1996
9 Ambulance Services Decree 2010
10 Allied Health Practitioners Decree 2011
11 Animals (Control of Experiments) Act (Cap.161)
12 Burial and Cremation Act (Cap.117)
13 Child Welfare Decree 2010
14 Child Welfare (Amendment) Decree 2013
15 Food Safety Act 2003
16 HIV/AIDS Decree 2011
16 HIV/AIDS (Amendment) Decree 2011
17 Illicit Drugs Control Act 2004
18 Marketing Controls (Food for Infants and Children) Regulation 2010
19 Medical Imaging Technologist Decree 2009
20 Medical and Dental Practitioner Decree 2010
21 Medical and Dental Practitioners (Amendment) Decree 2014
22 Medical Assistants Act (Cap.113)
23 Medicinal Products Decree 2011
24 Mental Health Decree 2010
25 Mental Treatment Act (Cap 113)
26 Methylated Spirit Act (Cap. 225A)
27 Nurses Decree 2011
29 Pharmacy Profession Decree 2011
31 Private Hospitals Act (Cap. 256A)
32 *Public Health Act (Cap. 111)
33 Public Hospitals & Dispensaries Act (Cap 110)
34 Public Hospitals & Dispensaries (Amendment) Regulations 2012
35 Optometrist and Dispensing Optician Decree 2012
36 *Quarantine Act (Cap. 112)
37 Quarantine (Amendment) Decree 2010
38 Radiation Health Decree 2009
39 Tobacco Control Decree 2010
40 Tobacco Control Regulation 2012
41 The Food Safety Regulation 2009
42 The Food Establishment Grading Regulation 2011
*currently under review

*Two pieces of draft legislation currently under review are the Quarantine Act Cap 112 and the Public Health Act Cap 111.

11
Key Cabinet Papers

Table 1: Key Cabinet Decision for 2015

N Cabinet Cabinet Paper Date Type of Paper Officer / Cabinet Decision
o Paper Paper submitted unit
No Tabled in Responsible
Cabinet
1 CP(15) Ministerial Visit to India 27/3/15 Information DPSH and Cabinet Noted the
54 and South Korea Paper DSHS Memorandum submitted for
Information by the Minister
for Health and Medical
Services
2 CP(15) Report on the 2nd 27-03-15 Information DSPH Cabinet Noted the
56 Meeting of African Paper Memorandum submitted for
Caribbean and Pacific Information by the Minister
Minister of Health, 25- for Health and Medical
26th February 2015, Services
Brussels, Belgium
3 CP(15)/ National Mental Health 27-03-15 Information Mental Cabinet noted the
55 and Suicide Prevention Paper Health Memorandum submitted for
Policy (2015) Unit - Dr. Information by the Minister
Peni for Health and Medical
(A/NAMH) Services.
4 CP Memorandum of 30-05-15 Written DSPH - Cabinet:
5/92 Understanding between Opinion SDMO 1) Endorsed the
Guangdong Health and Navua Memorandum of
Family Planning Understanding between the
Commission, People‟s Guangdong Health and
Republic of China and Family Planning Commission,
Ministry of Health and People's of China and the
Medical Services of the Ministry of Health and
Republic of Fiji on the Medical Services, the
Establishment of the Fiji- Republic of Fiji on the
Guangdong Medical establishment of the Fiji-
Training Centre Gundong Medical Training
Centre
5 CP 68th World Health 31/7/15 Discussion DSPH Cabinet :
15/129 Assembly; Paper (i) Noted the 68th Health
Assembly key resolutions
applicable to Fiji‟s local and
regional context;
(ii) Endorse the adaptation of
the following key 68th WHA
Resolution in the relevant
Government and Ministry
work plans:
a) WHA 68.4 Poliomyelitis;
b) WHA 68.5
Recommendations of the
Review Committee on
Second Extensions for
Establishing National Public
Health Capacities and on IHR
Implementation;
c) WHA 68.6 Global Vaccine
Action Plan;
d) WHA 68.7 Global Action
Plan on Antimicrobial
Resistance;
e) WHA 68.8 Health and the
Environment;
12
 f) WHA 68.15 strengthening
Emergency and Essential
Surgical Care and Anaesthesia
as Component of Universal
Health coverage;
g) WHA 68.19 Outcome of
the Second International
Conference on Nutrition; and
h) WHA 68.20 Global
burden of Epilepsy and the
need for Coordinated Action
at the Country Level to
address its Health, Social, and
Public Knowledge
Implications.
6 Tabling of Annual Report – Tabled in A / DPPD Minister for Health and
Ministry of Health & Cabinet Medical Services tabled the
Medical Services Annual MoHMS Annual Report
Report 2014 2014.
7 CP The Global Fund to Fight 19/6/15 Discussion GMU - 1) Cabinet noted the
15/98 Aids, Tuberculosis and Paper A/MS Memorandum
Malaria Tamavua 2) Endorsed the Framework
Agreement between the
Global Fund to Fight Aids, TB
and Malaria and the
Government of the Republic
of Fiji and
3) note the funding
obligations of the Framework
Agreement shall be subject to
the 2016 Budgetary process.
8 CP National Anti-Microbial 27/10/15 Discussion CP- Apolosi Cabinet:
15/208 Resistance Action Plan Paper Vosanibola 1) Noted the progress
- FPBS development of the
implementation of the World
Health Assembly Resolution
on Global Action Plan on
Anti- Microbial Resistance
2) Endorsed the adoption of
the National Antimicrobial
Resistance (AMR) Action Plan
and
3) Endorsed the Formation of
Multi-sectorial National
AMR.
9 CP(15) International Forum on 8/12/15 Information CP- Apolosi Cabinet Noted the
238 Traditional Medicine Paper Vosanibola Memorandum submitted for
- FPBS Information by the Minister
for Health and Medical
Services
10 CP(15) Report of the 66th Regional 08/12/15 Information DSPH - CHI Cabinet Noted the
239 Committee Meeting of the Paper Memorandum submitted for
Western Pacific Region of Information by the Minister
the World health for Health and Medical
Organization Services

13
11 CP(15) Technical Experts and 08/12/15 Information DSPH - CHI Cabinet Noted the
238 Ministerial Consultation on Paper Memorandum submitted for
Strengthening Climate Information by the Minister
Change Resilience through for Health and Medical
Reproductive, Maternal, Services
New Born, Child and
Adolescence Health

14
 Figure 1: Ministry of Health and Medical Services Organisation Structure

15
4. Reporting on RDSSED 2009-2015

Outcome 1: Communities are serviced by adequate primary and preventative health services
thereby protecting, promoting and supporting their wellbeing.

Table 2: RDSSED Performance Indicators for 2014 and 2015

Key Targeted Outcome Outcome Performance Indicators 2014 2015
Pillar(s) (Goal/Policy Objective or Measures (Key Performance
PCCPP RDSSED) Indicators –RDSSED)
Pillar 10: Communities are Child mortality rate reduced 18.0 16.6
serviced by adequate From 26 to 20 per 1000 live
Improving primary and Births (MDG).
Health preventative health
Service services thereby
Delivery protecting, promoting
and supporting their
well-being.
Percentage of one year olds 82.5 83.2
Immunised against measles
Increased from 68% to 95%
(MDG).
Maternal mortality ratio 44.4 29
reduced from 50 to 20 per
100,000 live births (MDG).
Prevalence of diabetes in 15-64yrs 25.9 **
age reduced from 16% to 14%
(note: baseline and target may
need revision).
Contraceptive prevalence rate 43.5 47.1
(CPR)amongst population of child
bearing age increased from
46% to 56% (MDG).
Increased Fiji resident medical 73 68
graduates from FSMed from 40 to
50 per year
Increase annual budgetary Increase of Health Increase of Health
allocation to the health sector by Budget by 0.52% Budget by 0.55%
0.5% of the GDP annually. An of GDP as of GDP as
annual growth rate of 5% over compared to 2013 compared to 2014
the medium term
Average length of stay for in- 4.6 5.1
patient treatment reduced from 7
to 5 days
Prevalence rate of STIs among 84.02 79.2
men and women aged 15 to 25
(per 100 000 population)
Admission rate for diabetes and its 112.7 98.9
complications, hypertension and
cardiovascular disease.
Amputation rate for diabetic sepsis 15.4 17.0

Prevalence of under 5 2* 38.3

malnutrition (per 1000
population)
Prevalence rate of Tuberculosis 110 2015 will be
reduced from 10% to 5% (part of estimated by
MDG 22). WHO in the 2016
Report.

16
 Prevalence of anaemia in 31.1 32.4
pregnancy at booking from 55.7%
to 45%
Rate of teenage pregnancy 4.91 24.3
reduced by 5% (per 1000 CBA
population)
Adolescent birth rate (per 1000 26.7 30.3
girls aged 15-19yrs)

*from PHIS

The Ministry has improved performance in the following categories: The child mortality performance indicator target has declined by
7.8% in 2015 and CMR being < 16 deaths per 1000 live births. There is a slight increase on one year old immunized coverage rates
by 1.2% in 2015; the maternal mortality ratio has a reduction of 35% from 44.4 in 2014 to 29 per 100,000 live births in 2015.
There was an improvement in CPR by 8.3% in 2015 being 47.1% compared to 43.5% in 2014 and these reflects the improvement in
capturing CPR. The prevalence of anaemia increased by 4.2%; the drastic increase of teenage pregnancy could be due to the
improved health information system in place which reflects the increased number of teen pregnancies being captured during ANC 1st
visit booking. Adolescent pregnancy increased by 13.4% with birth rate at 30 per 1000 girls aged 15 – 19years in 2015. The average
length of stay for hospital treatment increased over the year by 10.9% and this could be due to the increase in the number of
undischarged patients. It has been noted that there was a slight decrease in the prevalence rate of STIs by 0.72% (this could be a
reporting issue rather than a true decrease). Admission rate for diabetes and its complications decreased by 12.2% but the
amputation rate for diabetic foot sepsis increased by 10.4%.
**diabetes prevalence is available but not by age group for major collections systems such as the PHIS

Outcome 2: Communities have access to effective, efficient and quality clinical health care and
rehabilitation services.

Table 3: RDSSED Performance Indicators for 2014 and 2015

Key Targeted Outcome (Goal/Policy Outcome Performance Indicators or 2014 2015
Pillar(s) Objective RDSSED) Measures (Key Performance
PCCPP Indicators –RDSSED)
Pillar Communities have access to Participation of private and health 3 GPs 12 GPs
10: effective, efficient and quality care providers increased from 2 to 1 Private 5 Private
clinical health care and 10. Dentists Dentists
Improvi rehabilitation services.
ng
Health
Service
Delivery
Health (actual) expenditure increased Health actual Health actual
from the current 2.19% to at least expenditure is expenditure is
5% of GDP by 2013 2.6% of GDP 2.8% of GDP

Increase annual budgetary allocation Increase of Increase of

to the health sector by 0.5% of the Health Health
GDP annually. Budget by Budget by
0.52% of 0.55% of
GDP as GDP as
compared to compared to
2013 2014
Doctors per 100,000 populations 60.6 82
increased from 36 to 42.
Outsourcing non-technical activities Mortuary, Mortuary,
such as laundry, kitchen and security Security and Security and
by end of 2011 Cleaning Cleaning
services services
outsourced. outsourced.
Laundry and
kitchen are
still in process

17
 Health Policy Commission established Health Policy Health Policy
by 2011 Technical Technical
Support Support
Group Group
established established
2012 2012

Average length of stay for in-patient 4.6 5.1

treatment reduced from 7 to 5 days

Elimination of stock outs of drugs 70.5 17.5%

from present 100 items per month

„Proportion of tuberculosis cases det Case Case

ected and cured under directly obser Detection Detection
ved treatment short course Rate=60% Rate=63%
(DOTS)‟. Treatment All forms:
Success 87%,
Rate=86% Bacteriologica
lly confirmed
TB cases:
86%
Bed Occupancy Rate of Psychiatric 37.97 66
beds
Number of staff trained in mental 7 2
health

The bed occupancy rates (only for St Giles Hospital) for Psychiatric beds increased by 73% due to a combination of reporting,
decentralization of psychiatry services and establishment of stress wards. The ALOS increased by 10.9% in 2015.

18
5. Hospital Services
The Deputy Secretary Hospital Services is responsible for management and overall operation of the 3 divisional
hospitals Colonial War Memorial (CWMH), Labasa and Lautoka Hospitals and the 2 specialised hospitals, Tamavua
/Twomey and St Giles Hospital.

In addition to this core role, there are other areas that fall under the Hospital Services jurisdiction,

1) The Fiji Pharmaceutical and Biomedical Services (FPBS).

2) Health Systems and Standards.
3) Clinical Services Network.
4) Blood and Ambulance Services.
5) Overseas Referrals.
6) Specialist Visiting Teams.
7) Implementation of Service Excellence Framework.

Colonial War Memorial Hospital

Achievements

a. A Medical Team led by Dr Luke Nasedra, Consultant Anaesthetist left for Vanuatu for 6 weeks for the Cyclone
Pam Relief Assistance from the Fiji Government.
b. CWMH Sport Day combined with FNPF for the first time ever on Saturday 16th May opened by PS Youth and
Sports.
c. SDA Open Heart surgical team returns to CWMH after a lapse for one year; 243 patients were screened and 36
patients had surgeries.
d. Visiting Medical Team from Guangdong province, China visited CWMH from 29 th May to 1st June 2015.
e. Visit by US Navy Hospital Ship Mercy with surgeries performed on board the ship and symposium held at
CWMH – 6th to 10th June 2015.
f. Healthcare Waste Management Training Program conducted at CWMH by SPREP (Secretariat of the Pacific
Regional Environmental Program) under EU funding.
g. Opening of the refurbished IWA Lau Ward by His Excellency the President Ratu Epeli Nailatikau. Refurbishment
cost with purchase of new machines for the ward was $112,000FJD.
h. Visit by delegates of the Joint Working Group MoHMS Fiji and MoH India to CWMH.
i. New ambulance for CWMH valued at $105,000FJD donated by the Turkish government and received by
MHMS.
j. UN supported mock disaster exercise conducted at Albert Park and CWMH with 20 “injured” patients referred
to CWMH for further management.
k. Visit by Dr Tony Gherardin Senior Medical Advisor Department of Foreign Affairs and Trade, Government of
Australia.
l. Launch of the new Wellness Aerobics DVD by acting DSHS at the Peace Garden, CWM Hospital coinciding with
World Physiotherapy Day celebration.
m. 1st Audit of 5S implementation by the hospital audit team showed 57.1% overall compliance in 5S practice.
n. First ever Nephrology Workshop organized by Dr Amrish Krishnan on 18 th September.
o. Friends of Fiji Open Heart team returns to CWMH after 8 years on 11 th to 28th Sept 2015. A total of 24 adults
and 16 children had cardiac operations from the team.
p. MHMS commissioned phase 2 and phase 3 of OT & ICU refurbishment project & new OPG, mammography,
and Paeds DR Machine.
q. Launch of first ever Breast Awareness Campaign at Auditorium by PSHMS.
r. Donation of a total of $50,000 FJD received from John and Charles Wagner from their two Fiji based
companies – Sustainable Mahogany Industries Ltd and Pacific Western Timbers (Fiji) Ltd.
s. Visit by US Ambassador Ms Judith Cefkin to CWMH.
t. Launch of Landscaping and Beautification Unit for CWMH by MS.
u. Launch of the Infection Prevention and Control Manual for Maternity Units at Paediatric Seminar Room by
Hon Jone Usamate Minister for Health and Medical Services, and Hon Steven Ciobo, Minister for International
Development and the Pacific, Government of Australia.
v. Dr Vipul Upadhyay Visiting Paediatric Surgeon and Paediatric Urologist commenced his annual 5-day visit
performing specialist clinics and operations with Dr Josese Turagava at CWMH.
w. Donation of $10,000FJD received from the Women in Business (WIB) group represented by Ms Nur Bano, Ms
Alison Southey and Ms Ana Tuiketei.

19
 x. Donation of three Blood Pressure Monitors and three Thermometers received from Mrs Marica Hallacy BOV
Board Member.
y. Hon Jone Usamate launched the Early Warning Signs for Childhood Cancer Poster and the National Paediatric
Oncology Committee at the Paediatric Seminar Room.

Donation of medical equipment from Australian Aid to Paediatrics CWMH

Labasa Hospital

Achievements

a) 91% achievements towards 2015 Business Plan activities.

b) Opening of GOPD/Pharmacy Waiting area.
c) Commencement of exterior refurbishment.
d) Installation of Paging System.
e) Increase in establishment of Medical Officers and Medial Interns.
f) Implementation of 5S.
g) First ever Research Symposium for Labasa Hospital was conducted at the end of the year as an awareness
purpose with the theme “Promoting Culture of Research”.

Challenges

a) Business plan activities are carried out but there is no proper reporting of these activities.
b) No proper guidelines or standard operating procedures on existing processes.
c) Communication – information sharing is limited.
d) Training/Awareness Programs – limited, there are no specific plans in place to ensure all set out
trainings/awareness programs are monitored and executed.
e) Limited resources – Human, financial, infrastructure and equipment.
f) Establishment of the Monitoring and Evaluation Team to oversee the progress throughout the year has not
been successful.
g) Data Source – some are not very reliable; still finding difficulty in obtaining statistics from Patisplus and other
electronic data sources.

Way forward

a) Re-defining of planned activities to ensure that everyone knows what is required to be done in order to get
uniform feedback.

20
 b) Establish Standard Operating Procedures for services provided and sharing this information across the board to
ensure services are provided effectively.
c) Provision of resources (Human Resource, Financial, infrastructure, equipment) to enable achievement of desired
outcomes.
d) Timely and accurate reporting.
e) Proper and regular trainings offered for Labasa Hospital.
f) Quarterly review/evaluation of Business Plan Achievements.

Lautoka Hospital

Achievements

a. Lautoka Hospital Mother safe hospital initiative audited from 0% in the first quarter to 83% in the 4th Quarter.
b. Zero infection outbreak.
c. Accident and Emergency Department construction works 95% completed.
d. Visiting teams included Orthopaedic Team from Sydney, Eye team and the China Medical team from the
Wuhan Union Hospital. The overseas teams supported our local teams by performing surgical procedures such
as Orthopaedic cases and Eye operations.
e. National tooth brushing was conducted in Ba Provincial School and Lautoka Andhra Sangam College.
f. Blood Donation Bus received.
g. The Lautoka Hospital organised a Sports
family day on the 30th May 2015.
h. Staffs from the clinic went for the
Yasawa Tour and the Prosthetic
assessment to Nacula.
i. There was a decrease in number of
Malnutrition cases in 2016 by 55%.

Challenges

a. Staff shortage due to expansion in

services, promotion, transfer,
resignation and retirement.
b. Equipment and infrastructure needs improvement.

Way forward

a. Strengthening human resources by ensuring person to post is facilitated and ensure all vacancies are filled in a
timely manner.
b. Improving equipment and infrastructure by proper planning.

Tamavua / Twomey Hospital

Achievements

a. The Dermatology unit carried out 2 major outreaches in Bua and Yasawa.
b. The Albinism Symposium was launched on 12th August 2015.
c. Twomey hospital has now started clinic for Albinism cases.
d. Dermatology unit carries out rural outreaches every Mondays and in 2015 a total of 48 Outreaches were
conducted.
e. Commissioning of the new Liquid Culture Machine in the laboratory which is the only machine in Fiji.
f. The Out-Reach Program of the Rehabilitation unit was very effective. Coverage area increased to include
Yasawa and Rabi Islands. The increase in Out-Reach Rehab services saw a decrease in the number of clients
accessing Out-Patient services directly at the Unit. Majority of the clients received services either in their homes
21
 or at the Medical facility nearest to them. This saved clients lot of financial costs (Travel & Accommodation),
and caregiver burden was reduced.
g. Rehab Unit managed to network with LDS Church Charity Department and Spinal Injuries Association. Our role
was to identify and assess clients for mobility aid prescription (wheelchairs, walkers, crutches and canes). The
prescribed forms were then forwarded to SIA for release of items. LDS Charity provided mobility aids free of
charge. The end result was that clients needing mobility aids were assisted through the combined efforts of the
three Organisations.
h. The TB Microscopy decentralised to Savusavu laboratory and for adequate performance on EQA.
i. Secured TB funding support from KOICA and on-going funding from Global fund as well as governments
commitment to contribute to TB funding.
j. Establishment of TB Epidata- which is an up to date electronic TB database, recording 80+ data fields and
connected laboratory module.
k. TB Program restructure and establishment of new posts to allow succession planning.
l. Filling of New TB establishment under project positions for the next 2 years to maximally implement the End
TB Strategy.
m. Successful treatment outcome-Cure for Rifampicin resistant TB case in Nasoso, Nadi.
n. TB National Strategic Plan 2015-2020 (Executive summary & implementation plan) completed and endorsed at
NHEC.
o. TB-HIV policy endorsed by NHEC and HIV committee.

Challenges

a. No communication for progress on clinical and professional development.

b. There were out of stock of consumables for liquid and solid cultures.
c. There was a delay in the procurement of the prosthetic materials from Jaipur India. The delay was mostly at
the Procurement Office. This delay resulted in some disturbance to our clinics and functions of the prosthetic
department.
d. High turn-over of specialised staff.
e. High caseloads of TB patient in Central/ Eastern division has put the team under pressure in terms of case
follow up, reviews, late for clinic tracing, contact tracing, community visitation, etc.

Way forward

a. Timely procurement of prosthetic materials from India will not disrupt our Out-Reach programs and the overall
functions of the prosthetic department.
b. Emergency equipment‟s and consumables could be available for better services.
c. Recruitment process to be fast tracked once a post becomes vacant.

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6. Fiji Pharmaceutical and Biomedical Services Centre (FPBSC)

The Fiji Pharmaceutical & Biomedical Services Centre [FPBSC] main core services are:

a. Procurement and supply management [procuring, warehousing and distribution] of medical or health
commodities.
b. Essential Medicines Authority – development of product standardization and appropriate usage.
c. Inspectorate Regulatory Authority – strengthening quality assurance process of products import into the country.
d. Bulk Purchase Scheme – commercial arm providing social support to the private sector.

These associate programs ensure that commodities procured by the government are safe to be used for the right
purpose at the right place and at the right time.

Achievements

a) Standard 1, standard 2 and tracer product that is essential for laboratory and dental services provision was
available at facility level.
b) Nil shut down of laboratory and dental services in any facility due to unavailability of laboratory reagents and
Dental Prosthetic items.
c) Outbreak of diseases/ surge in positive cases of notifiable diseases was consistently followed up with facilities
and proactive steps were taken to ensure continuous supply of related items.
d) Working in conjunction with donor organisations in planning process such as KOICA helping expend TB
screening to 5 more labs in Fiji to increase service accessibility to public.
e) Successful implementation of the New CWM ICU equipment.
f) Enforcement of OH & S policy in the workplace and empowerment of committee.
g) Improvement in the availability of Tracer Products for Medicines at FPBS & Target Health Facilities.
h) Printing & Distributions of 4th Edition Essential Medicines List 2015
i) Advocating Antibiotic Week from 16th – 21st November 2015
j) Launching of the AMR National Action Plan 2015
k) Development/drafting of 6 Regulations for the Medicinal Products Decree 2011, and endorsement of 4
Regulations by the Fiji Medicinal Products Board.
l) Review of the Pharmaceutical Sector Strategic Plan.
m) Acquisition of the Drug Registration software through Australian Funding.

Challenges

a) Changes in testing policy such as implementation of revised Diabetes Management Guidelines laboratory testing
criteria. Revised criteria are heavily dependent on regular blood testing for any suspected high glucose blood
level individual. The poor and delayed communication of requirements to FPBS by specialised teams, outreach
teams, public health screening programs for supplies requirements. In an effort to sustain all roles of MOHMS,
such unplanned activities deplete stock levels faster than predicted leading to urgent purchases and over
spending of allocation.
b) The noncompliance from end users to follow set guidelines to request for purchase of nonstandard items.
c) Poor supplier performance in relation to honouring lead times.
d) Internal challenges include lack of „sense of urgency and responsibility‟ amongst staff members.
e) Very limited supervisory/audit visit opportunities to facilities were available in 2015.
f) Delays in finalizing contracts.
g) Systems and processes - causing delays in achievement of some activities.

Way Forward
a) Better and timely communication with all stakeholders, especially with special program managers.
b) Create awareness about role and processes of FPBS and what is the input required from end users.
c) Monitoring the end users and assisting them as required.
23
d) The need for further training in Quantification and management courses to upgrade capacity.
e) The need for Portable communication devices for efficient and effective response or communication.
f) Management to support the audit and training funding proposed.

Launch of Antibiotic week and National Antimicrobial (AMR) action plan

24
7. Divisional Report 2015

The Ministry of Health and Medical Services delivers health services throughout the four Divisions, Central, Eastern,
Western and Northern. The Health services range from general and special outpatient, maternal child health care, oral
health, pharmacy, laboratory, x-ray, physiotherapy, environmental, nutritional, outreach, school health and special
clinical services.

Figure 2: Four Divisions within Fiji

Northern Division

Western
Division

Central
Division Eastern Division

Table 4: Government Health Facilities

Health Facility Central Western Northern Eastern Total
Specialized Hospitals/ National Referral 2 0 0 0 2
Divisional Hospital 1 1 1 0 3
Sub divisional Hospital [level 1] 0 3 1 0 4
Sub divisional Hospital [level 2] 5 3 2 5 15
Health Centre [level A] 7 4 1 0 12
Health Centre [level B] 2 4 3 1 10
Health Centre [level C] 12 20 16 14 62
Nursing Stations 21 25 21 31 98
Total 50 60 45 51 206

Central/Eastern Division

The population profile below are collated from the demographic counts that are received from the respective nursing
zones, nursing stations and health centers.

The Central/Eastern division is the largest by population size and caters to about 100 health facilities. The total number
of people in this division is 422,917 with the majority people residing in the Suva subdivision. The Central/ Eastern
division is divided into 10 subdivisions as per table 4 below. The total population for the Central Division is 383,814
and the Eastern Division recorded 39,103.

25
Health services in the Central Division are delivered from 1 divisional hospital, 5 sub division hospitals (level 2), 21
health centres (7 level A, 2 level B, 12 level C), and 21 nursing stations.

Health services in the Eastern Division are delivered from 5 sub division hospitals (level 2), 15 health centres (1 level B,
14 level C), and 31 nursing stations.

Table 5: Demography of Central/Eastern Division

Subdivision 2014 2015
Suva 217,597 223,816
Rewa 84,872 88,361
Naitasiri 20,232 19,472
Serua/Namosi 29,588 30,587
Tailevu 22,384 21,578
Lomaiviti 16,187 16,187
Kadavu 10,946 10,978
Lomaloma 3,358 3,240
Lakeba 7,294 6,892
Rotuma 1,866 1,806
Total 414,373 422,917
Central (Total Population) 374,673 383,814
Eastern (Total Population) 39,651 39,103

In comparison to 2014 the total population for the Central division has increased by 9141 and Easter division saw a
decrease of 548.

Western Division

The Western Division is divided into 6 sub division (Ra, Tavua, Ba, Lautoka/Yasawa, Nadi and Nadroga/Navosa) with a
total population of 365,539. Health services are delivered from 1 divisional hospital, 6 sub division hospitals (3 level 1
and 3 level 2), 28 health centres (4 level A, 4 level B, 20 level C), and 25 nursing stations.

Table 6: Demography of Western Division

Subdivision 2014 2015
Ra 29,266 28,232
Tavua 26,376 26,551
Ba 56,143 56,450
Lautoka/Yasawa 132,385 110,733
Nadi 90,810 91,702
Nadroga/Navosa 52,730 51,871
Total 387,710 365,539

The total population for the Western division has decreased by 22,171 in comparison to 2014 which implies that the
reporting of populations by the zones and divisions are not consistent and may not be valid.

Northern Division
The Northern Health Division office provides health services for 4 sub divisions of Bua, Cakaudrove, Macuata and
Taveuni. Health services are delivered from 1 division hospital, 3 sub division hospitals (1 level 1 and 2 level 2), 20
health centres (1 level A, 3 level B, 16 level C) and 21 nursing stations.

Table 7: Demography of Northern Division

Subdivision 2014 2015
Bua 16,868 17,032
Cakaudrove 33,034 34,883
Macuata 64,439 66,699
Taveuni 16,649 16,668

26
 Total 130,990 135,282

It is noted that the population size for the Northern division increased by 4,292 in 2015.

Table 8: Summary Population by Division

Division 2014 2015
Central 374,673 383,814
Eastern 39,651 39,103
Western 387,710 365,539
Northern 130,990 135,282
Total 933,024 923,738

Achievements

1) Expansion and strengthening of services.

a. Pilot program of Strengthening SOPD documentation and reporting.

b. NCD Task Force Committee established in the Central and Northern Division.
c. Revisiting 4 Health Promoting School setting, healthy workplace and community settings.
d. Strengthening home based care whereby 53 officers were trained on Motivational Interview.
e. Mental Health Gap training for 8 Medical officers and 15 Nurses.
f. Strengthening BPP/CRP training in the community.
g. Training of service providers on family planning package.
h. Divisional Quarterly supervisory visits conducted.
i. NCD screening target achieved in the Western Division.
j. Roll out of PEN Model in all SD Hospitals
k. Hosting of the Pacific Ministers Meeting at Yanuca Island for Review of the Healthy Island Setting.
l. Preparedness Plan for Ebola and other Emerging Diseases like Chikungunya and Zika Viruses in terms of Border
Control especially at the International Airport in Nadi.
m. CD taskforce established in the Eastern Division.

2) Strengthening of Public/Private Partnerships.

a. “Dance for Health” at Shirley Park with an average of 35-40 participants 3 days per week.
b. Strengthening integration with key stakeholders MOEHA, MOY, private and public partners on service delivery
for adolescent health.
c. Strengthening the implementation of oral health education in secondary schools advocating on the theme your
smile matters.
d. Integrating involved stakeholders in reviewing of the current health care services.
e. Tobacco Free Settings for 3 Community Halls, 1 village and 1 City and Village was given award for the
maintenance of Tobacco Free status for the past 20 years.
f. Active Hand Washing Program with donation of Anti-Bacterial Bodyguard Soap by Punjas Group of Companies
to all Primary Schools in the West and Provision of Wash Stations in all Primary Schools in Ra subdivision.
g. Strengthening home based care in the central division

27
3) Infrastructural improvements.

a. Opening of Creche Room in Sigatoka Hospital.

b. Opening of the Extension of Sigatoka Hospital inclusive of the relocation of its Health Centre, Cuvu and
Vatukarasa H/Cs in Sigatoka, Punjas H/C in Lautoka and Nagatagata N/S in Tavua and Nayau-i-ra in Ra SD.
c. New Capital Projects- Ba Hospital, Nasova Hospital in Keiyasi, re - location of Nacula H/C in Yasawa and the
2 new H/Cs in Votualevu and Korovuto.
d. Renovation of Lami Health Centre
e. Waivaka N/S refurbishment of clinic & new qtrs.
f. Extension of Birthing Unit- Makoi Health Centre

4) Improvement in Services

a. Trainings for 93% of MI- 139 staff, 67% FCT staff and PEN Model was completed and mop-up done for
SOPD staff and MOs.
b. Implementation and monitoring of Learning and Training Development plan.
c. Foot Care Training and Attachments led to improved Amputation rates in the Western Division.
d. Multi- Disciplinary SOPD Services in all sub divisional Hospitals.
e. Mother Safe Hospital Initiative Audit with Sigatoka Hospital at 83% and Nadi Hospital at 93% which is the
highest in the Nation.
f. Internal Assessment of Baby Friendly Hospital Initiative conducted with ratings of 83% for Nadi and 93% for
Ra.
g. 80-100% HPV Coverage in the Western Division.
h. All Health Facilities are practising Integrated Management of Childhood Illnesses in the Western Division.
i. Water Safety Management Trainings and Development of Waste Care Management plans for SDs.
j. Motivational Interview Roll out Training, Foot Care Assessment Training facilitated through FHSSP and PEN
Model Roll out Training completed for Central/Eastern Division.
k. 258% increase in Oral health coverage of students for secondary schools in the Central division.
l. A grand total of 90% of children between the classes 6-8 are dentally fit within the central division compare to
88% in 2014
m. 2 BFHI trainings at Rewa sub-division and 1 BFHI training at Korovou hospital conducted.
n. Community health worker Training for Central Division completed.
o. Training on foot care and NCD tool KIT facilitated in the Eastern Division.
p. Mother Safe Hospital Initiative implemented in all sub divisional hospitals.

Challenges

a. SOPD/ PEN Clinic- staff turn-over, limited space, designated nurses and MO, lack of manpower, consumables and
teamwork.
b. Insufficient Budget to address planned activities.
c. Unfriendly Working Environment due to overcrowding, no staff rooms/ lockers, ventilation systems.
d. Lack of training opportunities.
e. Staff Morale and Attitude – lack of commitment/ motivation.
f. Limited space with no specific area for sterilization, storage and staff room in a few Dental Clinics in the Central
division.

Opening of new nursing station Nayavu-I-Ra

28
8. Public Health Services

The Deputy Secretary Public Health is responsible for formulation of strategic public, primary health policies and
oversees the implementation of public health programmes as legislated under the Public Health Act 2002. Effective
primary health care services are delivered through the Divisional and Sub Division Hospitals and National Programs
(Family Health, Wellness, Communicable Diseases, Food and Nutrition, Environmental Health, Oral Health and
National Health Disaster and Emergency Management).

Wellness Centre

The Wellness Unit was established in February 2012 by the merging of Non Communicable Diseases (NCD) control unit
and the Nation Centre for Health Promotion (NCHP).

Wellness unit is now rebranded “Wellness Fiji – harvest the wellness in you”.

All Fijians from conception to senior citizens have the potential to harvest wellness, as they sail throughout lifespan in
settings.

The strategic objective for Wellness and NCD is to reduce premature deaths (deaths aged less than 60 years) due to non
-communicable disease.

Achievements

a. “Tobacco Enforcement in Fiji” abstract was selected ahead of many other submissions from the Oceania at the
Oceania Tobacco Control Conference (OTCC) in Perth, Australia.
b. World No Tobacco Day Award 2015 to MHMS by WHO.
c. Increased publicity for Physical Activity via newspaper, radio, Parliament, talk back, Breakfast show, TV and
billboard.
d. 7 D Package (7 settings approach development process) presented and approved.
e. Publication of Global School-Based Health Survey (GSHS) results.
f. Established network and partnership with Five Religious Organisation.
g. Wellness Program conducted at 20 different sub-settings consisting of NCD Screening, Cervical Cancer Screening
and TB Screening.
h. Implementation of wellness intervention programs in workplaces.

Mental Health

The Mental Health Unit core functions as stipulated in the Mental Health Decree 2010 in general involves:

 The coordination and promotion of the decentralisation of mental health services through the integration into
primary health care and the general health care systems.
 The strengthening of existing community mental health services through the provision of training and adequate
infrastructure and resources in the community.

Achievements

a. The pilot mHGap training for Lomaloma Community Health Workers in Vanuabalavu that was conducted
with the assistance of WHO Funding and the MOH & Medical Services with the provisions of staffs to conduct
training.
b. mHGap training for 26 staffs in Western Division on the 15th - 19th February.
c. Training in Psychological First Aid conducted in JJ‟s On the Park on Wednesday and Thursday (9/3/16-
10/3/16) sponsored by WHO was attended by representatives from Empower Pacific and Red Cross, Fiji.
d. Screening of public with the assistance of the National Wellness Team as arranged with the National Wellness
Centre.
e. Completion of documentation for the National Mental Health Endorsement Project with the Trade Mission of
Taiwan is now to be submitted to Cabinet.
f. Minute to PS requesting rental of premises to allow Community Rehabilitations Outreach Program (CROP) to
move to safe, suitable premises.

29
 Way Forward

a) Training of Police Officers – this training was planned to be conducted with the police for the year 2015, this
was not done therefore it has been deferred to year 2016 program.
b) Continuous training program on mHGap training for Public Health Nurses.

Family Health

The Programs functions are,

To manage, implement, monitor and evaluate programs pertaining to Reproductive Health, Maternal Health, Child
Health and HIV/AIDS and Sexually Transmitted Infection.

Reproductive Health

Cervical Cancer Program (CECAP)

 The Cervical Cancer Program is known as the CECAP and is guided by the Cervical Cancer Screening Policy
2015.
 70% of health facilities in the Cakaudrove Subdivision have trained staffs to conduct cervical cancer screening.
 22 nurses have received training including maritime nurses – all health facility in Lautoka /Yasawa now have
trained staffs who can conduct cervical screening ie 100 % coverage.
 13 nurses nominated from health centers in the Central division attended the training.
 Tailevu Sub division – Thin Prep training on the 7th to 8th May, 2015.
 Refresher training on Thin Prep- Suva Sub- Division from 14th to 15th April for one group of Staffs and 16th
and 17th for second group to cover the whole of Suva Sub- division.

Launch of Cervical Cancer Screening Policy and Cervical Screening and Cryotherapy training manual

Family Planning

 There were five trainings conducted at divisional and National level with the aim of up skilling health workers
to be able to do proper counselling and provide modern methods of Family Planning (FP) at their stations.
 Eight Condom dispensers were installed in four Public Conveniences in the city of Suva, with the approval of
the Suva City Council. Peer educators are tasked to refill these dispensers.

30
Maternal Health

Provides support to all Maternal and New-born Health Activities in Fiji, in the best possible way in order to achieve
most of the Strategies as outlined in the Family Health Business Plan thus contributing to the reduction of Maternal
morbidity and mortality in Fiji.

Achievements

 The first „Violence against Women and Girls Clinical Guideline for Health care Workers in Fiji‟ was launched on
5th December 2015.
 Infection Control Manual for Maternity Services was developed with the support from FHSSP; the manual was
launched at CWM Hospital paediatric unit conference Room and rolled out with training.
 A teenage pregnancy chart and hand held flyer was successfully developed and printed with support from
UNFPA, planned for distribution to all Health Facilities in 2016.
 Mother Safe Hospital Initiative (MSHI) - the 6 target facilities were audited twice a year with support from the
Fiji Health Sector Support Program (FHSSP). Some facilities were audited once in the year. Generally all facilities
have improved in comparison to 2014 audits.
 Clinical Practice Guidelines (CPG) - about 20 CPGs created by the NICU team this year and they are also
looking at PICUs Clinical Practice Guideline.

Child Health

 WHO Pocket book- Seven (7) training were carried out with the main objective that at the end of the training,
health workers will be up skilled in the Management of Common Childhood Illnesses focusing on the inpatient
management of the major causes of childhood mortality.
 Integrated Management of Childhood Illness- One supervisory training conducted for the North, followed by
three Facilitator training, and ten days basic training.
 Paediatric Life Support- Seven (7) trainings carried out. The main objective is that after each training, health
workers are trained and equipped with the knowledge necessary for effective ways in managing emergencies in
children. This will improve the outcome of serious illness and injuries in children where resources are limited, if
the basic principles of resuscitation are adhered to.
 Disability Management Support- a speech Pathologist with extensive paediatric experience (Kat O Heir) was
invited to Fiji to participate in a one week developmental clinic. She was joined by the other local doctors also
carrying out workshops and lectures to nurses and doctors on child development, developmental milestones
and intervention ideas; other specialists accompanying her provided lectures on cerebral palsy, child protection
and genetics.
 Paediatric Oncology Services – Oncology communication material launched by the Honourable Minister for
Health & Medical Services on the 19th of November, 2015.
 Introduction of Inactivated Papilloma Virus Vaccination Program and EPI Training. A National TOT was
conducted in November; the 50 participants were mostly the DHS, SDHS, EPI focal people and MCH nurses.
Following the National training, 29 follow up trainings was conducted in all the subdivisions in the month of
December.

Expanded Programme of Immunization (EPI)

The EPI is a very important public health activity in Fiji. It is purported to improve child health and reduced child
morbidity and mortality through vaccination. There have been many changes to EPI in the last year. These changes
have occurred in programme delivery, the types and numbers of vaccines used, immunization schedule and how to care
for and store vaccines.

The celebration of World Immunization Week together with the other Pacific Island Countries was a success. This was
nationally launched at the Makoi health centre with the idea of strengthening communication as one of the strategies to
improve attendance to MCH clinics.

The Post Introduction Evaluation (PIE) for new vaccines introduced in 2012, i.e. HPV, Pneumococcal vaccine and
Rotavirus was carried out in September 7th – 18th, by two WHO consultants with our local team in the four Divisions,

31
the outcome were presented to NAFH and team from FHSSP. This PIE tool provides a systematic method for evaluating
the impact of the introduction of a vaccine on the existing immunization system in Fiji. One of the main areas in
particular that was identified was the impact of the Information Education materials (IEC) of the posters and brochures
of each vaccine and how the Health Care Worker used these materials to communicate the benefits and value of the
vaccines against the risks and the cost if the children were not vaccinated.

Fiji endorsed the Polio Endgame Strategic Plan (2013-2018) by supporting its efforts for global polio eradication. As
outlined in the end game strategic plan, Fiji introduced one dose of Inactivated Polio Vaccine (IPV) in the routine
immunization programs in December 2015, and will switch from tOPV to bOPV by 2016. The introduction of one dose
of IPV will provide immunity against type 2 polioviruses and therefore mitigate the risks associated with potential type
2 vaccine derived poliovirus outbreaks following the global switch from tOPV to bOPV. This will also boost immunity
against type 1 and 3 polio.

World Immunization Celebration

HIV/AIDS and Sexually Transmitted Infection

The Achievements for HIV/AIDS and Sexually Transmitted Infection Program were:

 Policies and Guidelines: The HIV Testing and Counselling Policy has been launched and ready for distribution
to all HIV implementers as a guide for their VCCT services and also for the adoption of the new HIV
Algorithm. This document was launched during the National Commemoration for World AIDS Day in Labasa
[December, 2015].
 National Strategic Plan: 2015 saw the end of the 2012-2015 HIV & STI National Strategic Plan and the
development of the 2016-2020 HIV & STI NSP. At the end of pocket consultations, trainings and stakeholders
consultation and participation through the support of UNAIDS, WHO, UNICEF & SPC, a draft NSP is in place
which will be submitted to the HIV/AIDS Board and also the Cabinet for endorsement on the 1 st quarter of
2016.
 New HIV Algorithm: a project officer was recruited in the beginning of 2015 to coordinate and monitor the
new HIV testing strategy in the divisional and sub divisional hospitals. 7 sites are currently conducting
confirmatory HIV testing. 5 additional sites have been identified for 2016.
 HIV Curative: 4 new PIMA machines were procured through UNICEF for the 3 hub centers and Mataika House
to assist clinicians in monitoring CD4 counts of PLHIVs. Training was conducted before the machines were used.
Plans are in place for Mataika House to have a GenoExpert machine that will detect viral loads for PLHIV
clients.
 World AIDS Day: the celebration for WAD was a success throughout Fiji. The National event was held in
Labasa and other build up events in other parts of Fiji including Suva. The next national event [2016] is planned
for the Western Division.

32
  Capacity Building: 4 clinicians were sent abroad through the support of the HIV/AIDS Board, UNICEF &
OSSHHM for training in the following areas:
a) HIV Spectrum Workshop [1 - Bangkok]
b) HIV Clinical Management [2 - Mendi, PNG]
c) HIV & Adolescent Health [1 - Bangkok]

Local Trainings were conducted which included the following:

a) VCCT Training
b) PPTCT Training
c) HIV Prescribers Training
d) STI Syndromic Management Training

Launch of the HIV Testing & Counselling Policy during the WAD Celebration in Labasa

Way forward

 Strengthen data collation and reporting process from sub divisional and divisional level.
 Strengthen networking with hub centers to improve coordination and facilitation of HIV activities.
 The Neonatal Resuscitation Program provider course should be made a requirement for all midwives currently
working in Divisional and subdivision Hospitals and should be included in nursing curriculum as a requirement
for license.
 Internal allocation within Ministry of Health and Medical services is required for Reproductive and Maternal
Health Program, noting that most of the trainings and program activities done by FHSSP will be handed over
to the Ministry in 2016.
 Vacant positions to be filled to ease workload for the Hub teams. Divisional activities which were coordinated
and facilitated by the Divisional HIV Project Officers were either delayed or not implemented because of the
absence of the appropriate officers.

Communicable Diseases (CD)

The core responsibilities of Communicable Disease program are:

a. To assist and advice in the formulation of relevant national plans, policies, guidelines and protocols for the
control of communicable diseases of priority to the Ministry of Health and Medical Services and PPHSN.
b. To establish and maintain an effective surveillance system for CDs of priority to Fiji and the Pacific Public
Health Surveillance Network (PPHSN).
c. To provide high quality reference laboratory services for the diagnosis of priority CDs to Fiji and PPHSN.
d. To conduct, support and advise on the investigation of a communicable disease outbreak and the consequent
response, monitoring and evaluation activity.

33
 e. To assist and advice in the ongoing dissemination of information to the general public and also health care
providers on communicable diseases and how to prevent them.
f. To develop, support and sustain communication networks with key stakeholders on communicable disease
prevention and control.
g. Through NTCOPD secretariat functions, coordinate CD control activities amongst internal and external
collaborating partners.
h. To provide consultation services on communicable disease issues from a community health perspective.
i. To assist and advice in the facilitation of training in CD surveillance, data management, outbreak investigation
and control, for the health division.
j. To conduct operational research on communicable disease prevention and control.
k. To provide outpatient care and domiciliary support services for lymphatic filariasis patients.

Achievements

National Public Health Laboratory

 Timely reporting of CD results was achieved which assisted clinicians response to the particular CD.
 NPHL was able to support the sub divisional and Divisional laboratories in confirming the screening test results.
 PPHSN network enabled NPHL to assist few PICT in confirming there laboratory samples which was referred
for testing and confirmation.
 Ebola suspected case was referred to VIDRL and the result was communicated within 24 hours from the
reference lab.

NIC
 On-going SARI surveillance in ICU CWMH. Implementation of Assays for Influenza H7, H3 variant, and Flu B
lineage typing and Mers-CoV and validation of assay by Dr Patrick Reading - WHOCC Melbourne. Ordering of
reagents from IRR CDC. Participate in External Quality Assurance Program from Hong Kong and CDC. Revision
of Influenza Testing SOP and revision of Flu Testing Algorithm.
 Acquiring new -80deg freezer through WHO for flu.
 IB VPD Surveillance – Routine testing of CSF by RT-PCR
 Assisting the typhoid research on environmental testing for S.Typhi on soil samples (first ever to be done)
 Attended training on Dengue serotyping in ILM Tahiti.
 Certification for Transport of Infectious Substances conducted by WHO. Assist with referral of samples to ILM.
 Actively assist in the Laboratory Quality Management System through formulation of policies and SOPs.

HIV
 All the three Divisional Hospital Laboratories including the selected assessed sub-divisional laboratories are fully
competent and capacitated to effectively and efficiently conduct HIV confirmation using the New Rapid HIV
confirmatory testing algorithm.

Rotavirus
 A batch with the total of 160+ samples was sent to MCRI in November. Also the laboratory has participated in
proficiency testing program in which samples were tested and results were submitted to CDC Atlanta on
25/11/2015.
 Proficiency Test Results: 100%.

Water
 In the progress of writing a concept paper to introduce new technique in water testing.
 Liaising with RCPA in enrolling into external quality control program.

Vaccine Preventable Disease

 A successful review from WPRO of the Invasive Bacterial Vaccine Preventable Disease (IB-VPD) and Rotavirus
(RV) Surveillance Systems.
 Invitation from WHO to join the Global Surveillance Network for Invasive Bacterial Vaccine Preventable
Disease (IB-VPD).

34
  Establishing the molecular meningitis surveillance system with qPCR testing at FCCDC which has provided
results on the common causes of meningitis in children in Fiji and identified an increase in Meningococcal cases.
 Serotyping of pneumococcal isolates at the reference laboratory to monitor the impact of PCV10 on
pneumococcal strains causing disease.
 Maintaining the RV surveillance and having data for the evaluations of the RV vaccine.

Surveillance Unit
 Divisional Outbreak Response Team (DORT) Training completed in all 3 divisions.
 Leptospirosis, Typhoid and Dengue updates provided regularly.
 NTCOPD and Technical Working Group (Clinical, Prevention and Control, Communication, and Surveillance
meetings).

Challenges:

 The NTD plan, including disease-specific implementation plans, has been facing numerous challenges through
the years. The foremost challenge is ensuring financial allocations are available to carry-out activities. Whilst the
LF and dengue program have government budget allocations, the other projects (STH, trachoma, and scabies)
and program (leprosy) relies on CD and Twomey hospital funding to carry-out its activities, and in most cases
donor funds are usually applied.
 Secondly, the program is currently not established within the health systems which provide a workload on the
current project officer. This shortage is also seen within its programs which in turn results in lack of or poorly
available surveillance and monitoring information.
 To have an establishment for the NTD program will enable availability of accurate information thus timely
delivery of activities in the plan which in turn enables the country to fulfil its goal of eliminating and
maintaining elimination levels for target diseases.
 Sentinel sites not able to send 5 samples per week per site as required by NIC for routine flu surveillance.
 Dengue serotyping not implemented and validated due to the above issue and therefore deferment till 2016 by
Consultant for validation.
 Regular communication and HIV reporting needs to happen and enhanced progressively driven by the
supervisors of the HIV surveillance network.
 PICT samples are also referred for further testing at NPHL for Rotavirus but due to poor communication within
regional Lab there is a delay of samples received for further testing.
 Manual registration and electronic mailing of results consumes a lot of time in releasing results to the specific
sites.
 More coordination is needed with the Environmental health team in receiving water sample for testing.
 Without a Vaccine Preventable Disease Surveillance Officer the work was supported by a partner project, the
New Vaccine Evaluation Project which is due to end in June 2016.
 Establishment of a surveillance unit into the MoHMS and the turnover of CD Surveillance officer position
results in interruption of implementation of activities.

Way forward

 More awareness on flu sampling through site visitation and timely reporting to sites
 On-going training on molecular testing.
 Reporting pathways and archiving of HIV testing information must be well established, clear and protocols
adhered to so that it assures the confidentiality of HIV cases at all testing sites.
 Frequent communication with the Lab focal person on the proper sample collection and referral to NPHL for
testing.
 Scheduling site visits to enhance the program assuring that standard protocols in place is adhered during all
phases sample collection.
 Need to establish a National Vaccine Preventable Disease Surveillance Unit, led by MoHMS staff.
 Retain staff trained in VPD surveillance
 Submit proposal paper to NHEC for establishment of a Surveillance Unit.
 Better collaboration with divisional and sub-divisional team in completing surveillance activities.

35
 Launch of MDA campaign 2015

Environmental Health (EH)

The Environmental department is responsible for:

a. Pollution control to ensure developments are carried out in sustainable manner without compromising the
essential natural ecological processes of the environment.
b. The enforcement of the food laws to protect the consumers against unsafe, impure and fraudulently presented
food by prohibiting the sale of food not of the nature, substance or quality demanded by the purchaser.
c. Emphasize the monitoring and improving sanitary conditions for populations in urban and rural areas.
d. Monitoring and controlling the agents of vector- borne diseases.
e. Monitor international travellers and cargoes via aircraft and vessels.
f. Community awareness programs to increase the people‟s capacity in understanding existing environmental risks
and mitigation measures.
g. Ensure building plans are in compliance with standards prescribed under the appropriate building legislation
prior to approval. It is also mandatory that EHO‟s conduct progressive inspections at critical stages of every
approved building that is under construction.

Environmental Health encompasses all measures necessary to deal with issues such as environmental degradation and
climate change, hazards including contaminated food and water, chemical exposure, and it also provided the
opportunities to enhance health by planning for improved health outcomes and work towards health promoting
environment.

The following legislation governs the EH department‟s responsibilities:

Public Health Act (Cap 111)
Food Safety Act 2003
Food Safety Regulation 2009
Quarantine Act (Cap 116)
Town and Country Planning Act (Cap 139)
Sub-Division of Land Act (Cap 125)
Burial and Cremation Act (Cap 117)
Tobacco Control Decree 2010
Tobacco Control Regulation 2012
Litter Decree 2009

Achievements

a) 626 import permits were issued to approve Food Business Operator (FBO) for importing perishable, non-
perishable, frozen and other food products into the country. The food program managed to process and issue
5264 health license for both new and renewals for the year 2015.
36
 b) A total of 237 community trainings were conducted in all divisions to promote healthy lifestyle and living
condition. Tobacco free setting initiatives were also introduced in 24 rural communities. 6 were reported in the
West, 7 in the Central, 8 in the North and 3 in the East.
c) In the year 2015, 11,937 vessels were cleared through the quarantine services. 5103 of the vessels cleared were
aircrafts and the remaining 6834 were ships.
d) In total, 91 land developments were completed and Completion Certificate (CC) was issued.
e) Healthcare Waste Management Plans (HWMP) were developed and submitted by the 3 major hospitals. A
generic HWMP was also developed and established as a guide for the 17 sub-divisional hospitals.
f) 6 major capacity building training was conducted for food and water safety.

Challenges

1. Insufficient manpower resources to provide maximum coverage of EH works in local populations given the
growing effect of environmental degradation and health impact from uncontrolled and lack of monitoring of
developments.
2. Lack of equipment‟s and non- availability of full time transport for EH stations lead to hindrance in services
provided by EH.
3. Inconsistent reporting system and EH data management.
4. High costs of laboratory tests for pollution surveillance and food adulteration testing.

Way Forward

1. Provision of full time transport for each sub divisional health office.
2. Review current EH organizational structure and role to identify and address existing manpower needs.
3. Procurement of field kits for rapid air, soil and water pollution assessment.
4. Procure electronic data collection and analysis system similar to AKVOFLOW currently used by EHO‟s during
disaster impact assessment for WASSH facilities.
5. Strengthen prosecution capacity through appropriate training of staffs in collaboration with SG‟s office local
training program.
6. Increase of EH Food and Water quality assessment budgetary allocation to adequately cater for specific tests
such as heavy metals etc.
7. Upgrading of Mataika Laboratory to become a certified reference laboratory for chemical and bacteriological
testing facility.

Dietetics and Nutrition

Dietetics and Nutrition Unit is responsible for all aspects of Hospital Dietetics and Public Health Nutrition Services. It
facilitates, coordinates and monitors at national level comprehensive preventive nutrition and curative Dietetics Services
programs for the promotion and maintenance of good nutritional health of the population.

The nutritional wellbeing of a population is a critical indicator of national development. Fiji is beset with serious but
preventable nutrition-related diseases such as diabetes, coronary heart disease, high blood pressure, obesity, anaemia
and malnutrition in children. These preventable conditions burden the economy with excessive medical costs in relative
as well as absolute dollar terms. Generally a healthy, well-nourished and educated population provides the best
foundation for promoting national economic growth.

Dieticians have always been an essential component of the health team, complementing medical treatment with the
provision of appropriate nutritional care to improve health status and lifestyles. Dieticians have taken challenges in
planning, implementing, and monitoring, evaluating nutrition related intervention programs. Dieticians have also had
challenges in projects that promote nutrition and wellness which have made the community and the government aware
of the demands for better nutrition at all levels to improve quality of life for the people of Fiji.

Achievements:

a) Breastfeeding Week was celebrated at various subdivisions.

b) BFHI Internal Assessments for the Western Division was completed throughout the 6 subdivisions from
October-November.

37
 c) Nutrition Month activities were conducted at various subdivisions with the focus on the Act Against Anaemia
campaign.
d) Khana Kakana Recipe book was awarded 2nd Place at the International Gourmet Cookbook Award. Locally -
overwhelming positive request for the cookbook.
e) Hospital Equipment procurement is needed for the equipment to effectively facilitate daily food service
operations.
f) Meal Satisfaction Surveys was conducted in various institutions.
g) SSF awareness programs was implemented through the various divisions.

Challenges

a) Supplementation Program needs to conduct end point evaluation of NIMS program, considering the
recommendations in the Mid Term Evaluation Report (2013) and re-strategize with more thorough
planning.
b) Wellness Unit – nutritional component of the Wellness Packages is currently under the NIMS PO. Staffing
needs to be addressed to ensure effective implementation of both programs.
c) Reporting templates – difficult to ascertain correct coverage and reach of programs.
d) Dieticians‟ Toolkits is underutilised due to unavailability of consumables.
e) Inadequate clinical staff - Clinical CWM Ward Coverage per quarter - 1st Quarter - 45%; 2nd Quarter -
43.5%; 3rd Quarter - 42%; 4th Quarter - 38%; SOPD – 5% : (Bed State 450+, Dieticians – 10 – covering
clinical and food service responsibilities), Western Subdivisional Hospitals - Total NCD cases admitted-
2059, Coverage by Dieticians - 47%.

Way forward

a) Reporting Format – standardization of reports for more effective compilation.

b) Align under 5 Nutritional status classification as per WHO classifications to improve detection and
management of malnutrition cases.
38
 c) Development and marketing of nutritional packages.
d) Development of auditing tool for various nutritional packages.
e) Conduct impact studies to assess interventions.
f) Capacity building - More opportunities for overseas and short term training attachments.
g) To increase establishments of dieticians to adequately cover all 3 cores of Dietetics and Nutrition – Clinical,
Food Service Administration and Public Health Nutrition.
h) Clinical protocols – finalisation and endorsements by various CSNs.

National Food and Nutrition Centre

The NFNC is tasked with 4 main responsibilities:

1) Monitor the food and nutrition situation in the country through field surveys and assessment of the national
food supply.
2) Advise Government (and other stakeholders) on the food and nutrition situation and formulate evidence-based
policy and programmes to improve the nutritional status of the people of Fiji.
3) Coordinate and review nutrition programmes/projects and the Fiji Plan of Action for Nutrition (FPAN), which
aims to combat nutrition-related diseases affecting the population.
4) Educate the population about adequate diet and nutrition.

Achievements

a) Completed all field work and data collection for the National Nutrition Survey(NNS).
b) Completed and validated all data entries for all NNS Questionnaires.
c) In-house presentation of basic NNS Preliminary Results.
d) Completed consultations and amendments for Policy papers and regulations.
e) Vacancies filled and staff needs met.
f) Requirements for Integration submitted.
g) Works on logistics for Govnet access commenced.
h) National calendar events and SSF Strategies coordinated and technical reports submitted.
i) Completed IYCF recipe testing and amendments made.
j) Nutrition component (Fruit and Vegetable Campaign) of HPS Initiatives coordinated and report submitted.
k) Quarterly prepositioning of all IEC materials to the Divisions.
l) Participation in technical meetings and plenary sessions with internal and external stakeholders, and submission
of technical papers and reports.

Challenges
a) Unplanned activities due to ad hoc requests for nutrition services meant impeding planned activities.
b) Financial constraints for staff recruitment for NNS data entry during the year, purchase of appropriate
equipment and furniture.
c) Staff overseeing more than 1 position and shared workloads.
d) Some activities are co-facilitated with the divisions and other ministries; delays and lack of support from them
results on non-achievement of outputs.
e) Inconsistent supply of seeds and seedlings, poor monitoring and sustainability of hospital gardens
f) Activities not fully undertaken due to limitations of infrastructure.
g) Poor staff attendance to PA sessions and non-completion of Diet and PA Worksheet.
h) Networking with external stakeholders.

Way forward

a) Strengthen and improve networking with internal and external stakeholders and within government ministries
to allow for successful implementation of food and nutrition programs within set timelines.
b) Strengthen M & E components of all food and nutrition activities and programs.

39
 c) Funds to be secured first before conducting surveys to ensure achievement of targets within planned timelines.
d) Increase operational budget to meet the service needs of the Centre.

Oral Health

A healthy mouth and good oral hygiene is necessary for the health and wellbeing of each and every individual. This
concept is at the centre of the oral health service delivery and oral health promotion for our citizens.

The Department of Oral Health is very proud of its achievement in their Business Plan with a successful implementation
rate of 74%. In terms of service utilization, there were slight variations between 2014 and 2015 patient attendances,
revenue collected, conservative restorations, extractions and the provision of prosthetic services. In addition to the high
volume of services provided, the staff also had many opportunities for capacity building through Continuing
Professional Development (CPD) sessions. The strong partnership with corporate bodies and service and religious
organizations has resulted in more services provided for the underprivileged and at risk members of society.

There were several memorable achievements in the dental services; the most exciting being the addition of 40 new
posts to the dental cadre in 2015, this allowed for more services to be provided and more senior posts to be created for
long serving and deserving officers who have more responsibility, knowledge and skills.

Continuing Professional Development (CPD) sessions increased in numbers and quality, resulting in a more
knowledgeable and informed workforce. We continue to strengthen our partnerships with service, religious and
corporate stakeholders to promote oral health in all sectors of the communities.

Oral Surgery services in Fiji achieved a memorable and proud moment in history with our first two local dental officers
graduating with a Diploma in Oral Surgery from the Fiji National University during the year. These dental officers are
now able to provide a more extensive range of oral surgeries (cancers, trauma and other oral pathologies) locally rather
than referring them overseas for treatment.

Taking prosthetic services (dentures) to the elderly in rural and maritime areas has seen a larger number of our senior
citizens achieving a better quality of life through better smiles and restored nutrition.

The inclusion of secondary school children in our school program has seen the introduction of oral health promotion
and tooth brushing after lunch for our adolescent population attending schools. We hope to eventually visit all
secondary schools annually to decrease the burden of dental caries in our young adult population and reduce tooth
lose.

To round off our achievements for 2015, we are indeed proud to have revised our 2006 policy and developed our
National Oral Health Policy 2015.

The major challenge faced in delivering oral health services during the year has been the chronic shortage of staff; this
caused a decline in curative services in the clinics and also decreased school coverage and outreach programs. Despite
the addition of 40 new posts to the dental cadre, we were still not able to fill all the posts because there were not
enough graduates to take up the posts. Service provision is always challenged and adversely affected by shortages in
dental consumables / materials and machines and equipment breakdown.

We will vigorously pursue discussions with the Fiji National University to ensure that training numbers and quality of
both under and post graduate training is aligned to the human resources for health needs of the country. The results of
the pending 2011 National Oral Health Survey must be published and also plans developed for the next survey to be
carried out in 2017.

It is anticipated that work will progress towards a more streamlined and inclusive oral health information in line with
the ministry‟s central repositories and data collection and reporting processes.

The Oral Health (CSN) Clinical Service Network will focus their attention on clinical specialities to strengthen tertiary
level of curative dental services.

We eagerly await the other 119 Cabinet Approved posts to be added to our establishment to enable us to provide
better coverage of services and cater to the increased demands by the public for more services and tertiary level
rehabilitation.

40
Table 9: Dental Statistics
2014 2015 Change 2014 - 2015
Attendances 298,458 297,542 916 ↓0.3%
Revenue Collected $606,383.39 $ 593,292.37 $13,091.02 ↓2%
Conservative Treatment 57,979 58,126 147 ↑0.3%
Prosthetics 3,593 3,751 158 ↑4.2%
Extractions & Oral Surgery 102,638 104,851 2,213 ↑2.1 %
Preventive Procedures 114,068 95,675 18,393 ↓19%
School Services 139,865 106,253 33,612 ↓32%
Outreach Programs 41,845 39,835 2010 ↓5%
Attendances

National Health Emergency & Disaster Management Unit

The National Health Emergency and Disaster Management Unit (NHED MU) was formally created in 2012 with the
establishment of a permanent coordinator based at the Ministry‟s HQ. The Unit is aligned to the Public Health
programs and reports to the Deputy Secretary Public Health.

The Unit‟s objectives are,

1. To strengthen and establish the MoHMS Emergency responses and build capacities and effective disaster
response at all levels of health service delivery.
2. Establish and reinforce emergency health coordination including rapid health assessments.
3. Provision of technical and normative support to National Authority, UN agencies, NGOs for public
interventions.
4. Define emergency health policy and program priorities in a structured manner.
5. Assist in the establishment and maintenance of health and nutritional surveillance, producing health intelligence
and managing information for health advocacy.

Achievements
 Fiji‟s first ever Medical Deployment to the Pacific Region on 23rd March 2015.
 Distributed the HEADMAP and SOP 2013-2017 to 4 Divisions including partners – UNICEF/
WHO/SPC/NDMO.
 National Disaster Awareness Week celebrated in the month of October.

Challenges
 No specific budget allocated to the National Health Emergency & Disaster Program.
 The Unit is in its teething stages as it is manned by one officer.
 Integration of Disaster Risk Management into health programs and activities is a challenge.

Way forward

 The special funding for NHED MU needs to be provided. The unit cannot continue to rely on external (donor)
funding and cannot utilize Public Health program Funds for its activities.
 It is envisioned that the long term target (10 to 15 years) would be to establish divisional level officers who are
solely tasked to look after disaster management within their respective divisions.
 Increased awareness on Disaster Management at all levels and the need to have a risk based approach rather
than event focused has been the norm over the years.
 There is a dire need for better coordination and support from the DMO‟s.

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9. Administration and Finance
The role of Human Resources mirrors the vision, mission and values of the Ministry of Health and Medical Services in
providing responsiveness and effective financial, human resource and training services to the Ministry staff to provide
goods and services. These staffs are internal clients and the “produce” of this ministry that supports its effective function
to provide quality health care services and promote wellness to all people of Fiji.

The Division is led by the Director Human Resource who reports to the Permanent Secretary for Health and Medical
Services through the Deputy Secretary Admin & Finance for the development, implementation and monitoring of
policies and guidelines in relations to Human Resource Management.

Training Unit

The Unit‟s objectives is to act as a central and initial point of reference in relation to all training activity conducted or
proposed for delivery to MoHMS staff; to maintain a Master Training Plan that reflects outcomes of Training Needs
Analysis in collaboration with recommendation of Divisional and Individual Learning and Development Plans and
matches against the training that is provided by internal partners (including the PSHMS) and external donor bodies or
Universities (including FNU, USP) and to manage and administer In-Service Training [IST] and Overseas Attachments for
MoHMS Personnel including:

a) Compilation of Bond forms for MoHMS sponsored students,

b) Ensure payment of Tuition Fees for MoHMS sponsored students,
c) Facilitate overseas attachment arrangements for health workforce,
d) Facilitate participation of staff in PSC Scheduled training courses,
e) In-house training on HRIS to facilitate effective monitoring of workforce.

In 2015, the Ministry of Health and Medical Services, Training and Development Unit administered In Service Training
to 98 officers at Local Institutions for Tertiary level programs. The unit further arranged logistics for 213 officers who
attended short workshops overseas. In order to strengthen Human Resources Management the unit conducted 5 In
House Workshops (mainly on FICAC Awareness) and facilitated 81 officers to attend 16 PSC Training.

The unit also provided Secretariat support to the National Training Committee which had 12 meetings and deliberated
over 140 requests.

Personnel Unit

The functional role of the Personnel Team is to provide sound policy advice to the Director Human Resources. Sound
policy advice are sourced from the 2013 Constitution of the Republic of Fiji, relevant Acts, 1999 PSC Regulations, 2011
General Orders [GO], PSC and Internal Circulars and Memorandums and other instructions that may be issued from
time to time.

The Unit monitors and direct:

(a) Terms and Conditions of service - interpretation, clarification, compliance and changes. All Leave [Annual, Long
Service, Sick, Bereavement, Maternity, Military, Sporting, Leave without Pay & Secondment & Long Service Leave
Allowance]. Although Leave under the GO is deemed to be the right of officers, this is granted at fair and reasonable
discretion of a supervisor.
(b) Late Arrival & Absenteeism Return & Salary forfeiture.
(c) Attrition – Retirement, Resignation, Death.
(d) Transfer/Posting – relevant allowances.
(e) Salary review & upgrading.
(f) Volunteers and attachees.
(g) Annual Performance Assessment [APA]
(h) Position Description [PD] & Individual Work Plans [IWP]

42
Table 10: Personnel Activities 2015

Activity Medical Nursing Dental Pharmacist Allied Corporate Government Total

Officer Cadre Health Services Wage
Workers Earners
[GWE]
1 Retirement 6 12 3 - 3 5 26 55
2 Resignation 32 84 8 11 18 6 48 207
3 Deceased - 8 7 5 7 27
4 Deemed - 13 3 1 1 3 12 33
Resignation
5 Contract expired 1 - - - 1 2
6 Retirement on - 2 - - - 3 6 11
Medical ground
7 Leave Abroad All Cadre 408
8 Leave Without Pay All Cadre
115
[LWOP]
9 Leave Allowance All Cadre 90
10 Leave All Cadre 15
Compensation
11 Secondment All Cadre 110
12 Forfeiture of salary All Cadre 510
13 Posting & Transfer All Cadre 622
14 Volunteers & All Cadre 92
Attachees
15 Salary All Cadre
36
Upgrade/Revision

Industrial Relations

The industrial Relations deal with the following issues:

a) Disciplinary cases in view of conduct and behaviour of the workers.

b) Grievances brought by officers in view of their supervisors.
c) Occupational, Health & Safety.
d) Ensure that all health facilities that have twenty or more workers are registered as per HASAW Act 1996
section.
e) The compliance of the HASAW Act 1996 and the 6 legal notices.
f) Workmen‟s Compensation.
g) Ensure that Laws of Fiji Cap 94 on Workmen‟s Compensation is adhered.

In 2015 there were 102 cases tabled before the National Disciplinary Committee. An increase of 6 more cases from
2014.

Post Processing Unit (PPU)

The Unit‟s role includes,

a) Management of all areas for recruitment.

b) Vacancy Processing.
c) Provide support and training of Divisional and Subdivisional HR staff to fully utilise the HRIS as a daily
operational tool to monitor, manage and report on the workforce in an efficient manner.
d) Follow guidelines and requirements set out by the Fiji Public Service Recruitment and Promotion Policy, and
State Service Decrees particularly the following principles.
e) Government policies should be carried out effectively and efficiently with due economy.
f) Appointments and promotions should be on the basis on merit & equal opportunity

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Table 11: Post Processing Activities 2015
Activity Total
1 NSB Submission 619
2 Contract Renewed 689
3 Advertised and processed vacancy 163
4 Employments including interns 376
5 Re-engaged Officers 48
6 Project Officers appointed/appointments renewed 88

Table 12: MoHMS Staff Establishment 2015

Cadres Approved No Filled Vacant

Medical [MD01-MD06] 747 504 243
Medical Assistant 6 3 3
Nursing [NU01-NU06] 2,621 2,476 145
Orderlies 58 48 10
Dental Officers 64 50 14
Para-Dental 177 119 58
Laboratory 177 158 19
Radiographers 75 55 20
Lab/X-Ray Assistant 21 21 0
Physiotherapist 46 26 20
Dieticians 79 69 10
Pharmacists 95 65 30
Environmental Health 124 111 13
Administrative Staff 182 153 29
Secretary/Typist 46 34 12
Statistician 13 13 0
Information Technology Staff 9 7 2
Stores Officer 32 28 4
Upper Salaried Staff 19 13 6
Bio-Medical Staff 23 17 6
Other Classifications 34 30 4
Established Staff Total 4672 4017 655
GWE Staff Total 1190 1083 107
OVERALL TOTAL 5862 5100 762

Workforce Planning

The Workforce Development Unit facilitates and coordinates the development, implementation and review of MoHMS
Annual Strategic Workforce Planning process in collaboration with all other units of the Corporate Services Division.
The primary aim of the Workforce Planning process is for Ministry of Health & Medical Services to achieve best
workforce outcome to train, recruit, retain and advance critical skills, roles and support the Ministry of Health &
Medical Services staff to provide and deliver quality health services to the citizens of Fiji.

44
Achievements:

a) Completion of the 2015 Employee Satisfaction Survey Report for 2016 Strategic Workforce Plan.
b) Completion of the 2015 MoHMS Succession Plan Report for 2016 Strategic Workforce Plan
c) Completion of the Workforce Survey (WS) Report for 2016 Strategic Workforce Plan.
d) Completion and endorsement of the 2015 Strategic Workforce Plan with all related attachments Succession Plan
and Learning & Development Plan.
e) Consolidation of the Final draft of the Human Resource for Health (HRH) Manual and it‟s submission to NHEC
for endorsement. Although the document has not been fully endorsed, the completion of the national
consultation through the divisions and completion of the draft submitted for NHEC endorsement within
specified time was a great achievement.
f) Revision, endorsement and implementation of the following Strategic Workforce Planning templates:
 Employee Satisfaction Survey
 Training Needs Analysis Surveys
 Strategic Workforce Plan
g) Completion of the revised Annual Performance Assessment (APA) for Ministry of Health & Medical Services
which incorporates the Technical and Clinical Competencies.
h) Completion and submission of the following Units WISN Report:
 Executive Support Unit
 Mental Health Unit
 National Vaccine Preventable Surveillance Project
 Typist Position – St. Giles Hospital
i) Conduct of (Human Resource Information System (HRIS) Online Training and roll out of HRIS to divisional
and major hospital facilities.

The Planning Process that started in January 2013 is proposed to continue until December, 2017 [5 years Plan].

Human Resource Information System

Achievements

 Leave data and other backlog of data entry completed under various modules in HRIS online system.
 Annual Performance Assessment module has been implemented in HRIS online where APA ratings are updated
in the system.
 HRIS Online User Guide developed and printed in April 2015 and distributed to users during training in the
Divisions and at Head Quarters.
 HRIS Online awareness was conducted in all Divisions in May, 2015 during HRH Workforce National
Workshop Series.
 Revised Performance Appraisal Template was made available to users through HRIS Online system.
 HRIS Online system was implemented at Divisional and Sub Divisional level.

Finance

The role of the accounts team is to monitor that goods and services are efficiently delivered on time as per the
budgetary provision.

The Unit‟s objectives include,

a) Ensure equitable budgetary distribution to the Divisions and Sub-divisions.

b) Proper management of budget allocation which is fundamental to ensuring value for money in delivering
services to the public as well as having cost effective internal controls within the purchasing and payments
system. This plays an important role to ensure that wastage of funds, over expenditure, misuse and corruption
does not happen.
c) Ensure Internal Control measures are in place, maintained and identified areas for improvements where
appropriate and recommendations designed to assist the Ministry in order to improve the system and
compliance with the Finance regulation.
d) Effective utilisation of the Financial Management Information System (FMIS).
e) To establish the Internal Audit team and processes at HQ, to cover areas in 3 main source of information:

45
 I. Examination of evidence on payments etc. - supporting the payments to ensure that the Finance manual
and other related regulation, process and procedures are complied with.
II. Review work performance and identify necessary changes to strengthen the unit‟s performance.
III. Interviewing personnel in order to confirm the functions and gain a holistic understanding of the
procedures and control of the system and identify general responsibilities and roles of individual within the
system.
IV. Having a job description for each position.

Achievements

 Budget preparation with the decentralization of the 2016 budget at cost centre.
 Opening up drawings account for Northern division.
 Budget increase for the Ministry for 2016.
 Minimizing customer complaints on payments.
 Managed to get Sahyadri trust fund on FMIS.
 Resolved Bulk Purchase Scheme – TMA trust issue from AFS.
 Improvement in revenue collection.

Asset Management Unit (AMU)

The Asset Management Unit looks after the management of non-technical physical assets for the Ministry of Health and
Medical Services from Procurement right through to the writing-off and disposal of assets.

Key stakeholders AMU works closely with include Ministry of Finance (Fiji Procurement Office), Ministry of Works,
Transport & Public Utilities, Ministry of Lands and Ministry of Industry & Trade.

Key Responsibilities include:

a) The AMU documents, registers, archives and monitoring of the physical assets of the Ministry nationwide.
b) Ensure that the acquisition of each physical asset is recorded with all relevant details in the fixed asset register.
c) Carry out Board of Survey procedures and inspections of assets on a regular basis.
d) Management of Quarters Issues
e) Management of Fleet
f) Infrastructure Maintenance Plan and Procurement Planning

Achievements

 Construction of New Ba Hospital project commenced.

 Construction of Makoi Maternity Unit commenced.
 Civil Works for New Naulu HC commenced.
 Major Maintenance works at Labasa Hospital, St Giles Hospital, Rakiraki SDH, Tavua SDH & Ba HC
commenced.
 Medical Gas Reticulation Upgrade at Rakiraki SDH completed.
 Commissioning of New Suction Machine at CWMH.
 Completed maintenance of various other Health Centres and Nursing Stations.
 New Cardiac Ambulance launched for CWMH.

46
10. Health Information Research and Analysis Division

The Health Information, Research and Analysis Division is responsible for providing policy advice and management
support to the Permanent Secretary for Health and Medical Services on the utilization of health data and information,
health research and analysis; management and development of information and communication technology for the
implementation of National Health Services Policies and Plan to ensure effective provision of health services throughout
Fiji through an established monitoring and evaluation framework.

The Division also assists the Corporate Services Division in management of Information Systems relating to Asset,
Finance and Human Resource Management; Public Health Division in disease surveillance and disaster management;
Health System Standards; and other operational divisions in maintaining standards, monitoring and evaluation of health
services; It plays a vital role in the compilation and analysis of health statistics and epidemiological data and
management of the information system (software) and also purchase and maintenance of computer hardware. It also
manages the entire computer network infrastructure of the Ministry together with all the servers and maintenance of
the Ministry‟s website.

2015 had been marked as a successful year for the Division with significant contribution to health systems strengthening.
Almost 85% of its overall performance targets were achieved as planned in the year 2015. Major contributions had
been in areas of Information, Service Delivery, Leadership and Governance, HR/Training and Technology investments.

Achievements

The DHIRA had been able to produce many outputs from its 2015 Business Plan that has been seen as achievements for
the unit as it has brought the results that it was intended for in strengthening Health Systems as described below:

HS 1.0 Leadership and Governance

Advocacy on Health Information Policy and critical role of information was made on various forums and meetings with
both internal and external stakeholders to ensure reliable, timely and accurate health information is used for decision
making. The Health Information Systems Strategic Plan 2012-2016 was reviewed and a new Clinical Information
Systems/Health Information Systems (CIS/HIS) Strategic Plan 2016 – 2020 was developed. National Health Information
Committee (NHIC) and National Civil Registration and Vital Statistics (CRVS) Committee were fully functional in
addressing national policy issues and rectification of challenges whilst also addressing strategic needs for Fiji around HIS
and CRVS.

HS 2.0 Finance
To address the Health Systems – Financing the unit conducted quarterly and bi-annual financial analysis and
demonstrated cost centre feasibility assessments to the National Budget Steering Committee. It also assisted in the
formulation of 2016 budget submission based on evidence of health information and service utilisation.

HS 3.0 Information

Objective: Strengthen the capture of relevant, reliable and timely health information
The Health Information Unit had compiled the information for the Annual Report 2014 together with the
review/update format, content and data interpretation in quarterly Health Information Bulletins based on regular
reporting from all routine information systems. It also updated and finalized the health information data flow mapping
based on manager input for all major reporting systems such as PATIS, CMRIS, NNDSS, Diabetes Notification, Cancer
Notification, MCDC and Hospital Returns. The unit also developed and updated the metadata (i.e., Performance
Indicator Reference Sheets) for 2015 ACP indicators and started the drafting the metadata for 2016 ACP indicators. To
ensure improvements in data quality Data Verification using the Audit Tool for PHIS was conducted at Facility Level,
PATIS data entry audits were carried out in Divisional Hospitals and numerous supervisory visits were made across the
country to ensure reporting standards were maintained. To further strengthen this the unit would collate, compile and
analyse and provide feedback for reports (PATIS, CMRIS, Hospital Returns, NNDSS, MCDC) to respective facilities on a
regular basis. Also Implemented an integrated disease notification surveillance system at all levels, with defined
frequency. Maintain ICD morbidity and mortality coding in compliance with the WHO Family of International
Classifications (WHO-FIC) standards. Developed plans and procedure to ensure all HIS sub-systems are standards-based
to promote interoperability can support a national health observatory or dashboard.

47
Health Information Dissemination and Use

Production of quarterly and annual HIS reports to meet the needs of the intended audience. Provision of health data
based on requests from existing data sources.

Data Request received 167

Completed 140
Verification 1
Relevant documents not provided 20
Cancel 6

Health Information Strengthening through training

Various training were conducted throughout the year for PATIS, PHIS, LIMS, HRIS, CMRIS, NNDSS, CAN REG and DM
Notification Form training. One of the key training was for the doctors on cause of death training to improve vital
statistics.

Conduct Cause of Death Trainings per quarter on targeted facilities

Facility & Date Total Trained Division

MoHMS Conference Room - 24th July 11 Central – 3, Western – 5, Northern – 2, Eastern - 1
Lautoka Hospital – 23rd – 25th September 60 Western [For Lautoka Hospital only]
Labasa Hospital – 4th November 18 Northern [For Labasa Hospital only]
TOTAL 89

Objective: Strengthen and sustain eHealth foundations to improve the ICT workforce, infrastructure, services and
applications
Information Communication and Technology Unit established further govnet connections to health facilities to enable
access to email, internet, intranet and also various Health Information Systems such as PATIS, CMRIS, HRIS, LIMS, etc.

Connectivity Update:

Accessibili
Division Sub Division Accessibility Division Sub Division
ty
Suva Subdivision Accessible Cakaudrove Sub-Division Accessible
Navua Hospital has no
Serua/Namosi connectivity
Macuata Subdivision Accessible
Subdivision but Navua HC already
on Govnet. Northern
Central Rewa
Accessible Taveuni Subdivision Accessible
Subdivision
Tailevu
Accessible Bua Subdivision Accessible
Subdivision
Naitasiri Nadroga/ Navosa
Accessible Accessible
Subdivision Subdivision
Levuka Hospital is on
Lomaiviti Govnet.
Nadi Subdivision Accessible
Subdivision but Levuka HC has no
connectivity Western
Eastern Kadavu
Accessible Ba Subdivision Accessible
Subdivision
Lakeba Inaccessible(Planned for
Tavua Subdivision Accessible
Subdivision 2016)
Lomaloma Inaccessible(Due to Ra Subdivision Accessible
48
 Subdivision unstable power supply
issues)
Rotuma
Accessible Lautoka/Yasawa Subdivision Accessible
Subdivision

The ICT Unit also developed Disaster Recovery Plan and review licensing of all software to ensure compliance and
concurrency. Standards on all applications were developed for easy data migrations/merging /reporting. Improvements
were made on PATIS online functionality and use with additional modules added to capture medical reports online
with better reporting features. LIMS was expanded to Lautoka hospital to allow all three Divisional hospitals to provide
digital test results on PATIS automatically. The Public Health Information Systems (PHIS) was reviewed and enhanced
were made to better collate births and maternal and child health information from both health centres and hospitals.
The unit also supports and maintains health social media (website: www.health.gov.fj, Facebook
www.facebook.com/FijiMoH and local shared drives). It has also conducted basic IT Training to Health Users. National
Data Repository Portal went live http://www.health.gov.fj/fijindr/index.php/home to strengthen research and
information use. Registration of eligible individuals for the Free Medicine Program had been carried out by the unit as
well. Over 7000 people had been registered in the program so far.

Objective: Strengthen health research (including system research and operational research) capacity, production and
use.

The Research unit was able to institutionalise knowledge management through establishment of a searchable repository
of all survey, research and statistical reports and consolidate HIS-relevant data from health areas and programmes using
the National Data Repository. Training was conducted based on needs analysis for analytical and research skills for
capacity development of staff. Reviewed procedures for approval of health-related research by the Fiji National
Research and Ethics Review Committee (FNRERC) for adherence to ethical standards, and for the National Health
Research Committee (NHRC) to advice on the technical soundness of health research conducted in the country. The
Research unit trained sixteen (16) Divisional Research Coordinators on ME Research Fundamentals of the three (3)
Divisions to be the arm of research at divisional level. One issue of the Volume 4 of the Fiji Journal of Public Health
(FJPH) was published with the respective theme – Environmental Health and Climate Change in December 2015. Eight
Published Researches were received on the portal. www.health.gov.fj/fijihrp Online Research Portal regularly updated.
Total Proposal Submitted in Jan-Dec 2015 – 99; Total approved: 62; Total Ongoing - 99; Total Completed: 3 (these
are completed studies and submitted study reports). FNHRERC meeting – nine (9) Full (Ethics) Committee meetings
held from twelve (12) meetings scheduled for the year 2015.

Objective: Strengthen M&E capacity, processes, systems, and tools at the national, divisional, and sub-divisional levels.

The Monitoring and Evaluation unit of the Division also had a successful year. Monitoring and Evaluation Technical
Team (METT) and Resource Network Terms of Reference was reviewed and updated. National meeting for M&E
Resource Network facilitators was held with the launch of M&E facilitators guides. Simple M&E self-assessment tool to
monitor M&E progress and needs in the MoHMS annually was developed and applied. Technical and logistical support
was provided to Resource Network members to provide M&E guidance to their units. Standard reporting template for
use in quarterly Divisional Plus meetings (for both clinical and public health content) was developed and implemented.
Standard observation sheet to monitor presentation of data and data use for decision-making in quarterly Divisional
Plus meetings was developed and implemented. M&E Resource Network Facilitator‟s Guide modules for core M&E
training content was created published and launched including training (44 out of 45 reporting units established with
fully trained M&E personnel). METT responsibilities into relevant Position Descriptions (public health and hospital
managers) were incorporate to further strengthen and institutionalise it. Compilation and submission of ICO report and
RDSSED report was done in a timely manner.

49
 Figure 3: ICO Performance trend 2011-2015

PM's Office Performance Assessments for MoHMS

100.00
Percentage Rating

80.00

60.00

40.00

20.00

0.00
Q1 Q2 Q3 Q4
2011 77.20 83.08 82.34 88.48
2012 69.27 80.75 87.40 90.47
2013 68.40 82.94 77.99 94.46
2014 73.40 83.85 94.56 95.27
2015 72.12 81.84 88.11 96.05

HS 4.0 HR / Training
Staff performance assessment and capacity building were carried out throughout the year through internal (in-service)
and external training and workshops. Human Resource Information Systems (HRIS) was strengthened to improve
records for all health workers in the Ministry. Additional Staff were recruited as project officers to cater for increasing
demands in the Division such as clinical coder, mortality data entry clerks, ICT Officers (4), Free Medicine Project
Officers and PATIS Product Manager.

HS 5.0 Service Delivery

Technical assistance and support were provided to HR team in the development of online surveys (Qualtrics) and also
to DLO during Health Emergencies and Disasters.

HS 6.0 Medicines, Consumables, Drugs, Infrastructure and Technology

Out of stock report for Supply Chain improvement were produced and provided to FPBS on a monthly basis to aid in
better forecasting and procurement.

Challenges

Despite having contributed significantly towards the Annual Corporate Plan 2015 of the Ministry, the Division went
through many challenges and constraints in its implementation of the Business Plan 2015. These had been due to limited
budget, human resources constraints, availability of key stakeholders whilst others were due to external factors and
procedures/processes in the Government machinery. Some of the projects that had been carried forward to 2016 due to
these are:

Health Information (Collaboration and Coordination with both internal and external stakeholder challenge)

1. Review Medical Records Policy (retention, archival, disposal; align registers to current international practice
and legal requirements)
2. Develop guidelines and implementation plans to address breaches in HI policy
3. Develop private and public health facility listings with service availability mappings for diverse diseases and
combine into a single register or inventory, using standardised facility codes and accurate GIS coordinates

50
Monitoring & Evaluation (Internal stakeholders, human resources and budget constraints)

4. Develop/update metadata (i.e., PIRS) for 2016-2020 Nat‟l Strategic Plan indicators to ensure annual monitoring
5. Develop Supervisory Visit Tool for Hospitals

Research (Collaboration and Coordination with both internal and external stakeholder challenge)

6. Research priorities for NSP 2016-2020, to be input into Health Information Strategic Plan
7. Prepare/update 10-year prospective matrix of national surveys to be conducted to meet MoHMS data needs

ICT (Collaboration and Coordination with external stakeholder challenge and budget constraints)

8. Design and establish a national ehealth governing council (ITC, MOH, Donors, PMs Office)
9. Implementation of Warehouse Management System
10. Provide technical guidance and assistance in the implementation of PACS/RIS for Radiology Unit
11. Provide technical assistance in the scoping of the Medical Supplies Information System

Other generic challenges that affected routine work were failure of reporting units submitting their reports on time, lack
of enthusiasm and initiative from supervisors for monitoring, evaluating and learning from evidence to make necessary
changes to routine work to make a difference. Most times the focus is on compliance as opposed to results and impacts
of program implementation.

Launch of Monitoring and Evaluation Manuals

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11. Planning and Policy Development Unit (PPDU)

The unit is responsible for coordinating the development, formulation and documentation of MoHMS Policies, the
National Health Accounts, Donor Coordination, Department plans, and medium to term strategies in alignment with
the MoHMS long term mission and vision.

PPDU is responsible for an inclusive planning process of national plans and strategies and ensure coherent
implementation of the national strategy and a proactive approach towards the coordination of all health partners and
external donors of the health sector in Fiji.

The main areas of work of the Unit can be characterized as follows,

a) Planning
b) Policy
c) Health Care Financing

Planning

The core responsibility of the Planning unit is development of National Health Strategic Plan for 5 years through a
systematic process that takes into consideration ideas, thoughts and priorities of all levels of health workers, national,
regional and international priorities. Coordinate and facilitates various activities in formulating the Annual Corporate
Plan of the Ministry. Review and develop health services planning for divisions in Fiji in order identify services gap in
different divisions and formulate necessary financial requirements for the provision of adequate HR, technologies and
equipment and infrastructures. To continuously monitor and evaluate business plan quarterly reports and make
recommendations based on results.

As reflected in the PPDU 2015 Business Plan (BP) some of the key achievements were:

a) The compilation and publication of the Ministry of Health and Medical Services Annual Report 2014.
b) The production of Ministry of Health and Medical Services National Strategic Plan 2016-2020 after various
consultations with internal and external stakeholders.
c) The MoHMS National Strategic Plan 2016-2020 was launched by the Hon. Minister for Health and Medical
Services Mr Jone Usamate on 16th December 2015.
d) MoHMS Annual Corporate Plan 2016 was developed after various consultations with respective Senior
Managers. ACP 2016 planning consultation began in September 2016 and two workshops were held to finalize
the ACP 2016, one was on the 16th of September and another on the 21st of October.

Policy

The Policy Unit is responsible for the technical support, initiation, coordination, monitoring and evaluation, of health
policies having an impact on health care delivery and preventive service delivery in all facilities under the Ministry. The
Director oversee the policy planning and development cycle through empowering and delegating required actions and
stages of policy development cycle with the assistance of Senior Administrative Officer. The unit provides secretariat
support to Health Policy Technical Support Group (HPTSG) Meetings and coordinates Stakeholders consultation.
The Unit constantly played a supportive and secretariat role to the major conventions and consultations either with
internal or National policies.

Policies Developed and endorsed include:

1. National Management of the deceased at hospital facility

2. National Oral Health Policy
3. Mental Health and Suicide Prevention Policy
4. Community Health Worker Policy
5. Paediatric Oncology Policy
6. National Acute Rheumatic and Rheumatic Heart Diseases
7. National Wellness Policy
8. Standardisation of Laboratory Clinical Services Policy
9. National Ambulance Policy

52
Health Care Financing

The healthcare Financing Unit (HCF) within the Policy Planning and Development Division (PPDD) is responsible to
coordinate monitoring of resource flow through production of National Health Accounts, writing of policy briefs from
the NHA finds and recommendations, provide secretarial support for the National Budget Steering Committee meetings
and sub-committees for budget management, evaluation and analysis of capital projects and its timely reporting to
central agencies, conducting costing studies as and when required for possible outsourcing or Public Private Partnership
(PPP) and provide local counterpart support to research institutions for undertaking health financing studies or analysis.

Some of the major achievements for the unit were:

a) Obtaining increases in the operational budget through the monitoring and evaluation of budget management
using expenditure trends and forecast,
b) Regular monitoring of capital projects by measuring the actual utilization of funds and the reporting of physical
progress which resulted in improvement in implementation,
c) The production of 2011-2014 National Health Accounts time series report using SHA 2011 guideline,
d) The successfully completion of the Sustainable Healthcare financing in Fiji and Timor-Leste (SHIFT) Study
project,
e) Cost analysis for Chronic haemodialysis treatment (CHT),
f) Cost Analysis for Coronary Artery Bypass Grafting (CABG) and
g) Successful coordination of development partners meeting

53
12. The Nursing Division
The Division of Nursing is responsible for the planning, development, coordination, monitoring and evaluation of
nursing standards, policies, and guidelines and protocols.
The objectives of nursing as a service, a profession and a practice is to provide quality nursing care via the overarching
provision of nursing technical support mechanism for quality curative and preventative health care in Fiji Health
System.

Nursing is managed in a 3 facet structure which includes clinical/curative, public health and basic specialization nursing
covering midwifery, advanced nursing practice (NP), mental health, TB and Leprosy. Nursing in the three (3) divisional
hospitals [CWM/Lautoka/Labasa] including St. Giles Hospital are managed by Manager Nursings whilst the four
divisions [Central/Western/Northern/Eastern] are managed by the four (4) Divisional Health Sisters. The other specialist
hospital [Tamavua/Twomey] is headed by the Sister In-charge.

Achievements

1. Completion of the development of the Nursing Regulations of the Nursing Decree 2011.
2. Development of the Nursing Internship Log Book. This will be used for the new cohort of Bachelor in Nursing
graduates in January 2016.
3. Another new cohort of 200 nursing graduates had joined the nursing fraternity thus totalling the nursing
establishment to 2800 (200 new additional nursing posts).
4. Work in Progress on the development of the Scope of Practice for Registered Midwives.
5. Overseas attachment for nurses in various specialization in Australia, New Zealand with in-service trainings in
Japan, Thailand continued to be facilitated via invitations and sponsorship from countries and donor partners.
6. Formal Postgraduate nursing trainings continued to be offered through Fiji National University and TISI Sangam
College of Nursing (PG Diploma in Midwifery, Advanced Diploma in Nursing Practice for Nurse Practitioners,
Postgraduate Certificate in Mental Health, and Postgraduate Diploma in Nursing Management).
7. Tripartite Forum between Ministry of Health & Medical Services, Fiji Nursing Association and Fiji Nursing
Council continue to meet every quarter to address nursing issues.
8. Retired Midwives were engaged by UNFPA to assist health service delivery in Vanuatu after the effects of
Cyclone Pam. 3 Cohorts of 10 were engaged for a month duration.
9. Another cohort of 8 nurses were engaged as part of the Medical Team deployed to Golan Heights under the
RFMF Regiment.
10. Uptake and compliance in renewal of Annual Practising License had seen noteworthy improvement in 2015
with only 14 non-compliant and were suspended.
11. In-services Training packages continued to be offered by the Fiji College of Nursing to assist nurses to gain their
20 CPD points which is the requirement for the renewal of the Annual Practising License.
12. First ever National Nursing Scientific Symposium themed „Embracing and Enhancing Research – a way forward
to improving nursing practice‟ was convened at the Pearl Fiji Resort on 19th & 20th November 2015 which saw
approximately over 150 nurses attending. This 2 days symposium covered 20 Continuing Professional Points
(CPD) and had seen some of our locally trained nurses who held nurse specialist positions off shore invited as
guest presenters including the Chief Nurse of the Kingdom of Tonga, Dr Amelia Afuha‟amango as one of the
keynote speakers.
13. 3 days Refresher training for Nurse Practitioners organised at the Pearl Fiji Resort in a back to back arrangement
with the National Nursing Scientific Symposium on from 16th -18th November 2015.

Challenges

a) Limited resources in implementing the Nursing plans.

b) High demand for an increase in nursing workforce at operational level which is further compounded with the
development of new clinical services, the extension of hours in Primary Health facilities, establishment of new
health facilities etc.

54
Way forward

1. Review of existing nursing structure to create top level positions.

2. Improve staffing distribution to allow better response to population health and health service needs.
3. Create specialist nursing cadre and its appropriate structure.
4. Work with the nursing education institutions in the development of nursing specialization curriculum.
5. Address nursing practice, attitude and competence gaps in nursing young workforce.
6. Fiji College of Nursing to offer more structured in-service trainings that will address nursing leadership,
management and clinical specialization.
7. Solicit support for more scholarships for nursing post graduate trainings.
8. Creation of higher nursing positions to improve supervision, and ease of responsibilities and accountability in
nursing practice.
9. Development of new nursing policies, standards and guidelines to improve practice and review existing ones
that needs it.
10. Working conditions for nurses to be reviewed to include nursing specialization remuneration package
proposals.

International Midwifery day celebration on May 5th. This event was fully funded by the UN Agency. The event was also marked by
workshop for the Midwives.

55
13. Development Partner Assistance

Development partners and international organisations provide financial and technical assistance to Ministry of Health
and Medical Services to deliver its mandate responsibilities.

Fiji Health Sector Support Program (FHSSP)

The Fiji Health Sector Support Program is a 5 year program of Australian government assistance to the Fiji Ministry of
Health and Medical Services. The goal of the Fiji Health Sector Support Program is to remain engaged in the Fiji health
sector by contributing to the Fiji MoHMS‟s efforts to achieve its higher level strategic objectives in relation to reducing
infant mortality (MDG4), improving maternal health (MDG5) and prevention and management of diabetes, as outlined
in the MOH‟s Strategic Plan (2011 – 2015). The total funding is 33million Australian dollars (AUD) over 5 years from
July 2011 to June 2016. The program is managed by Abt JTA on behalf of the Australian government.

The objectives of the Fiji Health Sector Support Program are:

1. To institutionalise a safe motherhood program throughout Fiji at decentralized level;

2. To strengthen infant immunisation and care and the management of childhood illnesses and thus institutionalise
a “healthy child” program throughout Fiji;
3. To improve prevention and management of diabetes and cervical cancer at decentralised levels;
4. To revitalise an effective and sustainable network of village/community health workers as the first point of
contact with the health system for people at community level; and
5. To strengthen key components of the health system to support decentralised service delivery.

Achievements

 The antenatal care flipchart The Road to Safe Motherhood was piloted in the Northern and Western divisions
covering eight medical areas.
 Latest Mother Safe Hospital Initiative (MSHI) audit results showed great improvements in reporting, newborn
care and postpartum care. Of note was the significant improvement seen at Nadi Hospital, having scored 50%
adherence to MSHI standards in Q2 2014 it increased to 92% in Q4 2015, meaning it is now „fully functional‟
against 11 of the 12 standards. Sigatoka and Lautoka hospitals both improved from a divisional average of 69%
in Q2 2015 to 83% adherence in Q4 2015.
 100% of targeted facilities now have adequately trained doctors and nurses trained in EmONC.
 83% of targeted facilities now have doctors and nurses who are adequately trained in birth preparedness
planning and complication readiness planning.
 Procurement of pneumococcal and rotavirus vaccines was fully transitioned to MoHMS in 2016.
 Preliminary rotavirus vaccine impact results show a 60% reduction in the incidence rate of rotavirus admissions,
and a 17% reduction in the incidence rate of overall diarrhoea admissions at CWMH in children under five
years of age.
 90% of target facilities have 60% of nurses trained in IMCI (up from 46%).
 From January-December 2015, a total of 153 doctors and nurses were trained in PLS with FHSSP funding (93%
of our annual target). 83 of these were trained between July and December 2015.
 35% of staff in targeted facilities trained on the Wellness Promotion Manual including motivational
interviewing.
 90% of targeted public health nurses in targeted facilities have been trained on „inspect and protect‟ package
for diabetic foot care.
 Procurement of human papillomavirus vaccine fully transitioned to MoHMS in 2016.
 69 nurses trained on cervical cancer screening methods, and 15 laboratory staff trained in cytology and cervical
cancer registration.
 92% of active CHWs trained in the core competencies module.
 67% of active CHWs trained in safe motherhood module.
 59% of active CHWs trained in healthy child module.
 46% of active CHWs trained in wellness module.

56
  Prioritised PHIS Review recommendations around changes to MCH data were completed in time for 2016.
Refresher training in CMRIS and the revisions provided to 84 MoHMS staff.
 Refresher Training was conducted in all three divisional hospitals on the Admission-Transfer-Discharge module
and Pregnancy & Birth. 71 staff were trained in the ATD Module and 42 staff trained in the Pregnancy and Birth
Module.
 Sixty-five M&E Resource Network Facilitators were trained on M&E Fundamentals, bringing the national total
to 196. The M&E Facilitators Guide is being used by these facilitators when coaching their units on planning,
implementation and analysis of data from all relevant data sources for their respective MoHMS units.
 The Workload Indicator of Staffing Need (WISN) assessment tool was updated to support budgeted workforce
projection analysis for the 2016 budget submission.
 The School Heath Policy has been drafted in consultation with the Ministry of Education and is focussed on the
NCD crisis by addressing NCD related diseases in school children.

Donation of medical equipment from Australian Aid to Paediatrics CWMH

Grant Management Unit (GMU)

The Global Fund (GF) grant supports the Ministry of Health on strengthening of health systems and the control of
tuberculosis (TB) in Fiji Islands. The Ministry of Health has set up the Grant Management Unit to manage grant
implementation, coordination and reporting of the GF grant.

The GMU goals are:

1) To reduce the burden of TB in Fiji (target; 20/100,000 population in 2015).

2) To achieve improved TB and HIV/AIDS outcomes through strengthening the capacity of the health system to
deliver services.
3) To strengthen the health system by means of improving the production, management and use of information.

The GMU objectives are:

1) To improve high quality DOTS in all provinces with increased case detection and high treatment success.
2) To address TB in high risk groups and underserved populations, TB-HIV and MDR-TB.
3) To engage and empower all health care providers and communities to control TB.
4) To strengthen the quality of laboratory services and procurement supply management.
5) To strengthen the organisational capacity of the Principal Recipient (MoHMS).
6) To improve data quality and management of information.

57
Achievements

 Signing of grant agreement between Government of Fiji and GF for the period of 1 July 2015 to 31 December
2017 of USD$4,445,477.
 Creation of separate budget line in the national budget for 2016 presented in 2015; separate allocation for
Tamavua/Twomey Hospital.
 Strategic screening in HRGs has increased (particularly for contacts & HIV). Even though the number fell in Q4,
the average for Q3 & Q4 is still high compared to NCE period.
 Use of new technology in TB laboratories (Gene Xpert; BDMGIT) has contributed to increase in
bacteriologically confirmed cases – both Pulmonary & Extra-pulmonary cases.
 The diagnosis of cases have improved; although the NTP have not achieved the target of 384 for 2015 (actual –
377); the number of cases is still increasing but those registered are now Real TB cases – due to increases in
bacteriologically confirmed cases.

Challenges

 Delay in recruitment process for new staff at National Staff Board level.
 Procurement process for tender items – Fiji Procurement Office tender board delay meeting due to non-
attendance of members thus causing delay in approval of tenders and procurement of items or services and
delays in technical specification submissions by NTP.
 Delay in disbursement of grant funds from Ministry of Finance which affect implementation of plan. GF
disbursed funds on 18 August 2015 however fund were disbursed to GMU on 18 November 2015.
 Distribution of screening activities very low especially in the Western Division shows the different capacities to
screen.
 Transfer of knowledge to Public Health (Diabetes Programmes) to conduct TB screening activities.
 TB-HIV collaboration needs to be strengthened – fluctuations in TB screening in Hubs and IPT uptake.
 Closure of Tagimoucia Ward (TB Ward) in Lautoka Hospital that affects treatment outcome (only 2 isolation
beds in Medical ward; 1 Male & 1 Female).

Way forward

 Improve recruitment process for new staff. National Staff board to improve decision making process.
 Improve procurement process for tender items – Fiji Procurement Office tender board plan tender meetings
regularly and ensure members attend.
 Ministry of Finance should follow the 10 working days RIE process when funds are disbursed from overseas
funding agents it is received by the recipient within agreed timeframe.
 Seamless connections with both clinical and public health in continuum of care
 Strengthen public health network - transfer of knowledge to Public Health (Diabetes Programmes) to conduct
TB screening activities.
 TB-HIV collaboration needs to be strengthened – fluctuations in TB screening in Hubs and IPT uptake.
 Management of Co-Morbid cases to be strengthened – increase stay in hospital and closer monitoring in the
community.

58
14. Health Outcome Performance Report 2015
Non Communicable Disease

Diabetes

Figure 4: Diabetes Cases by Age Group 2015

Incidence of DM (from Notification forms)

140 25.0

120
20.0

x 100000 population
100
15.0
Numbers

80

60 10.0
40
5.0
20

0 0.0
1-4 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Cases (n) 2 3 3 6 25 39 61 107 120 113 64 38 30
IR 1.4 1.6 1.6 2.1 5.1 7.3 10.8 18.0 20.1 19.0 11.2 7.1 5.9
Source: Diabetes Notification Forms, 2015

The above graphs shows that those in the 45-70yrs and above age groups were most afflicted [new cases] by Diabetes. However,
there is significant underreporting on the DM notification forms. It was noted that male had aquired diabetes at an early age
of 1-19 years age group. The denominatior used is the total of forms received from the facilities.

Table 13: Diabetes Cases by Facility 2015

Proportion (%) of
Sub Division Reporting by Facility Grand Total (# of patients notified) DM forms received
per Sub Division
Ba Balevuto Health Centre 9 4
Nailaga Health Centre 17
Bua Lekutu Health Centre 1 3
Nabouwalu Hospital 17
Cakaudrove Savusavu Hospital 31 5
Tukavesi Health Centre 2
Lakeba Lakeba Hospital 7 1
Lautoka Lautoka Diabetic Hub 68
13
Lautoka Hospital 1
Natabua Health Centre 11
Lomaiviti Levuka Hospital 4 1
Qarani Health Center 2
Lomaloma Lomaloma Hospital 6 1
Macuata Dreketi Health Centre 10
Labasa Diabetic Hub 58 12
Naduri Health Centre 1
Wainikoro Health Centre 2

59
Nadi Nadi Hospital 245 40
Namaka Health Centre 3
Nadroga/Navosa Korolevu Health Centre 1 2
Lomawai Health Centre 13
Serua/Namosi Namuamua Health Centre 1 5
Navua Hospital 33
Ra Rakiraki Hospital 5 1
Rewa Wainibokasi Health Centre 2 0
Suva CWMH 5
Makoi Health Centre 12
National Diabetic Hub, Suva 21 8
Samabula Health Centre 1
Tamavua Twomey 1
Valelevu Health Centre 7
Tavua Tavua Hospital 21 3
Grand Total 618 100

Source: Diabetes Notification Forms, 2015

The table above shows the proportion of DM notification received from the facilities. There were a total of 618 diabetic
notifications received nationally compared to 609 cases for 2014 resulted to an increase by 1.5% in 2015. The vast
majority of the new cases were reported from Nadi Hospital, Lautoka Diabetic Hub, and Labasa Diabetic Hub Centre.
This may be due to good reporting from these facilities.

Figure 5: New Diabetes Cases (Incidence) by Gender and Age Group 2015

Proportion of New Diabetes Cases (%) by Gender, 2015

39%

F M
61%

Source: Diabetes Notification Forms, 2015

The above pie chart shows the proportion for incidence of new diabetic cases. It clearly indicates that more female
(374 cases) are diagnosed with diabetes than male (244) in 2015. The total number of DM received is 618 and female
composed of 61% comapred to male with 39%. In an overal context, DM notification is still under reported as
proportion calculation is based on the number of DM notification received at HIU.

60
Cancer

Table 14: Top 5 Leading Cancer Sites by Sex and proportion distributions, Fiji

Male Cases 2015 % Female Cases 2015. %

Prostate gland 49 11 Breast, NOS 270 28
Liver 36 8 Cervix uteri 221 23
Lung, NOS 25 6 Endometrium 64 7
Unknown primary site 21 5 Ovary 37 4
Colon, NOS 20 5 Unknown primary site 28 3
All Sites 435 100 All Sites 951 100
Source: Cancer Registry 2015

The leading causes of cancer in females are breast and cervical cancer followed by endometrial cancer. The leading
cancer in males are cancer of the prostate glands, liver and lungs.

Table 15: Age Specific and Age Standardized Rates of all cancer sites per 100,000 population by age group, by
World Standard Population 2000 – 2025 (direct standardization)

WHO Standard
Age groups Cases FBOS Pop Age Specific Rate Age Standard Rate
Pop weight
1-4 5 87,233 5.7 0.09 0.51
5-9 8 87,958 9.1 0.09 0.79
10-14 8 77,539 10.3 0.09 0.89
15-19 14 76,094 18.4 0.08 1.56
20-24 25 72,967 34.3 0.08 2.82
25-29 42 67,321 62.4 0.08 4.95
30-34 63 66,470 94.8 0.08 7.21
35-39 79 59,976 131.7 0.07 9.41
40-44 86 52,703 163.2 0.07 10.75
45-49 129 50,191 257.0 0.06 15.52
50-54 153 48,931 312.7 0.05 16.79
55-59 203 40,556 500.5 0.05 22.77
60-64 162 30,198 536.5 0.04 19.95
65-69 140 21,883 639.8 0.03 18.93
70+ 268 28,512 940.0 0.05 49.57
All Ages 1386 868,532 159.6 1 182.39

Source: Cancer Registry 2015

The table above shows the age specific and age standardised rates per 100,000 population. It is calculated using the
WHO standard population and re-weighted by 1.

61
Cardiovascular

Figure 6: Leading 3 Cardiovascular Disease Conditions

Top 3 Cardiovascular Diseases Conditions for 2015

14.0 12.3
Rates per 1000 Admissions

12.0
10.0
8.0 6.4 6.0
6.0
4.0
2.0
0.0
Cardiomegaly Cardiovascular disease, Heart failure
unspecified
Diseases

Source: PATISplus (Clinical Performance Management Report)

The most common cardiovascular diseases in 2015 included Cardiomegaly (ICD 10 AM code I51.7), Cardiovascular
Disease unspecified (ICD 10 AM code I51.6), and Heart Failure (ICD 10 AM code I50.0 – I50.9)

Communicable Diseases

Typhoid

Figure 7: Typhoid Cases for 2015 by Month

Source: Laboratory confirmed Data from Mataika House and NNDSS

There is high number of typhoid fever cases received through NNDSS data compared to Mataika house lab data as
NNDSS captures the clinically suspected cases whereas lab data consists of only lab confirmed cases.

62
Dengue

Figure 8: Dengue Cases for 2015 by Month

Source: Laboratory confirmed Data from Mataika House and NNDSS

There is an increase in cases since the beginning of the year until July as this was the period the outbreak was declared.
The NNDSS cases are high as it reports the clinical and the suspected cases whereas lab only reports the confirmed cases
(or lab positive cases).

Leptospirosis

Figure 9: Leptospirosis Cases for 2015 by Month

Source: Laboratory confirmed Data from Mataika House and NNDSS

There was no testing conducted in the month of October for the Lab data due to the stock out. The NNDSS data is
lower than lab clinical diagnosis as diagnosis for leptospirosis is often challenging and cases are more than often
identified through laboratory tests.

63
HIV

Figure 10: New HIV Cases 1989- Sept 2015

HIV New cases from 1989 to September 2015

70 8.0

7.0
60

6.0
50

5.0
40
New Cases

4.0

30
3.0

20
2.0

10
1.0

0 0.0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Cases 5 2 3 4 6 5 6 4 4 6 11 14 16 25 32 36 24 15 40 31 43 33 53 62 64 64 37
Incidence 0.7 0.3 0.4 0.5 0.7 0.6 0.7 0.5 0.5 0.7 1.3 1.6 1.9 2.9 3.7 4.2 2.8 1.7 4.6 3.5 4.9 3.7 5.9 6.9 7.0 7.0 7.0

HIV incidence has increased over the last 25 years from 0.7 to 7 per 100 000 population. This may be due to better
diagnostics, better reporting and also may be a true increase in the number of cases.

Tuberculosis

Figure 11: Number of TB Cases (TB Notification)

CNR (ALL FORMS OF TB) 2001-2015

45
40
35
NUMBER OF TB CASES

30
25
20 41.7
34
15
23 23 22 25 24
10 18 18 16 16 14 17
5 11 13
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
YEAR

Source: National TB Program, 2015

64
In 2015, 362 cases of Tuberculosis (All forms) bacteriologically confirmed and clinically diagnosed was notified to the
National TB Program. This represented 22 cases less than those reported in 2014.
The case notification rate stood at 41.7 per 100,000 population (All forms of TB, population estimate Fiji Bureau of
Statistics, 2015)

The period 2010 to 2015 demonstrated steep increase in TB case notification rates and correlates with increased
programmatic funding through the GFATM

Figure 12: TB Case Detection Rate 2015

TB CASE DETECTION RATE (%), ALL FORMS OF TB, 2015

120

100
CASE DETECTION RATE (%)

80

60

92 99
83 90
40 75 79
71 69 74 67 66
58 56 60 63
50
20

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
YEAR

Source: National TB Program, 2015

In 2015, TB case detection rate was 63% (All forms of TB) high and erratic case detection in the past represent revisions
in TB burden estimates by WHO at the request of the program.

Figure 13: New Sputum Smear Positive TB – Treatment Success Rate

Treatment Success rate (1998-1013: Sputum Smear Positives, 2014: All forms of TB &
bacteriological confirmed) Fiji
100 100
90 94 93 93 90
90
85 85 86 85 86
80 78 80
75
70 71 70
66 67
Rate (%)

60 60
50 50
40 40
30 30
20 20
10 10
0 0
1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
Year

New ss+ treatment success (%) All forms Bacteriologically confirmed

Source: National TB Program, 2015

Prior to 2014, the National TB program assessed and reported treatment success rate (TSR) among the cohort of
sputum smear positives. In 2015, with the NTP adopting the new definitions for TB, TSR was measured among all forms

65
of TB as well as the bacteriologically confirmed TB cohorts. In 2015, the TSR for all forms of TB was 87% and for
bacteriologically confirmed TB cases was 86% (The targeted TSR being > 85%) The NTP will be responsible for
maintain this TSR.

Figure 14: Treatment Success Rate among bacteriologically confirmed cases

Treatment Outcome for Bacteriologically confirmed cases, Fiji, 2015

TO
Treatment Outcome

Not evaluated
Died
Lost to follow up
TC
Cured

0 20 40 60 80 100 120
Number of bacterial confirmed cases

PTB BC EPTB BC

National TB Program, 2015

The Treatment Success rate (TSR) for bacteriologically confirmed cases in 2014 was 86%. (100/116) of which PTB
accounted for 98% of cases. Of the 16 cases that did not have a successful outcome 12 cases died (11 PTB and 1 EPTB).
Additionally, 3 cases were lost to follow up and 1 not evaluated. The biggest contributing reason for poor outcome was
death, which the program will have to address in the future.

Figure 15: TB in children

CHILDHOOD TB CASES (0-14 YEARS) FIJI, 2000 TO 2015 (AND AS A

PERCENTAGE OF TOTAL TB CASES)
90
80
70
NUMBER OF CASES

60
50 63
40
47
30
20 17 23 20 21 26
14 16
11 14
10 7 6 7 17
10 10 11 12 8 5 7 3 11 10 10 13
0 4 6
5 3 5
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
YEAR

%of total TB cases No. of children with TB

National TB Program, 2015

In 2015, childhood cases of TB (0-14 years) accounted for 17% (n. 63) of all TB cases. This represent an increase
over the past few years.

66
Maternal Child Health

Figure 16: Under 5 Mortality Rate for Fiji 2000-2015

Under 5 mortality rate for Fiji, 2000 - 2015

Under 5 mortality rate (per 1000

30
25
20
livebirths)

15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Child mortality rate MDG Target

years

Source: Medical Cause of Death Certificate, 2000 – 2015, Ministry of Health,

There has been a fairly large reduction in the child mortality rate from the year 2000 but the MDG target has yet to be
achieved. However, it is important to note that the MDG target may not be the best indicator for small island countries
like Fiji due to the small population size.

Figure 16 (i): Maternal Mortality Ratio for Fiji 2000-2015

Maternal Mortality 2000 - 2015

70
numbers & rates of maternal deaths

60

50

40

30

20

10

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
number 10 7 6 13 11 14 10 6 6 5 5 8 12 4 9 6
rate 34.6 29.03 23.5 22.3 33.9 50.5 43.5 31.1 31.7 26.5 22.6 39.2 59.47 19.07 44.4 29.3
MDG target 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8 6.8

Source: Medical Cause of Death Certificate, 2000 – 2015, Ministry of Health,

The MMR (per 100,000 live births) continues to be elusive of the MDG target; as developing countries like Fiji with
small populations have large variations in the MMR with even a minute number of maternal deaths. There is a decrease
of MMR from 44.4 in 2014 to 29.3 in 2015. The SDG targets Goal 3 is ensuring healthy lives and promote well-being
for all at all ages. It is aimed by 2030 to reduce the global MMR to less than 70 per 100,000 live births.

67
 Figure 16 (ii): Maternal Mortality Rate Rolling Average of 3 years

Maternal Mortality Rate Rolling Average of 3years

45.0 41.7
39.2
40.0 35.6
34.7
35.0 30.9
Average Rate of 3 years

29.8 29.4
30.0
24.9
25.0
20.0
15.0
10.0
5.0
0.0
1999-2001 2001-2003 2003-2005 2005-2007 2007-2009 2009-2011 2011-2013 2013-2015
Year

The above graph shows the‟ 3year average‟ of maternal mortality rate for the period 1999 – 2015; the trend still
indicates that there is a need to improve awareness on maternal child health care and addressing these issues would
help reduce maternal mortality.

Figure 17: Contraceptive Prevalence Rate for Fiji (per 1000 CBA) 2000-2015

Contraceptive Prevalance Rate (per 1000 CBA)

2000 - 2015

60
contraceptive prevalance rate

50

40
(per 1000 CBA)

30

20

10

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Protection rate 43.50 43.70 35.50 42.00 45.90 42.30 49.10 43.10 44.7 28.9 31.8 36.5 35.7 38.4 38.3 47.1

Source: Public Health Information System, MoHMS

The CPR continues to increases to 47.1 in 2015 compared to 38.3 in 2014 which is an increase of 9%. A decrease in
CPR in 2008 from 44.7 to 28.9 in 2009 is due to the changes been made to the reporting forms. In the last 5 years it
shows a gradual increase of CPR and this may be due to improve in documentation and good record keeping.

68
Figure 18: Percentage of 1 Year Olds Immunised against Measles 2000-2015

Percentage of 1 year olds Immunised Against Measles, 2000 - 2015

100.0
90.0
% 1 year olds immunised

80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
% 73.7 85.4 76.4 62.3 62.9 68.0 74.2 80.6 73.3 71.6 71.8 82.5 85.9 79.9 82.5 83.5

Source: CMRIS Online [Hospital MCH & PHIS], MoHMS

There is a decrease of immunization coverage in 2013 by 7%. The immunization coverage rate continued
to increase thereafter by 1.2% in 2015. The improvement may be due to proper documentation, and
inclusion of data captured through hospital maternal child health report. The 2030 agenda for Sustainable
Development Goal (SDG) as per Goal 3 Target is ensuring healthy lives and promote well-being for all at
all ages. It is aimed that by 2030, for countries to end the epidemic of AIDS, Tuberculosis, Malaria,
neglected tropical diseases and combat hepatitis, water borne diseases and other communicable disease.

69
16. Health Statistics
Table 16: Vital Statistics
2014 (n) 2015 (n)
Population 933,024 923,738
Women (15-44yrs) 217,434 214,934
Total Live births 20,249 20,510
Crude Birth Rate /1000 population *23.4 22.2
Crude death Rate /1000 population *8.0 7.7
Rate of Natural Increase 1.5 1.6
Under 5 mortality rate/ 1000 livebirths (0-5 yrs) 18.0 (364) 16.6 (340)
Infant Mortality rate / 1000 live births (0-12months) 13.8 (280) 12.6 (259)
Perinatal Mortality (stillbirth and early neonatal deaths/1000 livebirths) 12.7 (259) 12.7 (262)
Early Neonatal (deaths 0-7days) /1000 livebirths 5.8 (118) 4.6 (94)
Neonatal Mortality (deaths 0-28days/ 1000 live births 7.7 (156) 6.8 (139)
Post-neonatal mortality (deaths 1-12 months)/ 1000 live births 6.2 (124) 5.9 (120)
Maternal mortality ratio /100,000 live births 44.4 (9) 29 (6)
General Fertility rate / 1000 CBA Population 99.4 95.4
Family Planning Protection Rate (per 1000 CBA Population) 43.6 47.1
*Use of FIBOS 2015 population projection

Table 17: Life Expectancy – 2015

Life expectancy (years) at various ages
Age Male Female Total
(yrs) ex (95%CI) ex (95%CI) ex (95%CI)

at birth 67.1 (66.6-67.5) 71.9 (71.4-72.3) 69.4 (69.0-69.7)

at 5 yrs 63.6 (63.2-64.0) 68.0 (67.6-68.4) 65.7 (65.4-66.0)

at 15 yrs 53.8 (53.4-54.2) 58.2 (57.8-58.7) 56.0 (55.7-56.3)

at 40 yrs 30.7 (30.4-31.1) 34.7 (34.3-35.1) 32.7 (32.4-32.9)

at 60 yrs 15.9 (15.6-16.3) 19.2 (18.8-19.5) 17.6 (17.3-17.8)

Life expectancy is an estimate of the average number of years a person can expect to live, based on age-specific death
rates in a given year. Life expectancy at birth is one of the most commonly used measures to describe the health status
of a population. In Fiji, on average, a Fijian male born today is expected to live sixty-six (66) years if the economic
status of the country remains the same with confidence interval of 65.9-66.8 percent whereas for a Fijian female is
expected to live seventy-one (71) years with confidence interval of 70.3-71.2 percent. On average, a forty (40) year old
is expected to live another thirty-two (32) years (CI, 31.6-32.1) and a sixty (60) year old is expected to live another
sixteen (16) years (CI, 16.4-16.9).

70
Mortality Pyramid for Fiji – 2015

Figure 19: Mortality Pyramid for 2015

Mortality pyramid 2015

Male Female
85 to 89

75 to 79

65 to 69

55 to 59
age groups

45 to 49

35 to 39

25 to 29

15 to 19

5 to 9

Less than 1 year

10 8 6 4 2 0 2 4 6
percentage (%)
Source: MCDC, HIU, MOHMS

The mortality rates between males and females demonstrate that males have a peak between 50-79yrs and females
have a peak between 55-84 yrs. Most males are dying earlier than females.

Table 18: Immunization Coverage 2015

Immunization Coverage (%) 0-1 yr 2014 2015
Number % Number %
HBV0 20176 99.6 18060 88.2
BCG 19923 98.4 17790 86.8
DPT-HepB-Hib1 18319 90.5 18874 92.1
OPV1 18317 90.5 18843 92.0
Pneumoccal 1 18328 90.5 18870 92.1
Rotavirus 1 18320 90.5 18874 92.1
DPT-HepB-Hib2 18220 90.0 18509 90.4
OPV2 18211 89.9 18483 90.2
Pneumoccal 2 18199 89.9 18508 90.3
DPT-HepB-Hib3 18398 90.9 18225 89.0
OPV3 18383 90.8 18226 89.0
Pneumoccal 3 17776 84.9 18237 89.0
Rotavirus 2 17510 83.6 18182 88.8
MR1 16113 79.9 16908 83.5

71
Table 19: Notifiable Diseases 2015
No. Diseases Total No. Diseases Total
1 Acute Poliomyelitis 0.0 (0) 30 Rheumatic Fever 3.34 (29)
2 Acute Respiratory Infection 7604.78 31
Smallpox 0.0 (0)
(61382)
3 Anthrax 0.0 (0) 32 Tetanus 0.0 (0)
4 Brucellosis 0.0 (0) 33 Trachoma 62.10 (539)
5 Chicken Pox 428.06 34
Tuberculosis (a) Pulmonary 44.81 (389)
(3702)
6 Cholera 0.0 (0) (b) Others 2.07 (18)
7 Conjunctivitis 734.63 35
Typhus 0.0 (0)
(6334)
8 Dengue Fever 287.51 36 5,837.61
Viral Illness/ Infection
(2490) (47905)
9 Diarrhoea 3248.67 37
Whooping Cough 0.92 (8)
(27328)
10 Diptheria 0.0 (0) 38 Yaws 0.0 (0)
11 Dysentry (a) Amoebic 0.23 (2) 39 Yellow Fever 0.0 (0)
(a) Bacillary 18.43 40
Sexually Transmitted Diseases
(160)
12 Encephalitis 0.23 (2) 130.85
(a) Gonorrhoea
(1135)
13 Entric Fever (a) Typhoid 48.73
(b) Candidiasis 19.00 (165)
(423)
(b) Para Typhoid 0.23 (2) (c) Chlamydia 0.35 (3)
14 Fish Poisoning 176.70
(d) Congential Syphilis 2.07 (18)
(1532)
15 Ciguatera Fish Poisoning 4.95 (43) (e) Gential Herpes 0.0 (0)
16 Food Poisoning 3.34 (29) (f) Granuloma Inguinale 0.0 (0)
17 German Measles (Rubella) 8.75 (76) (g) Herpes Zoster 4.26 (37)
18 Infectious Hepatitis 36.63
(h)Lymphogranuloma Inguinale 0
(318)
19 Influenza 3,307.75
(i) Ophthalmia Neonatorium 1.38 (12)
(27809)
20 Leprosy 0.23 (2) (j) PID 0.0 (0)
21 Leptospirosis 17.16
(k) Soft Chancre 0.0 (0)
(149)
22 Malaria 0.12 (1) (l) Syphilis 64.29 (558)
23 Measles (Morbilli) 4.49 (39) (m) Trichomoniasis 8.75 (76)
24 11.52
Meningitis (n) Veneral Warts 0.0 (0)
(100)
25 Mumps 0.46 (4)
26 Plague 0.0 (0)
27 678.82
Pneumonia
(5856)
28 Puerperal Pyrexia 0.0 (0)
29 Relapsing Fever 0.0 (0)
Source: NNDSS

The top notifiable diseases for 2015 are Acute respiratory infections, Viral infection, Diarrhoea, and Influenza.
The Incidence rates were calculated using the FIBOS Population of 868532 and expressed as per 100, 000 population.

72
Table 20: Health Service Utilization Statistics 2015

Divisional and Sub-Divisional Hospital Utilization Statistics

No Institution Number of Number Total Total Total Occupancy Daily Average

of Bed Length
Outpatient Beds Admission Discharge Patient Days Rate State of Stay
1 CWM Hospital 117,899 481 25,962 25,762 159,971 91% 438 6.2
2 Navua Hospital 1,914 22 1,422 1,411 4,437 55% 12 3.1
3 Vunidawa Hospital 8,218 24 358 342 758 9% 2 2.2
4 Korovou Hospital 4,858 16 937 910 2,037 35% 6 2.2
5 Nausori Hospital 2,355 17 2,350 2,238 2,720 44% 7 1.2
6 Wainibokasi 3,497 12 808 783 3,440 79% 9 4.4
Hospital
Central Division 138,741 572 31,837 31,446 173,363 83% 475 5.5
Sub-total
7 Lautoka Hospital 163,115 305 14,359 14,128 71,332 64% 195 5.0
8 Nadi Hospital 135,558 75 4,739 4,469 14,657 54% 40 3.3
9 Sigatoka Hospital 64,048 66 3,950 3,349 11,736 49% 32 3.5
10 Ba Mission Hospital 75,217 50 4,057 3,978 8,069 44% 22 2.0
11 Tavua Hospital 46,523 29 1,251 1,149 2,889 27% 8 2.5
12 Rakiraki Hospital 42,535 30 1,306 1,115 4,087 37% 11 3.7
Western Division 526,996 555 29,662 28,188 112,770 56% 309 4.0
Sub-total
13 Labasa Hospital 133,862 182 9,042 7,578 34,896 53% 96 4.6
14 Savusavu Hospital 67,329 56 2,103 2,048 5,929 29% 16 2.9
15 Waiyevo Hospital 16,417 33 1,083 1,045 2,799 23% 8 2.7
16 Nabouwalu 25,110 26 980 942 3,711 39% 10 3.9
Hospital
Northern Sub-total 242,718 297 13,208 11,613 47,335 44% 130 3.6
17 Levuka Hospital 21,508 40 755 710 2,410 17% 7 3.4
18 Vunisea Hospital 7,647 22 292 272 1,249 16% 3 4.6
19 Lakeba Hospital 3,831 12 173 154 553 13% 2 3.6
20 Lomaloma Hospital 5,996 16 103 90 480 8% 1 5.3
21 Matuku 1,808 5 49 49 134 7% 0 2.7
22 Rotuma Hospital 3,696 14 48 48 163 3% 0 3.4
Eastern Division 44,486 109 1,420 1,323 4,989 13% 14 3.8
Sub-total
TOTAL (Divisional) 952,941 1,533 76,127 72,570 338,457 60% 927 4.7
SPECIALISED AND PRIVATE HOSPITALS
No Institution Number of Number Total Total Total Occupancy Daily Average
of Bed Length
Outpatient Beds Admission Discharge Patient Days Rate State of Stay
1 St Giles Hospital 7,785 86 460 356 20,861 66% 57 58.6
2 Tamavua/Twomey 22,189 91 361 329 15,278 46% 42 46.4
Hospital
4 Military Hospital 9 0% 0 0
5 Naiserelagi 2,026 7 185 180 259 10% 1 1.4
Maternity

73
 Specialized Hospital 32,000 193 1,006 865 36,398 52% 100 42.1
Sub-total
GRAND TOTAL 984,941 1,726 77,133 73,435 374,855 60% 1,027 5.1

Source: Hospital Monthly Returns and PATISPLUS

Based on the above reporting, the overall average length of stay is 5.1 days. The St Giles Hospital and
Tamavua/Twomey Hospital have the longest average length of stay as the patients with mental and TB patients have
longer Inpatient days. The Occupancy rate is at 60% which illustrates the number of beds occupied by hospital
inpatients. The analysis is based on the reports received by Divisional and Sub divisional Hospitals. The discrepancy
between discharges and admissions was noted to be 3698 patients; this meant that 3698 were not discharged from the
hospitals. This also indicates the quality of entry from the providers and their level of supervision of data. This is also a
quality check for the team at HIU and simply means that cases admitted are not discharged due to administrative
omissions or in some cases due to chronic disease such as TB or psychiatric co-morbidities. The bed occupancy rates
have improved and with improved statistics on admissions and discharges, the perception is that BOR will reflect the
true facility incidence.

Table 21: Morbidity and Mortality Statistics 2015

i) Top ten causes of mortality 2015

# Chapter Diseases Total %

1 I00-I99 Diseases of the circulatory system 2267 33.9

2 E00-E90 Endocrine, nutritional and metabolic diseases 1461 21.8

3 C00-D48 Neoplasms 739 11.0
4 V01-Y98 External causes of mortality 404 6.0
5 J00-J99 Diseases of the respiratory system 347 5.2
6 A00-B99 Certain infectious and parasitic diseases 326 4.9
7 R00-R99 Symptoms, signs and abnormal clinical and laboratory 208 3.1
findings, not elsewhere classified
8 K00-K93 Diseases of the digestive system 194 2.9
9 N00-N99 Diseases of the genitourinary system 177 2.6
10 P00-P96 Certain conditions originating in the perinatal period 116 1.7
G00-G99, L00-L99, Q00-Q99, Remainder of other diseases 449 6.7
D50-D89, M00-M99, F00-
F99, O00-O99, H00-H59,
H60-H95

Grand Total 6688 100.0

The top cause of mortality remains NCD related (78% of top ten causes of mortality) with disease of the circulatory
system being the top cause of mortality, similar to the top cause of mortality in 2014.

74
 ii) Top ten causes of mortality 2015

Tabular Diseases Total Proportionate Mortality

Mortality (%) Rate per
1,000
population
1-052 Diabetes mellitus 1318 19.7 151.8
1-067 Ischaemic heart disease 1108 16.6 127.6
1-069 Cerebrovascular diseases 495 7.4 57.0
1-066 Hypertensive diseases 320 4.8 36.8
1-068 Other heart diseases 275 4.1 31.7
1-094 Symptoms, signs and abnormal clinical and laboratory findings, 208 3.1 23.9
not elsewhere classified
1-076 Chronic lower respiratory diseases 188 2.8 21.6
1-012 Sepsis 185 2.8 21.3
1-086 Other diseases of the genitourinary system 155 2.3 17.8
1-046 Other malignant neoplasm 146 2.2 16.8
Other diseases 2290 34.2 263.7
Grand 6688 100.0 7.7
Total

The top seven diseases accounting for deaths in 2015 were all NCD related (60% of top ten deaths). Diabetes and its
complications were the top cause of mortality in 2015.

Table 22: Top ten causes of morbidity by disease cause group 2015
No. Disease Classification Total Cases Proportionate Morbidity
(%)
1 Diseases of the respiratory system 5151 9.3
2 Diseases of the circulatory system 4834 8.8
3 Certain infectious and parasitic diseases 4445 8.1
4 Injury, poisoning and certain other consequences of external 3858 7.0
causes
5 Diseases of the genitourinary system 2854 5.2
6 Diseases of the skin and subcutaneous tissue 2813 5.1
7 Diseases of the digestive system 2784 5.0
8 Endocrine, nutritional and metabolic diseases 2033 3.7
9 Neoplasms 1520 2.8
10 Certain conditions originating in the perinatal period 1430 2.6
11 Other diseases 23470 42.5
Grand Total 55192 100.0
Source: HDD from Sub-Divisional and PATISPLUS

Diseases of the circulatory system are the leading cause of morbidity in our admitted population and the same trend
was observed last year.

75
Table 23: Top ten causes of morbidity by disease 2015
No Disease Classification Total Proportionate Morbidity
. Cases (%)
1 Pneumonia unspecified 1454 2.6
2 Viral Infection unspecified 1315 2.4
3 Type 2 Diabetes Mellitus with foot ulcer due to multiple
898
causes 1.6
4 Diarrhoea & gastroenteritis presumed origin 883 1.6
5 Septicemia unspecified 721 1.3
6 Congestive heart failure 680 1.2
7 Local infection of skin & subcutaneous tissue, unspecified 625 1.1
8 Stroke not specified as haemorrhage or infarction 573 1.0
9 Acute severe asthma 569 1.0
10 Cellulitis of lower limb 510 0.9
11 Other diseases 46964 85.1
Grand Total 55192 100.0
Source: PATISplus (Clinical Performance Management Report)

Pneumonia unspecified is the leading cause of admissions, while the 10th leading cause of admission is Cellulitis of lower
limb when compared to 2014 the leading cause of admission is Viral Infection and 10th leading cause was Acute
subendocardial.

Table 24: Health Status Indicators 2014-2015

Indicator 2014 (n) 2015 (n)
Reduced Burden of NCD (Strategic Plan Outcome 1)
Prevalence rate of diabetes (per 1000 population) 25.9* 105.6
Admission rate for diabetes and its complications, hypertension 112.7 (4638) 134.5(3876)
and cardiovascular diseases (per 1000 admissions)
Amputation rate for diabetes sepsis (per 100 admission for 15.4 (628) 17.0
diabetes and complications)
Cancer prevalence rate (per 100,000 population) 373.7 (1682) 353.3 (1387)
Cancer mortality (per 100,000 population) 79.9 (691) 85.1 (739)
Cardiovascular disease (ICD code I00-I52.8) Mortality rate per 215.4 (1862) 200.5 (1741)
100,000 population
Admission rate for RHD (1000 admission) 3.0 (125) 2.1 (116)
Motor and other vehicle accidents mortality rate (per 100,000 7.3 (63) 7.9 (69)
population)
Healthy teeth index (DMFT) – 12 year old 1.4 1.4
Begin to reverse spread of HIV/AIDS and preventing, controlling or eliminating other communicable diseases (Strategic
Plan Outcome 2)
HIV prevalence rate among 15-24 year old pregnant women
per 1000
Prevalence rate of STIs among men and women aged 15-24 84.02 (784) 79.2 (688)
years per 100000
TB prevalence rate per 100,000 110 2015 will be estimated by
WHO in the 2016 Report.
TB case notification rate of new and relapse cases (per 100,000 39 41
population)
TB case notification of new smear positive cases (per 100,000) 12.2 201
From 2015, the NTP notifies notification for bacteriologically

1. Note: 2014 data is using smear positive cases (per 100,000), from the year 2015 the program will be using the 2013 revision - new definitions
and reporting framework for tuberculosis which measures new bacteriologically confirmed TB cases instead .

76
confirmed TB cases (per 100,000 population)
Tuberculosis case detection rate 60% 62.8%
TB treatment success rate 86% All forms: 87%,
Bacteriologically confirmed
TB cases: 86%
TB death rate 4.7 3.02 (26)
Incidence of dengue (per 100,000 pop) 1150.20 (9942) 287.51 (2490)
Incidence of leptospirosis (per 100,000 pop) 20.36 (176) 17.16 (149)
Prevalence rate of leptospirosis (per 100,000 pop) 20.36 (176) 17.2 (149)
Incidence rate of measles (per 100,000 pop) 7.98 (69) 4.49 (39)
Prevalence rate of Leprosy (per 100,000 pop) 0.35 (3) 0.2 (2)
Incidence rate of Gonorrhoea (per 100,000 pop) 135.13 (1168) 130.85 (1135)
Incidence rate of Syphillis (per 100,000 pop) 60.74 (525) 64.29 (558)
Improved family health and reduced maternal morbidity and mortality (Strategic Plan Outcome 3)
Maternal mortality ratio 44.4 29
Prevalence of anaemia in pregnancy at booking 31.1 32.4
Contraceptive prevalence Rate 43.5 47.1
Proportion of births attended by skilled health personnel 99.7 99.9
Improved child health and reduced child morbidity and mortality (Strategic Plan Outcome 4)
Prevalence of under 5 malnutrition 38.3
% of one year fully immunized 82.5 83.5
Under 5 mortality rate/ 1000 births 18.0 (364) 16.6 (340)
Infant mortality rate (1000 live births) 13.8 (280) 12.6 (259)
Improved adolescent, health and reduced adolescent morbidity and mortality (Strategic Plan Outcome 5)
Rate of teenage pregnancy (per 1000 CBA pop) 4.91 24.3
Number of teenage suicides 9 2

The health status indicators for 2015 demonstrate:

The prevalence rate of diabetes is better captured in Public Health Information System (PHIS) since DM
notification is currently underreported, the use of PHIS data resulted in the sudden increase of prevalence rate of
diabetes being 105.6 compared to 25.9 in 2014. PHIS currently has the best reporting frequency and
completeness than the DM notification forms. There is an increased admission rates for diabetes and its
complications by 19.3% the prevalence of Cancer decreased in 2015 compared to 2014 by 5.5% and cancer
mortality increased by 6.5%. The cardiovascular diseases mortality rate decreased by 7% and the result could be
due to the reporting coverage for MCDC; and the admission rates for RHD decreased by 30%. Mortality from
MVAs increased by 8.2%. The incidence of Dengue decreased as last year was an outbreak (national) year. And
also may be attributed to public awareness, promoting healthy living and interventions which may have also
impacted on the incidence of leptospirosis. The MMR has decreased significantly in 2015 compared to 2014 by
35%, and the MDG target is yet to be realized. The other indicator of maternal health such as anaemia in
pregnancy has increased by 4.2% and proportion of births attended to by skilled professionals remains
consistent. There is an increase in CPR by 8.3%.This indicates an overall improvement in capturing maternal
child health and births information in the PHIS and CMRIS reporting. Teenage and adolescent health issues have
improved; the rate of teenage pregnancy increased drastically. The rate of suicide amongst teenagers decreased
by 78% in 2015 and the figures are dependent on the number of reports received and analysed at HIU.

77
17. Overseas Patient Referral 2015
Table 25: Patient Referral by Medical Category, 2010-2015
Category 2010 2011 2012 2013 2014 2015 Total
Cardiac 45 97 43 23 3 31 242
Oncology 30 50 23 17 22 20 162
Renal 2 7 4 1 2 3 19
Surgical 11 14 3 15 16 24 83
Ophthalmology 5 25 15 9 8 3 65
Other 0 10 12 2 3 4 31
Total 93 203 100 67 54 84 601

Table 26: Patient Referral Costs by Category 2015

Category 2015 Costs
Cardiac 31 $182,384.42
Oncology 20 $88,386.13
Renal 3 $273,479.42
Surgical 24 $13,877.86
Ophthalmology 3 $24,063.70
Other 4 $23,439.80
Total 84 $605,631.33

78
18. Disease Trend Analysis 2000-2015
Figure 20: Diabetes Cases 2000–2015
Diabetes Rates for the Year 2000-2015
Rates per 100,000 population

80.0 700
70.0

Number of cases
600
60.0 500
50.0 400
40.0
30.0 300
20.0 200
10.0 100
0.0 0
2000 2001 2002 2003 2004 2005 2006 2007 2088 2009 2010 2011 2012 2013 2014 2015
Cases 525 534 406 394 228 209 544 415 352 354 443 620 322 485 609 618
IR 68.4 69.6 52.9 51.3 29.7 27.2 70.9 49.6 42.1 42.3 52.9 74.1 38.5 58.0 72.8 73.9
Year

Source: Diabetes Notification, 2015

The number of diabetes cases remains variable depending on the number of cases reported. It is noted that there is an
increase of notification received within the last 3 years, which shows an improvement in report submission even though
it is still underreported.

Figure 21: Diabetes Cases 2013–2015

Diabetes Rates for the Year 2013-2015

Rates per 100,000 population

600.0 5000
4500
500.0 4000
Number of cases

400.0 3500
3000
300.0 2500
2000
200.0 1500
100.0 1000
500
0.0 0
2013 2014 2015
Cases from PHIS 4750 2195 3381
IR 570.6 262.9 405.4
Year

Source: CMRIS Online [PHIS]

The number of new diabetes cases detected are from medical area level and below. Please note that PHIS reflects the
more accurate numbers of new cases of Diabetes than the DM notification forms.

79
Figure 22: Cancer Cases from 2000 – 2015

Cancer Cases for the years 2000 - 2015

250 1800
Rates per 100,000 population

1600
200 1400

Number of Cases
1200
150
1000
800
100
600
50 400
200
0 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Cases 499 566 425 365 495 395 304 466 465 453 1189 1091 1145 1553 1682 1387
Rates 65 73.8 55.4 47.6 64.5 51.5 39.6 55.7 55.6 54.1 142.2 130.5 136.9 185.8 201.3 165.9
Year

Source: Cancer Registry 2015

The number of cases of cancer increased in 2010 due to multiple sources of reporting. There is a decline in the cancer
cases in 2015 with 1387 confirmed lab cases compared to 1682 cases in 2014. The number of cancer cases reported
depends on the number of Pathology lab confirmed cases received from the 3 Divisional Hospitals.

Figure 23: Sexually Transmitted Infection Cases 2000-2015

Sexually Transmitted Infection Cases from 2000 to 2015

350.0 Veneral Warts

Trichomoniasis
300.0
Syphilis

Chancroid
Rates per 100,000 population

250.0
PID

200.0 Ophthalmia Neonatorium

Herpes Zoster
150.0
Lymphogranuloma
Venereum
100.0 Gential Herpes

Congential Syphilis
50.0 Chlamydia

Candidiasis
0.0
2003
2000
2001
2002

2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015

Gonorrhoea

Year

The incidence of syphilis and gonorrhoea is variable over the years. This could be due to underreporting and differences
in syndromic and laboratory case definitions.

80
Figure 24: Cardiac Related Cases 2000–2015

Cardiovascular cases from 2000 - 2015

120.0
110.0
Rates per 1000 Admissions

100.0
90.0
80.0
70.0
60.0
50.0
40.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rates 62.5 59.3 75.0 91.1 111.8 73.6 61.1 75.6 95.7 44.6 50.1 93.5 106.2 87.5 76.4 66.7
Source: PATISplus (Clinical Performance Management System)

The trend of cardiac related cases fluctuates between the 15year periods (2000 – 2015). There were two peaks
identified; 1st peak in 2004 with 111 per 1,000 admissions due to cardiovascular cases (I05 – I52.8) and 2nd peak in 2012
it recorded 106 per 1,000 admissions for cardiovascular cases (I05 – I52.8). The codes used are from ICD 10AM 4th
edition. There was a slight decrease of admission in the two year period (2013 & 2014) and in 2015 an increase of 95
per 1,000 admissions for cardiovascular cases were noted. The fluctuation in rates reflected the inconsistency of
information pertaining to CVD and may also be reflective of the need for improved data quality in this area.

Figure 25: Depression Cases 2000–2015

Depression cases from 2000 - 2015
30.0
Rates per per 10000 Admissions

25.0

20.0

15.0

10.0

5.0

0.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rates 5.7 0.7 3.4 7.3 23.2 14.5 2.2 25.0 5.6 2.7 2.5 6.6 6.9 6.8 6.8 12.3
Source: PATISPLUS (Clinical Performance Management System) & Manual Tear Offs

The trend of depression cases (F32 – F32.9) was fluctuating between2000 – 2007 and saw a major decline between
2008 – 2010. The codes used are from ICD 10AM 4th edition. This trend is reflective of inconsistency of information and
suggests that there need to be data quality interventions similar to the CVD area.
However, it was apparent that the admission for depression cases continued to increase gradually in the last 4years.
This could be due to stress, having certain medical illnesses and change in lifestyle.

81
Figure 26: Acute and Chronic Renal Failure Cases 2000-2015

Acute Renal Failure & Chronic Renal Failure cases from 2000-2015
80.0 350
70.0 300
Rates per 10,000 population

60.0
250

Total Admission
50.0
200
40.0
150
30.0
100
20.0
10.0 50

0.0 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Years

Acute Renal failure Chronic Renal Failure Acute Renal failure Chronic Renal Failure

Source: PATISplus (Clinical Performance Management System)

There has been an increase in admissions for Chronic Renal Failure (N18 – N18.91) compared with Acute Renal Failure
(N17 – N17.9) with both at a peak in the year 2008. A peak was also noted in 2011, and Chronic Renal Failure is a
concern.

Figure 27: Typhoid Cases 2011–2015

Source: NNDSS add in lab data from Mataika House

The number of Typhoid cases reported through NNDSS is more compared to lab confirmed cases in the last 5 years;
The NNDSS incidence rate reduced by 35% in 2015 and lab incidence rate reduced by 23%. The analysis on NNDSS is
based on the clinically diagnosed cases inclusive of government health facilities and few private practitioners whereas
analysis for Lab data cases is based on the confirmed numbers that is provided by Mataika House. However, the last
5years have been also reflective of increased burden of typhoid in-country.

82
Figure 28: Typhoid Cases by Divisions 2000-2015

Typhoid Fever Cases by Division 2000 - 2015

250.0
Rates per 100,000 population

200.0
Central
150.0
Western

100.0 Northern

50.0 Eastern

0.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Years

Source NNDSS

Typhoid dominates in the Northern division, followed by the Western divison, the Central divison and the lowest
incidence was recorded from the Eastern Division. The ranking as such is repeated over the last 14 years. The number of
typhod cases analysed also depends on the number of notifications received from the various health facilties .

Figure 29: Dengue Fever Cases 2011 - 2015

Source: NNDSS add in lab Mataika House and add in DLI Surveillance Data

In 2014, there was a drastic increase from 2013 by 192.2% and this was due to the national outbreak. There is a
decrease in dengue fever cases in 2015 by 73.3%. The analysis on NNDSS cases is based on the clinically diagnose cases
inclusive of government health facilities and few private practitioners whereas analysis for Lab data cases in based on
the confirmed numbers that is provided by Mataika House.

83
Figure 30: Leptospirosis Cases 2011-2015

Source: NNDSS add in lab data from Mataika House

In the general context, lab data cases is more than NNDSS cases. There was a peak in 2012 and this may be due to
national outbreak. It declines in the 2years after and increase by 12.2% in 2015. The analysis are based on the reports
received from the reporting facilities.

84
19. Donor Assisted Programs/Projects 2015
Table 27: Donor Assist Programs
i) Cash Grant

Donor Program Amount

Global Fund Assistance for (Malaria / Tuberculosis) Program $3,792,439
UNFPA Family Planning $339,069
UNFPA Health Systems Strengthening $35,000
UNFPA Reproductive Health Program $382,287
UNICEF Health and Sanitation $75,000
UNICEF Policy Advocacy, Planning and Evaluation $30,000
Total Cash Grant $4,653,795

ii) Aid in Kind

Donor Program Amount

DFAT Fiji Health Sector Support Programme $8,659,508
JICA Fiji-Okinawa Physiotherapy/Rehabilitation Project $148,349
JICA Filariasis Elimination Campaign $195,820
JICA Prevention and Control of NCDs $27,759
NZAID Medical Treatment Scheme $471,254
Taiwan Mental Health Care System Enhancement Project $131,300
Taiwan Mobile Medical Teams $153,600
UNFPA Technical Assistance $70,000
UNFPA Family Planning $91,500
UNFPA Health System Strengthening $15,000
UNFPA Reproductive Health Programme $148,933
UNFPA Volunteer Scheme $494,001
UNICEF Policy Advocacy, Planning and Evaluation $190,000
UNICEF Health and Sanitation Program $85,000
WHO Program Assistance $1,137,847
Total Aid –in-Kind $12,019,871

85
20. MDG Progress Report

Table 28: MDG Performance

Targets 2009 2010 2011 2012 2013 2014 2015

Goal 4 Reduce Child Mortality
Child Mortality 17.9 20.1 16.6
Rate/1,000 live births
(0-5yrs)
Proportion of 1 year 71.7 71.8 82.5 85.9 79.9 82.5 83.5
old immunized
against Measles
Infant Mortality 13.7 15.8 12.6
Rate/1,000 Live
Births
Goal 5 Improve Maternal Health
Maternal Mortality 27.5 22.6 39.8 59.47 19.07 44.4 29
Ratio per 100,000
live births
Contraceptive 28.9 31.77 36.5 44.3 38.4 43.5 47.1
Prevalence Rate
among population of
child bearing age
Rate of teenage 7.75 4.9 24.3
pregnancy reduced
by 5% (per 1000
CBA population)
Adolescent birth rate 40.1 26.7 30.3
(per 1000 girls aged
15-19yrs)
Goal 6 Combat HIV/AIDS and other Diseases
HIV/AIDS prevalence 0.037
among 15-24 year
old pregnant women
Prevalence rate of 83 55 84.02 79.2
STIs among men and
women aged 15 to
25 (per 100 000
TB Prevalence rate 40 30 51 110 2015 will be
(per 100,000) estimated by
WHO in the
2016 Report.
TB Death rate (per 2.68 3.44 3.56 3.7 4.7 3.02
100,000)
TB Incidence rate 27 24 67 2015 will be
(per 100,000) estimated by
WHO in the
2016 Report.
TB Detection rate 56% 79% 92% 99% 50% 60% 63%
under DOTS (%)
TB cure rate under 94% 67% 93% 93% 85% 86% All forms: 87%,
DOTS (%) Bacteriologically
confirmed TB
cases: 86%
Goal 7 Ensure environmental sustainability
Proportion of 96% 96% 96%
population using and
improved drinking
water source
Proportion of 87% 91.1% 91%

86
population using and
improved sanitation
facility

The under 5 mortality rate has decreased significantly over the last 5 years with general improvement noted in
immunization status of one-year olds. The MMR target is still elusive with an increase in the number of maternal deaths
noted for 2014. However, the CPR shows improvement between 2013 and 2014.

87
21. Finance
Figure 31: Auditors Report 2015

88
89
Table 29: Segregation of 2015 Budget
Program / Activity Original Budget Revised Budget % of Overall
($m) Revised Health
Budget

Program 1 Activity 1 Administration $24,420,240 $26,885,612 9.97%

Program 1 Activity 1 Research $633,644 $633,644 0.23%
Program 2 Activity 1 Urban Hospitals $100,266,025 $102,238,563 37.90%
Program 2 Activity 2 Sub Divisional Hospitals,
$84,700,478 $79,991,257 29.66%
Health Centres and Nursing Stations
Program 2 Activity 3 Public Health Services $5,512,669 $5,968,052 2.21%
Program 2 Activity 4 Drugs and Medical Supplies $50,077,267 $50,077,267 18.57%
Program 3 Activity 1 Hospital Services $3,217,565 $3,033,493 1.12%
Program 4 Activity 1 Senior Citizen‟ s Home $910,344 $910,344 0.34%
Total $269,738,232 $269,738,232 100%

Table 30: Proportion of Ministry of Health Budget against National Budget and GDP
Year Revised Health Budget National Budget % of Overall Total % of GDP
Budget
2015 $269,738,232 $3,336,292,100 8.08% 3.48%

90
Table 31: Statement of Receipts and Expenditure for the Year Ended 31st December 2015
Notes 2015 2014
$ $
RECEIPTS
State Revenue

Operating Revenue: Indirect Taxes 0 0

OPR 0 16,826
Rental for Land 0 0
Rental for Qrts 12,113 13,696
Commission 53,518 49,747
Miscellaneous Revenue 527,193 928,520
Fees Govt B/School 0 0

Total State Revenue 3 (a) 592,824 1,008,789

Agency Revenue

Health Fumigation & Quarantine 1,696,697 1,778,602

Hospital Fees 3,166,652 2,112,170
License & Others 1,147,381 1,269,624
Fiji School of Nursing 0 0
Miscellaneous Revenue (112,008) 215
3 (b)
Total Agency Revenue 5,898,722 5,160,611

TOTAL RECEIPTS 6,491,546 6,169,400

EXPENDITURE
Operating Expenditure

Established Staff 3 (c) 111,613,327 103,781,190

Unestablished Staff 3 (d) 13,110,237 14,300,629

Travel & Communication 3 (e) 4,599,599 4,249,572

Maintenance & Operations 3 (f) 12,775,696 12,772,759

Purchase of Goods & Services 3 (g) 42,745,792 35,265,801

Operating Grants & Transfers 3 (h) 1,045,988 1,170,544

Special Expenditure 3 (i) 7,332,660

10,205,271
Total Operating Expenditure 196,095,910 178,873,155

Capital Expenditure
Construction 3(j) 21,503,832 31,306,429

Purchases 3(k) 9,506,003 8,745,113

Total Capital Expenditure 31,009,835 24,398,328

Value Added Tax 11,907,563 10,407,715

TOTAL EXPENDITURE 239,013,308 213,679,19

91
Table 32: TMA Trading Account for the Year Ended 31 st December 2015

Trading Account 2015 2014

($) ($)

Sales 426,341 544,121

Opening Stock of Finished Goods 22,711 34,196

Add : Purchases 385,252 403,115

Less : Closing Stock of Finished Goods - 22,711

Cost of Goods Sold 407,963 414,600
Gross Profit Transferred to Profit & Loss Statement 18,378 129,521

Table 33: TMA Profit and Loss Statement for the Year Ended 31 st December 2015

INCOME 2015 2014

($) ($)

Gross Profit Transferred to Profit & Loss Statement 18,378 129,521.49

Total Income 18,378 129,521.49

EXPENSES
Sales and Related Payments 43,752 48,269
Travel Domestic 1,044 1,108
Telecommunication 923 785
Office Upkeep and Supplies 948 321
Power Supplies 343 669
Special Fees and Charges 4,143 4,031
Rent 15,653 15,653
Total Expenses 66,806 70,836

NET (LOSS)/PROFIT (48,428) 58,685

92
Table 34: TMA Balance Sheet for the Year Ended 31st December 2015
2015 2014
($) ($)
Current Assets
Cash at Bank 563,028 488,827
Account Receivables 2,339 98,345
Finished Goods 22,711
VAT receivables 11,906 134,794
Total Current Assets 577,273 744,677

Current Liabilities
- -

TOTAL NET ASSETS 577,273 744,677

EQUITY
TMA Surplus transferred to consolidated fund (397,915) (384,998)
TMA ACC Surplus 1,023,616 1,070,990
Net Loss (48,428) 58,685
Total 577,273 744,677

Table 35: Appropriation Statement for the Year Ended 31st December 2015
SEG Item Budget Appropriation Revised Actual Lapsed
Estimate Changes Estimate Expenditure Appropriation
$ $ $ $ $
a b (a-b)
SEG Item Budget Appropriation Revised Actual Lapsed
Estimate Changes Estimate Expenditure Appropriation
$ $ $ $ $
a b (a-b)
1 Established Staff 111,015,022 4,000 111,019,022 111,613,327 (594,305)

2 Unestablished Staff 11,997,912 - 11,997,912 13,110,237 (1,112,325)

3 Travel & Communication 4,615,400 729,040 5,344,440 4,599,599 744,841

4 Maintenance & Operations 12,989,300 1,295,362 14,284,662 12,772,696 1,508,966

5 Purchase of Goods & 44,586,690 3,165,577 47,752,267 42,745,792 5,006,475
Services
6 Operating Grants & 1,007,520 110,000 1,117,520 1,045,988 71,532
Transfers
7 Special Expenditure 11,433,795 590,718 12,024,513 10,205,271 1,819,242
Total Operating Costs 197,645,639 5,894,697 203,540,336 196,095,910 7,444,426

Capital Expenditure
8 Construction 46,142,893 (5,500,012) 40,642,881 21,503,832 19,139,049

9 Purchases 7,550,000 2,105,314 9,655,314 9,506,003 149,311

10 Grants & Transfers - - - - -

Total Capital Expenditure 53,692,893 (3,394,698) 50,298,195 31,009,835 19,288,360

13 Value Added Tax 18,399,700 (2,499,999) 15,899,701 11,907,563 3,992,138

TOTAL EXPENDITURE 269,738,232 0 269,738,232 239,013,308 30,724,924

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Table 36: List of Health Facilities

Divisional Hospital
Central Eastern Western Northern
1. CWM Hospital 1. Lautoka Hospital 1. Labasa Hospital
Sub Divisional Hospitals
1. Navua 1. Levuka 1. Sigatoka 1. Savusavu
2. Korovou 2. Vunisea 2. Nadi 2. Waiyevo
3. Vunidawa 3. Lakeba 3. Tavua 3. Nabouwalu
4. Nausori 4. Lomaloma 4. Rakiraki
5. Wainibokasi 5. Rotuma 5. Naiserelagi Maternity
6. Ba
Specialised Hospital
1. St.Giles Hospital
2. Tamavua/Twomey Hospital
Private Hospitals
1. Suva Private Hospital
2. Nasese Medical Centre
Health Centres and Nursing Stations

Central Division Western Division Northern Division Eastern Division

Health centres Nursing Stations[21] Health Centres[28] Nursing Health Nursing Health Nursing
[21] Stations [25] Centres[20] Stations [21] Centres[15] Stations [31]
Suva Sub-Division Lautoka/Yasawa Sub-Division Macuata Sub-Division Lomaiviti Sub Division
1. Suva Naboro 1. Lautoka Yalobi 1. Labasa Cikobia 1. Levuka Batiki
2. Raiwaqa 2. Kese Somosomo 2. Wainikoro Visoqo 2. Gau Nairai
3. Samabula 3. Nacula Yaqeta 3. Lagi Coqeloa 3. Koro Nacavanadi
4. Nuffield 4. Malolo Teci 4. Naduri Vunivutu 4. Bureta Narocake
Clinic
5. Valelevu 5. Natabua Yasawa I 5. Dreketi Udu Nawaikama
Rara
6. Lami 6. Viseisei Viwa 6. Seaqaqa Dogotuki Nabasovi
7. Makoi 7. Kamikamica Yanuya 7. Nasea Kia Nacamaki
Womens 8. Punjas Naqumu Moturiki
Wellness
Centre
Serua/Namosi Sub-Division Nadi Sub-Division Cakaudrove Sub-Division
1. Navua Raviravi 1. Nadi Nawaicoba 1. Savusavu Naweni
2. Beqa Galoa 2. Namaka Momi 2. Natewa Bagasau Kadavu Sub-Division
3. Korovisilou Waivaka 3. Bukuya Nagado 3. Tukavesi Kioa 1. Vunisea Ravitaki

4.Namuamua Navunikabi Nausori 4. Saqani Tawake 2. Kavala Soso

Naqarawai Nanoko 5. Rabi Navakaka 3. Daviqele Gasele
6.Korotasere Nabalebale Naqara
Rewa Sub-Division Ba Sub-Division 7.Nakorovatu Vacalea

1. Nausori Baulevu 1. Ba Namau Nalotu

2. Mokani Namara 2. Nailaga Nalotawa Bua Sub-Division Talaulia

3. Wainibokasi Naulu 3. Balevuto 1. Nabouwalu Bua Lakeba Sub-Division

Nailili 2. Lekutu Yadua 1.Lakeba Vanuavatu
Vatukarasa Tavua Sub-Division 3. Wainunu Navakasiga 2. Moala Nayau

Tailevu Sub-Division 1. Tavua Kubulau 3. Matuku Oneata

1. Korovou Verata 2. Nadarivatu Nadrau 4. Kabara Komo

2. Lodoni Dawasamu Nagatagata Taveuni Sub-Division 5. Ono I lau Moce

3. Nayavu RKS 1. Waiyevo Bouma Nasoki

QVS Nadroga/Navosa Sub-Division 2. Qamea Yacata Cakova

Tonia 1. Sigatoka 3. Vuna Vuna Totoya 94

 2. Lomawai Loma
Naitasiri Sub-Division 3. Keiyasi Naqalimare Levuka-I-Daku

1. Vunidawa Lomaivuna 4. Raiwaqa Nukuilau Udu

2. Naqali Waidina 5. Korolevu Wauosi Namuka
3. Laselevu Narokorokoyawa 6. Vatulele Tuvu Fulaga
4. Nakorosule Nabobuco 7. Cuvu Ogea
Nasoqo 8. Vatukarasa Vatoa
Ra Sub-Division Lomaloma Sub-Division

1. Rakiraki Vunitogoloa 1. Lomaloma Mualevu

2. Nanukuloa Tokaimalo 2. Cicia Tuvuca

3. Namarai Nasavu Rotuma

4. Nasau Nayavu-I-Ra 1. Rotuma

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