The critical issues in the delivery of health care can literally break Government's back. In the United States of America, health care was a major political issue in the lead up to the presidential election. Escalating costs of care and the need to widen the health safety net also remain issues in our setting in Fiji.
Escalating costs of health delivery and the dire need to widen the health net care may seem divergent issues but need convergent planning in Fiji.
A four pronged fork approach to optimise the costs of health delivery and widening the health net care is suggested in this article especially as we face difficult economic times and increasing poverty.
The first prong:
Establish a Health Commission
Health delivery in this country continues to be a politically driven engine.
There are complementing, opposing needs and wants daily with limited financial and human resources additionally burdening the healthcare system.
Politically driven health plans and directions fluctuate with challenging government policies and ever changing executive decisions which lack direction and a phenomenally inadequate civil service driven health administration.
A high level health commission composed of members from civil society, medical epidemiologists, statisticians, administrators, financial personnel, health economists and academics will provide the platform for a wider and even playing field in making objective short to long term medical plans at a national level.
The administration of health will become holistic and transparent unlike what it represents today, a lopsided medical view.
The commission will assist, direct longer term health planning and realise medical targets and visions.
The delivery of health care will become structured, comprehensive and transparent to the common individual. Short comings can be adequately addressed and strategy and vision established.
We cannot continue propping a decadent system with band aid when major capital injection is warranted.
We can not run an efficient health service without infrastructural and technological changes and upgrades.
We cannot deliver improved clinical and primary care services because the top heavy health administration cannot plan and deliver.
The health administration remains blind to emergent needs in the community.
Second prong.
Financial planning
With the current budgetary discussions underway in government circles, it is essential that the financial wizards in the Health Ministry target a bigger slice of the G.D.P and national budget.
To be able to obtain this big piece of the cake much ground work would be needed to demonstrate the needs to finance the workforce, revamp the failing primary health care structures, upgrade the broken down technology and maximise financial out lays in the area of our pharmaceutical bulk purchase scheme and non essential clinical services.
Negotiators to the Budget committee cannot attempt to surmount all the financial and manpower restraints unless the financial wizards at the Ministry of Health work out a clear health financial strategy to realise a health driven vision.
Involving the current health planners will assist in more then one way. Implementing a time framed study the national insurance scheme is now long overdue.
These two important prongs of our fork are directed at the health administration.
Currently most public servants are weathering the storm and do not have the commitment to work outside their box. Fear has it, that national politics will change soon enough and stalling is the best policy.
Third prong.
Workforce analysis.
The Ministry of Health and the Public Service Commission should instigate a major manpower needs assessment and rationalisation of this undertaken with seriousness.
The continued loss of medical and nursing professionals remains major strategic issues. All issues related to improving salaries, work conditions, promotion and training programs need to be reflected and resolved in a short time frame.
The push factor in migration of health professionals needs to be addressed now not when instructed by politicians in power.
Fourth prong.
Re-brand our health image
At the level of practical health delivery, all three divisional hospitals, sub-divisional hospitals and primary health centres must implement low cost strategies to tidy up, clean, paint, refurbish the wards, outpatients and accident/emergency units must be undertaken to look presentable.
Public/private sector collaborations already in place can be widened and a general sense of hygiene and cleanliness should be emphasised.
Internal audits of waiting time, patient satisfaction, aimed at reducing negativity should be undertaken by hospital administration.
Much can be achieved if our medical superintendents, supervisors get of their backs and give the hospitals a beautified, healing image.
Conclusion
The healthcare system needs a major overhaul. The four pronged approach will set in motion matters which have been of concern to civil society and health care providers of all cadre.
The administration of health is not an easy undertaking with limited resources, increased migration of medical and nursing personnel on one hand and the continued onslaught of the double burden of diseases and demands of an increasing population which is becoming increasingly self-centered.
Much thought has been given to our specific health issues in many forums but what remains is putting policies into practical action. Yes, its time to walk the talk.
* Dr Sharma is the Editor-in-Chief of the Fiji General Practitioner, the official journal of the Fiji College of General Practitioners, and is the chairperson of its publication committee.
