This section reviews the Ministry of Health and Medical Services and Office of the Fijian Auditor General (OAG) as case studies. The focus is on outcome-based public sector performance measures. We outline the background information on Fiji governments’ budget which is followed by the two case studies of the Ministry of Health and Medical Services and the Office of the Auditor-General.

Fiji Government Budget

The Fiji government budget is predicated on the achievement of the vision of “A better Fiji for all.” The two essential strategies are:

  • 1. Inclusive social development: basic needs and essential services and
  • 2. Sustainable economic development: a pathway to a regional hub.
  • (Ministry of Economy 2016, 16)

Social inclusion is the process of improving the terms for individuals and groups to take part in society. The strategy or inclusive development focuses on meeting each individual’s basic needs and strengthening social inclusion. Implementing this strategy will embrace a wide range of sector policies and programs including water and sanitation, housing, food security, energy, education, health, social empowerment, national security, youth development, gender, and cultural heritage (National Development Plan 2017). Underpinning the two-pronged twenty-year strategy is an acknowledgment of the imperative of sustainable development and the need to restore and maintain the balance between the three pillars of economic, social, and environmental development.

Case Study 1: Ministry of Health and Medical Services Fiji

The Ministry of Health and Medical Services’ budget and strategic plan are aligned with the Fiji National Development Plan that underscores inclusive socio-economic development to improve the social well-being of all Fijians. The Ministry’s delivery of services with clear outcomes is identified. The focus is on quality health care that is essential for good health.

Table 10.1 summarizes the Ministry of Health and Medical Services’ key strategic priorities and outcomes.

The Ministry of Health and Medical Services is working to improve access to quality preventative, curative services that help individuals and the population overall, underpinned by a strong health system. The main focus is on the United Nations’ Sustainable Development Goal 3: ensure healthy lives and promote well-being for all at all ages. The ensuing paragraph analyzes the outcomes in relation to the different strategic priorities.

Strategic Priority 1: Reform Public Health Services to Provide a Population-Based Approach for Disease and the Climate Crisis

Outcome 1.1 Reduce Communicable Disease and Non-Communicable Disease Prevalence, Especially for a Vulnerable Group

Reducing the burden of both communicable disease and non- communicable disease is key to the Strategic Plan, focusing on preventive action from the community to hospital levels. The Ministry wants to see a reduction in the number of cases of communicable diseases, particularly dengue, typhoid, and leptospirosis, and to start controlling the burden of non-communicable diseases. A core aspect of the outcome will be to strengthen the Ministry’s surveillance, case detection, and diagnosis for communicable diseases and non-communicable diseases, across all levels of the health system from the community to hospital.

Outcome 1.2 Improve the Physical and Mental Well-Being of All Citizens, with Particular Emphasis on Women, Children, and Young People Through Prevention Measures

The Ministry emphasizes the integration of mental health, nutrition, physical activity, and oral health into reproductive, maternal, newborn

238 Nirmala Nath and Umesh Sharma

Table 10.1 Key Strategic Priorities and Outcomes of Ministry of Health and Medical Services

Strategic Priority


Strategic Priority 1 Reform public health services to provide a population-based approach for disease and the climate crisis

  • 1.1 Reduce communicable disease and non-communicable disease prevalence, especially for vulnerable group.
  • 1.2 Improve the physical and mental wellbeing of all citizens, with particular emphasis on women, children and young people through prevention measures.
  • 1.3 Safeguard against environmental threats and public health emergencies.
  • 1.4 Strengthen population wide resilience to the climate crisis.

Strategic Priority 2 Increase access to quality, safe and patient-focused clinical services

  • 2.1 Improve patient health outcomes, with a particular focus on services for women, children, young people and vulnerable groups.
  • 2.2 Strengthen and decentralize effective clinical services, including rehabilitation, to meet the needs of the population.
  • 2.3 Continuously improve patient safety, and values of services.

Strategic Priority 3 Drive efficient and effective management of the health system

  • 3.1 Cultivate a competent and capable workforce, where the contribution of every staff member is recognized and valued.
  • 3.2 Improve the efficiency of supply chain management and procurement systems, and maintenance of equipment.
  • 3.3 Implement more efficient financial processes, while reducing the financial hardship of the most vulnerable.
  • 3.4 Ensure infrastructure is maintained to match service needs.
  • 3.5 Harness digital technologies to facilitate better health care for our patients.
  • 3.6 Continue to strengthen planning and governance throughout the Ministry of Health and Medical services.
  • 3.7 Widen our collaboration with partners for a more efficient, innovative and higher-quality health system.

Source: Data from Ministry of Economy (2016, 7).

child, and adolescent health. The Ministry continues to focus on integrating mental health within primary health care through the Mental Health gap (mhGAP) Action Program to improve detection, clinical management, and referral, with particular emphasis on specialist populations that include mothers, children, and adolescents. The Ministry aims to reduce the number of inpatients presenting with symptoms of communicable diseases and non-communicable diseases, especially women, children, and young people, and to reduce the obesity rate in schoolchildren monitored during school visits.

Outcome 1.3 Safeguard Against Environmental Threats and Public Health Emergencies

Improving environmental health and reducing the risk of public health emergencies to reduce the burden of communicable diseases.

Outcome 1.4 Strengthen Population-Wide Resilience to the Climate Crisis

Fiji has strengthened its capacity to deal with diseases and the climate crisis. The threat of climate crisis is real, and the Ministry focuses on locations most at risk, such as those areas prone to flooding or environmental shocks. The Ministry aspires to increase the number of health facilities that meet minimum standards for health emergency and disaster preparedness.

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