Different therefore equal: towards equity in the health services in Fiji.

Abstract

“Equitable resource distribution” is one of the health policy indicators used to monitor the World Health Organization's (WHO) Health for All by the Year 2000 strategy. However, many countries find the monitoring of equity problematic because it is a difficult notion to define. This article discusses various possible definitions and concludes that equality of expenditure per unit of population (or preferably, per unit of need) is the best definition of equity to pursue In operational terms. However, the weaknesses of this approach are acknowledged — most importantly, the definition ignores the fact that geography and the distribution of the population into small, Isolated groups result in different costs for equivalent items of service. This is clearly of great relevance to Pacific Island states. The state of resource distribution in 1986 in the government health services in Fiji is examined. Only equity amongst divisions and provinces — i.e., geographical equity — is considered. Per capita annual expenditure ranges from F$15.70 in Nadroga and Navosa province to F$36.20 in Naitasiri. It would be premature to conclude that such a distribution is necessarily inequitable and unfair. Rather, the data should be seen as a springboard for further research to investigate to what extent, if at all, the “over-funding” of some divisions and provinces is justified. This article does not answer neatly the question: are government health service resources distributed fairly in Fiji? This cannot be done without the development of either nationally defined norms of service or calculations of the costs of meeting needs in different regions. Finally, it is emphasised that empirical investigations into equity will lead nowhere unless the political will exists to supply services fairly, regardless of the user's race, religion or place of residence.