Wave Upon Wave: Fiji's Experiments in Decentralizing Its Health Care System.

Abstract

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