ABSTRACT
Two major healthcare reforms have been attempted in Fiji. The first was radical and ambitious, but failed to be supported by Ministry of Health (MoH) personnel and was eventually abandoned. The second, more successful, reform, was tailored to local context. In 2009, a less ambitious decentralization program was initiated, aiming to improve access to primary care through the strengthening of health centers in the Suva subdivision, accounting for approximately one-quarter of Fiji's population. Fiji's constitution guarantees a right to health, which is reflected in universal health coverage with an emphasis on primary healthcare. Starting in 2009, first-contact care was decentralized from hospital outpatient services to the six health centers in Suva subdivision in order to enhance both access to health services and the responsiveness of primary healthcare, and to encourage the use of outpatient services. In Suva subdivision, decentralization has resulted in increased utilization of health centers, reflecting the increased availability of community-based services and removal of divisional hospital self-referrals.
