The path to the Human Right to healthcare in Fiji is at risk

Reports from clinical nurses showcased the effectiveness of public sector healthcare in Fiji; healthcare professionals demonstrating innovation and quality improvement cycles in the care they provide.  Examples included the effective role out of a mass immunisation programme, delivered effectively and efficiently at short notice to deal with an outbreak of an infectious disease.  A number of reports outlined the success of culturally based models of nursing care, and how Pacific Island nurses are leading the way across the region in this respect.  There was a report on the utilisation of Motivational Interview techniques and the positive impact that this approach is having for people with non-communicable diseases (NCDs).  Nurse and midwife led reviews reflected aims to decrease surgical wound infection rates and the rate of babies being born before arrival to hospital.  These reports gave hope that Fiji might achieve the SDGs and the recognition of the human right to health.

But in Fiji the human right to health is at risk at the hands of global actors.  One such example is the West’s inaction on climate change.  This is seeing the loss of arable land across the Pacific as waters rise.  Increases in the severity and rate of cyclones are causing damage to property, loss of crops and increasing rates of infectious diseases.  The rate of meningococcal infections is increasing exponentially in Fiji, another clear indicator that developing and small nations carry the costs of inaction by large wealthy nations like Australia.

Another actor is the increasing influence multinational companies are able to exert through free trade agreements.  These trade agreement open the door for increasing amounts of cheap, highly processed and high fat foods to be imported into the Pacific Islands.  Some of the highest rates of NCDs, which are linked to poor diet, are found across the Pacific Island nations.  Despite this free trade agreements have been criticised for decreasing the capacity of local, healthier, food producers and making it harder for governments to limit the import of unhealthy food like turkey tails and lamb flaps.

Perhaps amongst the most devastating reports at the symposium related to the growing incidence of chronic kidney disease (CKD), often the outcome from high sugar, high salt diets linked to NCDs.  This life threatening condition is affecting more and more young people in Fiji.

The life saving symptom management for CKD is renal dialysis.   In Fiji however renal dialysis is only provided free of charge when you are so ill that you need to be in the Intensive Care Unit (ICU).  Once the ICU care team has stabilised your condition, you are transferred to the wards.  But you won’t receive any further dialysis unless you can afford $750 per week, which is well beyond the reach of most.  This leaves many families in Fiji with no choice but to decline on-going treatment.

People in Fiji are dying for a lack of affordable access to dialysis – this is exactly what the SDGs are trying to prevent as we pursue global commitments to the human right to health through universal access.  Of course Fiji is not alone in this.  Many communities across the region are impacted by the lack of access to treatment due to cost.

In searching for answers Pacific Island nations are discussing primary health care measures to lower the incidence of NCDs.  A presentation by the World Bank’s Eva Jarawan[1] argues that that there are four key actions that countries can take including tobacco control, reducing unhealthy food and drink, improving the efficiency of existing health dollars and strengthening their evidence base to ensure resources are used well.  But often free trade agreements prevent the first two actions being utilised effectively.  What of the other two measures?

We know that the best way to attain universal healthcare and achieve our sustainable development goals is through government owned and run public healthcare.  The evidence for this is strong; Medicare, the NHS (before it was decimated by the current UK government) and similar systems across the globe.  They have been proven to be more efficient and effective that the private sector.

There is strong evidence too that shows investment in healthcare and the healthcare workforce adds to the economy.  It creates jobs and sustainable development.  In other words, healthcare should be seen as a government investment, not expenditure.  But another global trend, austerity and privatisation, are wrecking public healthcare systems.  And privatisation is the latest global force set to wreak havoc on Fiji.

Nurses have confirmed that at least three of Fiji’s public hospitals (Lautoka, Ba and Labasa) are to be privatised.  Fiji’s Minister for Economy and Attorney-General Aiyaz Sayed-Khaiyum argues that the government “are now going to offer, through the PPP (public, private partnership), a range of services that are currently unavailable”.  Other news reports link the privatisation to an attempt for Fiji to cash in on the health tourism industry.  The proposal is for the government, the Fiji National Provident Fund (workers capital) and an “international certified hospital” to be the partners.

Workers capital funds and private operators have one key shared interest; to make a profit.  Companies are eager to collect government funds, tax-payers money, and user “out-of-pocket” payments from the patients for service provision.  This is why they want to invest in healthcare through privatisation.

But there is little evidence to show that privatisation maintains, let alone improves, healthcare provision for the bulk of people in the community; even in developing nations.  The opposite is true.  There is growing evidence that the privatisation of public hospitals leads to failures; failures that have both economic and human costs.

Australia ranks as one of the top three privatising nations in the world but continues to have poor experiences of healthcare privatisation.  At least six hospitals that were privatised, including through PPPs, have had be brought, or bought, back into government ownership.  Other partial privatisations, such as the privatisation of sterilising, cleaning and porters, have also failed, leaving the public sector to clean up the mess.

The privatisation failures arose due to poor contract design and management, and cost overruns for the private provider leading to cuts in staff, services and quality.  Examples of the failures to the public have included:

• Hundreds of public patients were left waiting over a year for surgery as private patients were prioritised
• Loss of services to the community
• At one hospital 172 patients acquired infections due to poor cleaning services, at another poor services led to massive delays in transferring patients out of the Emergency Department causing bed block
• Alleged breaches of laws regulating the administration of medicines due to insufficient nursing numbers at a privatised gaol

If a wealthy, resource rich country, so adept at privatising assets and services as Australia is can’t get the privatisation of healthcare right, what chance do developing and small nations have?

The health tourism proposal is also worrying.  Health tourism sees rich overseas visitors accessing their care needs in developing and small nations, cheaper and quicker than they can at home.

Health tourism is widely criticized by civil society organisations as it drains resources away from the local population.  Often the new hospitals or wings built for this purpose are not open to locals.  It creates an economic drain as publically-trained healthcare professionals are utilised by the private provider, for wealthy patients, rather than providing quality care to the broader community.

It is clear that the only people who benefit from healthcare privatisation are the companies, their shareholders and their bankers.  The only way profit can be made from public healthcare is either through cutting services, cutting corners, or cutting staffing levels.  Nurses have already been placed on individual contracts with yearly appraisals that can affect their pay.  This will make it easy for their new private sector employer to cut the workforce at will.

These are the types of facts and evidence that the people of Fiji need access to if they are to heed Eva Jarawan’s third and fourth action items.  The people of Fiji, like others across the Pacific Islands, cannot properly fight the rising waters and the rising tide of NCDs whilst climate change, free trade agreements and privatisation are undermining the SDGs.

There is wind of a Fiji election in the air.  The Government has flooded Suva with billboards that declare “Embrace Truth, Reject Lies”.  The truth and lies about healthcare privatisation need airing in Fiji so that the community can decide how their healthcare is provided.

The nurses closed their symposium by talking about the need for resilience – they’ll certainly need resilience if they are to turn the decision to privatise the hospitals around, but their determination to speak out gives hope.  Hope not only for the healthcare system of Fiji, but to the broader union and public healthcare movement.  The FNA’s determination to speak out against the privatisation in the face of adversity is inspiring.  They are following the recent lead of nurses in India, New Zealand and Australia in taking firm action for the human right to health.