MoHMS continues to be challenged by losing its older and more experienced staff to retirement at age 55. High staff turnover in MoHMS, and also to a certain extent in FHSSP, has meant posts have been vacant and new staff have had to be ‘brought up to speed’. Not surprisingly, the Program has struggled to find traction where the policy environment has been weak. Although progress has been made on the CHW Program, sustainability in this area is questionable and Objective 3 on NCDs has had limited impact partly because the Ministry has been evolving its thinking on ‘wellness’” but also because the wider policy environment vis a vis NCDs, beyond that controlled by MoHMS, means that making an impact on NCDs is challenging. Throughout the Program, interventions dependent on infrastructure have been problematic. Objectives 1 and 3 have suffered from this, and the Program did well to contend effectively with the request to fund a new birthing centre. An ongoing issue is the failure of MoHMS systems to fund the equipment needed for people to do their jobs. Often FHSSP was asked to fund procurement of basic equipment because it was easier than waiting months for the system to provide. This is neither sustainable nor a strategic use of project funds. Recommendations for the next phase of DFAT funding These recommendations have been selected to inform the design of the next phase of DFAT funding for health in Fiji. In depth analysis of the recommendations, their prioritisation and feasibility should be undertaken during the design phase. Strategic framework The United Nations’ Sustainable Development Goals should help to frame the priorities for the Program including Goal 3, Good Health and Well-Being, (reducing maternal mortality, ending preventable deaths of newborns and children under five, reducing premature mortality from NCDs, increasing health financing, building capacity to deal with national and global health risks and addressing HR shortages), Goal 5, Gender Equality (access to sexual and reproductive health and reproductive rights, end discrimination, opportunities for leadership) and Goal 16 Strong Institutions (Effective accountable and transparent institutions). The forthcoming Health National Strategic Plan 2016 – 2020 should also frame engagement by the Australian aid Program. Continuity from FHSSP Continued support to health information will be important to underpin any efforts in health systems strengthening. FHSIP and FHSSP have made a very important contribution to helping MoHMS improve its M&E, and the future Program should continue to support a growing results focused culture.
The report will be no more than 40 pages (plus annexes). The report will include an executive summary of up to 2 pages, key findings and conclusions, and recommendations. Annexes should include these terms of reference, the final evaluation plan, consultations undertaken, documents reviewed and any other information the consultants deem relevant and useful. All reports will be in Microsoft Word format. Annex A: Key Documents FHSSP Design Document (2011-2016) FHSSP Quality at Implementation Reports FHSSP Activity Quality Check Report FHSSP Annual Reports FHSSP M&E Framework FHSSP Program Coordinating Committee Minutes Annex 2: References No. Date Document Name Author 1996 ‘Great Ideas Revisited’, Training & Development , Vol. 50, No. 1 Donald Kirkpatrick 2008 The Paris Declaration on Aid Effectiveness and the Accra Agenda for Action OECD DAC 19 Jul 2010 Fiji Health Sector Improvement Program (FHSIP): Independent Completion Report Paul Freeman & Ross Sutton Sep 2010 Fiji Health Sector Support Program Design Document David Wilkinson, Lynleigh Evans, Ross Sutton 23 Nov 2010 Fiji Health Sector Support Program Design Document - Final David Wilkinson, Lynleigh Evans, Ross Sutton 28 Mar 2011 Subsidiary Arrangements for the Australian Government’s Bilateral Health Assistance to Fiji: 2011-2015 DFAT 2011 Shaping Fiji’s Health: Strategic Plan MoH Nov 2011 Fiji Budget Estimates 2012 GoF 2012 DFAT’s Fiji Country Strategy 2012–14 DFAT 2012 Fiji Health Sector Support Program 2011 Annual Report FHSSP Team 09 Mar 2012 Fiji Health Sector Support Program Technical Advisory Group: Review of Mobilisation Phase and Appraisal of QAI Report David Wilkinson, Sara Webb & Cate Keane March 2012 Quality at Implementation Report for Fiji Health Sector Support Program DFAT
October 2012 Proposal to FHSSP for consideration for funding – evaluation of pneumococcal conjugate fight vaccine, rotavirus vaccine and the human papilloma virus vaccine immunisation Program in Fiji MCRI 2013 Fiji Health Sector Support Program 2012 Annual Report FHSSP Team March 2013 Quality at Implementation Report for Fiji Health Sector Support Program DFAT March 14, 2013 Draft No 4 Fiji Health Sector Support Program Monitoring and Evaluation Framework FHSSP Team 27 May 2013 Fiji Health Sector Support Program Technical Advisory Group: Mid-term Review David Wilkinson, Sally Duckworth &Cate Keane Nov 2013 Fiji Budget Estimates 2014 GoF Dec 2013 Fiji - Maternal Health Services Review and Strategic Action Plan Dr Janet Hohnen & Mary Bythell Dec 2013 Pacific Regional Health Program Delivery Strategy 2013-2017 DFAT 2014 Quarterly Performance Reports for the Provision of Hospital Based Psychosocial Support Services, Quarters 1-4, 2014, Empower Pacific March 2014 Fiji Health Sector Support Program 2013 Annual Progress Report FHSSP Team March 2014 Quality at Implementation Report for Fiji Health Sector Support Program DFAT 9 May 2014 High Level Strategic Review: Fiji Health Sector Support Program -Final Report Gillian Biscoe & Carol Jacobsen June 2014 DFAT Monitoring and Evaluation Standards DFAT 20 Oct 2014 FHSSP – six-month workplan: July – December 2014 (final) FHSSP 29 Oct 2014 Aid Program Performance Report 2013-14: Fiji DFAT Nov 2014 Fiji Health Sector Support Program – monitoring and evaluation plan. Draft release 5.0 FHSSP 11 2014 Nov Fiji health sector support Program – annual workplan: January – December 2015 FHSSP 25 Nov 2014 Program exit strategy FHSSP 4 Dec 2014 Research Project Agreement: New Vaccine Evaluation Project MoHMS & Murdoch Children’s Research Institute
Dec 2014 FHSSP Newsletter FHSSP 2015 Fiji Aid Investment Plan (2015/16 to 2018/19) DFAT 2015 Fiji Health Sector Support Program – progress report: July – December 2014 FHSSP 2015 Fiji Community Development Program (FCDP): Achievements of the First Three Years FCDP 5 March 2015 Fiji Health Sector Situational Analysis 2014 Ashleigh O’Mahony May 2015 Monitoring & Evaluation: Research Fundamentals, applied learning. M&E Resource Network Facilitator’s Guide, Version 1.1, FHSSP 15 June 2015 Health for Development Strategy 2015–2020 DFAT May 2015 Aid Quality Check for FHSSP DFAT 2015 Aid Investment Plan Fiji 2015-16 to 2018-19 DFAT 23 Sept 2015 Fiji Health Sector Support Program – Program progress report: January – June 2015 (draft) Oct 2015 Australian Aid to Fiji DFAT 16 Oct 2015 Address to Australia Fiji Business Forum, delivered in Sydney The Hon Steven Ciobo MP, Minister for International Development and the Pacific Nov 2015 Fiji Country Brief DFAT Nov 2015 Overview of Australia's aid Program to Fiji DFAT Nov 2015 Improved human development in Fiji DFAT Nov 2015 Community Health Worker Policy MoHMS Nov 2015 FHSSP Exit Strategy FHSSP Nov 2015 Fiji Budget Estimates 2016 GoF Nov 2015 Program Handover Plan FHSSP Dec 2015 Financial report summary, July 2011 – Nov 2015, FHSSP, FHSSP Undated The New Vaccine Evaluation Project, Fiji Health Sector Support Program and the MCRI
Friday 20 November Central and Eastern Divisional Plus Meeting Presentation by Leah Ekbladh MoHMS, Central & Eastern Divisions 24 Kelly Robertson Program Administrator FHSSP F 25 Dr Rachel Dewi, Former National Adviser Family Health Formerly, MoHMS F 26 Josua Ligairi Senior Project Officer, Targeted NCDs FHSSP M 27 Rita Reyburn Epidemiologist Murdoch Children's Research Institute F Saturday 21 November 28 Marybeth Sarran Workforce Development Adviser FHSSP F Sunday 22 November 29 Douglas Glandon M&E Adviser FHSSP M 30 Karen Kenny Corporate Representative (and former Senior Program Administrator) AbtJTA F Monday 23 November 31 Dr Inosi Voce Consultant Gynaecologist Labasa Hospital M 32 Sr Tavaita Suraki Matron & Manager Nursing Labasa Hospital F 33 Sr Matelita Kadin CHW Champion Macuata, Northern Division F 34 Glenda Cawaru CHW Macuata, Northern Division F 35 Dr Ashneel Prasad Medical Officer Seaqaqa Medical Centre M 36 Sr Katherine May Degi Sister in Charge Seaqaqa Medical Centre F 37 Sr Salote Tikoibua Zone Nurse Nabalebale Nursing Station F Tuesday 24 November 38 Dr Kusitino Saumalua SDMO Savusavu Hospital M 39 Sr Tarisi Racule Sister in Charge Savusavu Hospital F 40 Sr Ateca Lepper Sangam School of Nursing & formerly SDHS, Savusavu Savusavu Hospital F 41 Sr Loata Pio CHW Champion Cakaudrove, Northern Division F 42 Tirisa Viti CHW Nabaka Settlement F 43 Vivita Vasaqa Northern Operations Officer FHSSP F
Wednesday 25 November 44 Joanne Choe Counsellor, Fiji and Tuvalu aid Programs DFAT F 45 Dr Luisa Cikamatana A/g Deputy Secretary Hospital Services MoHMS F 46 Dr Eric Rafai Deputy Secretary Public Health MoHMS M 47 Muniamma Goundar A/g Director, Policy and Planning MoHMS F 48 Atelini Wainiveikoso Program Manager, MCH FHSSP F 49 Amini Mucunabitu Program Manager, Health Systems FHSSP M 50 Naomi May Program Manager, CHW FHSSP F 51 Nanise Raika Director, Workforce Development MoHMS F 52 Dr Lisi Tikonduadua Consultant paediatrician and former and Head of Paediatric Department CWM Hospital, Suva F 53 Dr Ilisapeci Tuibeca Consultant paediatrician and Head of Paediatric Department CWM Hospital, Suva F 54 Sr Silina Waqa National Director of Nursing Services CWM Hospital, F 55 Apolosi Vosanibola Chief Pharmacist CWM Hospital, M 56 Don Lewis Short-Term Adviser, Health Information Systems FHSSP M 57 Shivnay Naidu Director, Health Information, Research and Analysis (DIRA) MoHMS M 58 Mary Bythell Health Data Specialist MoHMS F Friday 27 November 59 Dr Isimeli Tukana National Adviser, NCDs & Wellness MoHMS M 60 Sr Vositi Vatuwaqa Midwife Sigatoka Hospital F 61 Shinya Matsuura Project Formulation Adviser Wellness Centre, JICA M 62 Kozue Shimizu Project Officer Wellness Centre, JICA F 63 Nila Prasad Program Officer JICA Fiji Office F
Annex 9: FHSSP: Results Table Latest available data (incomplete) from Sept 2015, Fiji Health Sector Support Program – Program progress report: January – June 2015 (draft) Strategic Approaches End-of-Program (EOP) Outcome Progress indicator or evaluation Baseline (date) Target (date) Latest results Objective 1 – Safe Motherhood Early and adequate antenatal care 1.1 MoHMS sustains behaviour change campaign to promote early booking Percent (%) of pregnant women with first ANC visits in the first trimester 0% 2012 15.7% 2015 22% Q1, 2015 Percent (%) of mothers with at least 4 ANC visits 39% Q2, 2014 50.6% 2015 59% Q1, 2015 Safe pregnancy, motherhood and childbirth 1.2 MoHMS sustains Mother Safe audits in hospitals to guide improvement in care Percent (%) adherence to MSHI standards in FHSSP targeted hospitals 36% average Q4, 2013 39% average Q2, 2014 Nadi, Sigatoka, Nausori , CWMH, Lautoka, Labasa 80% CWMH, Lautoka and Labasa 60% Nadi, Sigatoka Nausori (2015) 61% average for CWMH, Lautoka, Labasa 69% average for Nadi, Sigatoka, Nausori (Q2, 2015) 80% of all cardres of maternity staff are trained by facility: EmONC BPP/CRP EmONC 0% (Q2, 2014) BPP/CRP 0% (Q2, 2014) 100%, 6 out of 6 targeted hospitals meet the MSHI standard for EmONC and BPP/CRP (Nadi, Sigatoka, Nausori, CWMH, Labasa, Lautoka) (2015) EmONC and BPP/CRP – 83% 5/6 target facilities have met the MSHI standard: Nadi, Nausori, Sigatoka, CWMH, Labasa hospitals (Q2, 2015)
Percent (%) adherence to MSHI standards in all hospitals comprising 3 divisional hospitals and 15 subdivisional hospitals and to specialise maternity facilities (20 facilities in total) 44% average for all SDH (Q4, 2013) > 60% adherence in 10/19 SDH (2015) TBC, this information will be available in quarter 4, 2015 in line with MoHMS audit schedule for facilities Percent (%) adherence to MSHI standards in all (divisional) hospitals 25% for divisional hospitals (Q2, 2014) > 80% adherence in 3/3 divisional hospitals (2015) 61% average for divisional hospitals – CWMH, Lautoka, Labasa (Q2, 2015) Safe and effective post-miscarriage services 1.3 MoHMS sustains effective post-miscarriage services Staff training adequacy in MVA, by facility (Q2, 2014) Labasa – 2 CWMH – 4 Lautoka – 3 Nadi – 1 Sigatoka – 1 Navua – 1 Nabouwalu – 1 Dreketi H/C – 1 Not applicable Labasa – 8 CWMH – 5 Lautoka – 5 (Q2, 2015) Objective 2 – Child Health Childhood immunisation for rotavirus and pneumococcal disease 2.1 MoHMS fully funds pneumococcal & rotavirus vaccines Total amount (FJD) of annual MoHMS funding towards vaccines FJD 434,043 July 12 – July 13 FJD 1,312,628 July 13 – June 14 FJD 1,728,017 % MoHMS contribution for 17% 50% 68%
vaccines relative to external funding July 12 – July 13 51% July 13 – June 14 July 14 – July 15 80% July 15 – June 16 July 14 – June 15 Percent (%) coverage for RV immunisation 0% 2012 95% 2015 76.3% Q1, 2015 Percent (%) coverage for PCV 1 one immunisation 0% 2012 95% 2015 76.2% Q1, 2015 2.2 MoHMS conducts routine surveillance of pneumococcal & rotavirus vaccines - Outcome flagged by Program for transition to next phase of support 2.3 Vaccine evaluation results guide MoHMS procurement planning - Outcome flagged by Program for transition to next phase of support Consistent, high quality child health care 2.4 MoHMS sustains child health training and quality of care audits to guide improvement Staff training adequacy by facility: IMCI 26 targeted facilities, 60% of the nurses in each facility must be trained 46% (2013) 31% (Q2, 2014) 50% (Q4, 2014) 100% of target facilities (26/26) have 60% of the nursing staff trained on IMCI (2015) Data not yet available PLS subdivisional level: 16 targeted SDH facilities, 30% of the doctors and nurses need PLS 15% (2013) 31% (Q2, 2014) 15% (Q4, 2014) 30% of staff at SDHs (6/16 facilities) 50% of staff at Data not yet available
to SDH must be trained. Level a health centres: 12 target facilities Central 8 Eastern 1 Western 3 At least 50% of medical officers and nurses trained per facility H/C level trained (2015) APLS 3 divisional hospitals: all emergency medical doctors who take care of children should be trained per facility 17 subdivisional hospitals: at least one medical officer (DMO) trained per facility 8 level a health centres: at least one medical officer trained per facility 32% (9/28 facilities) (2013) 69% (Q2, 2014) 71% (Q4, 2014) 100% of facilities (28/28) have at least one MO trained (2015) Data not yet available WHO pocket book hospital care for children 17 subdivisional hospitals. (The facility is counted as covered if all medical officers and at least 50% of nurses are trained per facility) 15% (Q2, 2014) none of the facilities met the requirement in Q4, 2014 100% (17/17) of subdivisional hospitals (2015) Data not yet available Percentage of subdivisional hospitals adhering to WHO 0% (2013) 53% (9/17) (Q4, 100% (17/17) subdivisional Data not yet available
3.2 MoHMS routinely monitors diabetes screening coverage to target outreach - - - No information given 3.3 MoHMS sustains audits of diabetes centre minimum standards to guide improvement Percent (%) adherence to diabetes centre minimum standards for all MoHMS SOPDs (20 facilities) 2% average (2013) 14% average (2014) 15% 3 of the 20 targeted facilities (2015) MoHMS has fully taken over audits in phase 2. The tool for SOPDs audits is in the process of being reviewed and finalised. Cervical cancer prevention and screening 3.4 MoHMS sustains HPV vaccination for Class 8 girls and cervical cancer screening for women Total amount (FJD) of annual MoHMS funding toward HPV vaccines $225,487 July 12 – June 13 $387,780 July 13 – June 14 $517,041 July 14 – June 15 $631,939 July 15 – July 16 $517,041 July 14 – June 15 Percent (%) of MoHMS contribution for HPV vaccines relative to external funding 33% July 12 – June 13 52% July 13 – June 14 69% July 14 – July 15 85% July 15 – June 16 69% July 14 – July 15 HPV vaccination coverage among class 8 girls in school 0% (2012) HPV1: > 95% (2015) HPV1: > 100 % (Q1 2015) Cervical cancer screening coverage 8% (2004 – 2007) 15.8% (2013) 25.8% (2015) data not yet available 3.5 MoHMS monitors vaccine and screening coverage and assesses vaccine efficacy - - - No information given Objective 4 – Community Health Worker Network Standardised core 4.1 ≥65% of active CHWs Training coverage for core Curative figure – 65% 69% national
Ratio of vacancies to the establishment NU – 6.2% (154/2466) M0 – 28.5% (172/603) Dental – 24% (48/201) Dieticians – 28% (17/61) Engineering – 41% (9/22) HI – 11.3% (14/124) Lab – 7.3% (12/164) Physio – 14.3% (5/35) Radiology – 9% (8/87) Pharmacy – 21% (18/87) Admin – 19.6% (45/230) Accounts – 23.5% (4/17) IT – 33% (3/9) Stores – 16% (5/31) To maintain also cadres within 5 – 10% of establishment in any time over the year 654:4679 – 14% (Q1, 2015) Attrition rate for medical, nursing and administrative NU – 55/2279 NU:<2% of nursing NU – 38:1.4%