Government has just given up
Health in the Balance
The Government has just given up
by Prof. Biman Prasad, NFP Leader
Opinion piece published in the Fiji Times on:
Saturday 27th November 2021
Fiji has just come out of its worst public health disaster in its 50 years as an independent country. That disaster once again exposed the all too clear weaknesses in our health system, including our public health management.
695 people died directly of Covid-19. We do not know how many hundreds more died because the health system, overrun by Covid demands, could not give them proper care.
Zero on health
So it is all the more shocking that, last Monday, there was nothing in the President’s speech at the opening of Parliament about health and how Government plans to halt the state of decay in Fiji’s health system.
The National Federation Party has moved a number of motions on health in Parliament since 2014. We have continued to ask questions on both key aspects and the smaller details – the lack of a functional boiler at Fiji’s biggest hospital, or why Levuka Hospital has had no lab technician for an extended period.
Those details are the people’s reality of the failures at Ministry of Health headquarters.
We have called for an inquiry into the appalling health facilities and services. All our calls have been systematically ignored by the government.
The Government has talked endlessly about the “Public Private Partnership” (PPP) with FNPF and the Aspen Australia group to manage Ba and Lautoka Hospitals.
It first announced it in March 2018 and made a big deal about it before the 2018 General Election. Three years later, it is still talking about it.
Earlier this month the visiting Australian International Development Minister, Senator Zed Seselja, told the media: “I was excited to be briefed about the public-private enterprise between the Fijian Government and Aspen, an Australian company that comes from my hometown of Canberra and has done some great things around the world.”
“I am really looking forward to seeing how that partnership sees improved facilities in Lautoka. They were certainly telling me that they hoped to be commencing very soon.”
Perhaps Senator Seselja should curb his excitement. He needs to be better briefed by his Fiji diplomats about “the reality of the matter”. Three years since this initiative was first announced, and we remain none the wiser.
In the meantime the newly-built Ba hospital has lain idle for the same three years. It is already falling apart. Additional funding will also be needed to fix it before operations there can even start.
What's the deal, FNPF?
FNPF is a key investor in this partnership. FNPF is also the custodian of tens of thousands of Fiji citizens’ retirement funds (or perhaps what is left of them). So why is it not telling us what is going on?
FNPF must clearly lay out its plans, a timetable and the amount of investment required, as well as a transparent due diligence report on the likely return on investment, that FNPF members can expect for Ba and Lautoka Hospitals. FNPF also needs to tell the people how much it has already invested.
There is no excuse for secrecy or confidentiality. It is not like there are any competitors for this investment.
Is ASPEN being supported by the Australian government? Is the Australian Government also contributing separate funding for this partnership, because of our so-called Vuvale ties?
All we have heard so far is that discussions have been on-going. “Ongoing discussions” is about all the Fiji First Government is good for.
PPPs: Yes or no?
We have warned the government and the FNPF earlier about the risks involved in Public Private Partnerships, especially in the management of hospitals and medical services.
Our concerns were echoed at the Human Rights Council's 47th session in June, 2021.
At that meeting the UN Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, tabled a report on his November 2019 visit to Fiji.
His executive summary of the report made the following pointed observations:
"While Fiji has initiated public-private partnerships in the health sector, the delegation of State’s duties to private providers does not absolve the State of its human rights obligations,” he said.
“Any public-private partnership should provide sufficient guarantees for the protection, respect and realization of the right to health, ensure transparency and participation and be backed by strong regulatory, monitoring and accountability mechanisms."
In Australia there have been five major health PPP failures in the 1990s. These failures cost taxpayers’ tens of millions of dollars to clean up. The five Australian experiences illustrate the risks involved in entering into these arrangements.
The notion that the private sector is always more efficient than the public sector is both a myth and a dangerous approach to public health. Health is not a matter of boom or bust. It is a human right, particularly in a country such as ours where most people cannot afford private health care.
There is a difference between a health business and a retail business. If a phone company or a burger shop goes bust, there are fewer phones or burgers for consumers to choose from, but otherwise, life goes on. But when a hospital or health facility fails, that is not the end of it.
Every day, people are still getting hurt and needing treatment; babies are still being born; and patients who need dialysis or diabetes medication still need to be helped.
And so the overseas experience has been that governments have to quickly come back in to clean up after the failed PPP, which has taken its profits in the good times and disappeared in the bad times.
That is why we need transparency in what is going on with this partnership.
This Government is notorious for announcing big projects before elections which then never happen. So are the recent announcements just another pre-election gimmick? All we have is talk. We have no information and we certainly have no action.
Starting from Jerusalem
The Covid-19 crisis has distracted us from the reality of how poor our basic health facilities are. Now, as it subsides, the same reality is returning.
We receive phone calls and emails on a daily basis about serious issues in the hospitals and health centres.
Hospitals lack basic medicine. The government cannot even organise a consistent supply. Urgent tests cannot be done because of a lack of basic testing equipment and materials.
Anything above basic outpatient care is becoming a challenge, including kidney dialysis in the Western Division.
The angiogram at CWM hospital is not working. Heart patients requiring immediate medical attention and those who don’t have medical insurance are at the mercy of public hospitals.
Earlier this month NFP issued a statement about the non-functional angiogram at CWM, the only public hospital to offer that service.
Four days after the statement, it was reported in the media that the angiogram was fixed. However, we are told by patients this week that it is still not working and that appointments for angiogram services still cannot be made.
Patients need health care, not media management.
We are told patients requiring tests relating for kidney ailments are referred by CWM hospital doctors to a private specialist. So those with money or insurance can get tests done outside of the public hospitals. But the majority of people cannot -- and these include families living below the poverty line. Many simply die - the ultimate consequence of lack of treatment and facilities in the hospitals.
Hospital buildings are in such a shocking state that it is impossible even to keep them clean, a basic need for any health facility. Doctors, nurses and patients and their families highlight to us the decay in their buildings, hoping we can bring attention to this.
Many families of patients tell us that they only find out how bad hospital facilities are only when they end up there.
If you are poor and uninsured you are in a worse situation. Lack of simple medicines, equipment and diagnostic facilities is literally condemning people to death.
They have given up
How has it come to this? We know. Our government is focused on photo opportunities, globetrotting and handing out freebies. It does not care what takes place out of sight of the cameras.
The government’s disastrous Covid-19 measures led to Fiji having world-beating infection rates, with hundreds of deaths – both from the disease and from denied health care. It overwhelmed and hollowed out our health system.
Months ago, however, we received hundreds of millions of dollars from Japan, Australia and New Zealand in loans and grants. We continue to get this money. How much of this money has been re-invested in our health system?
From what we can see, the Government has just given up. We need a fresh approach to our health system, focused both on meeting people’s immediate needs and long-term prevention of the basic NCDs that continue to burden our hospitals, health centres – and families.
That will not come from the Fiji First Party.
Professor Biman Prasad is the leader of the National Federation Party. The views expressed in this article are not necessarily those of The Fiji Times.