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Lower-middle-income countries

A general tax-funded health system in Fiji provides universal health coverage

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Wayne Irava, of The Centre For Health Information, Policy & Systems Research in the College of Medicine, Nursing and Health Sciences at Fiji National University, wrote an assessment of his country’s progress towards UHC for GNHE.

You can read the full assessment here.


Here are the author’s main conclusions:

  • The Fijian health system is largely publicly financed: 66% of total health expenditure was funded through general taxation in 2012.
  • The progressive nature of direct taxes ensures that general taxation is progressive overall.
  • Out-ofpocket expenditure as a share of total health expenditure, while having increased over the past few years, remains relatively low (at approximately 22% in 2012).
  • This out-ofpocket expenditure was largely incurred by people in the higher income brackets of society.
  • What is more, there is very little fragmentation of pooling mechanisms in Fiji. The large majority of health funds are pooled and managed by the Ministry of Health. This integrated pooling enhances income cross-subsidies.
  • Health financing in Fiji is therefore equitable. This indicates that those with the worst ability to pay for health care bear the lowest financing burden (and vice versa).
  • Further, the financial protection indicators of catastrophic health care expenditure and impoverishment due to health care spending are both very low. This means there is a low incidence of households pushed into poverty because of having to pay for health care.
  • With respect to equity of access, government funds are used to provide health services across the range of public health providers at little or no cost to the population. Public facilities provide the majority of outpatient services and the vast majority of inpatient visits.
  • However, because the Ministry of Health is both the pooling organisation and the provider of the majority of health services, there exist inefficiencies that reduce the effectiveness of the Ministry to better address the health care needs of the population.
  • In addition, the skewed distribution of public health services results in better access to health services for the population living in urban areas compared to residents of remote and rural areas.
  • This is aggravated by the small but growing private sector that mainly provides curative outpatient health services in urban areas, on an out-of-pocket basis.
  • In summary, Fiji’s existing health financing system provides a good foundation for achieving Universal Health Coverage goals.


Irava W. 2015. Universal health coverage assessment: Fiji. Global Network for Health Equity (GNHE). Available at: