Working Group 8
MEETING BASIC NEEDS: EDUCATION, HEALTH AND HOUSING
[Terms of Reference]

BACKGROUND

Fiji must create a political, social and governance framework that, eventually, will be truly democratic, accountable, inclusive, equitable, non-racial and which unifies Fiji’s diverse communities as a nation.  The latter of which can be addressed by ensuring that all people are able to meet their basic needs, particularly in the areas of education, health and housing.

The role of the Working Group 8 is to:

(a) To conduct factual, diagnostic and analytical work on meeting basic needs in education, health and housing;
(b) To undertake any further studies or investigations on this topics; and
(c)  To summarize and report back to the NTT 3 on the deliberations and recommendations of the Working Group on this priority topics.

ISSUES

Human Development
The Human Development Index (HDI) is a widely accepted measure of a country’s progress in attaining satisfactory levels of education, health and income. The ranking is based on the value of the HDI, which is a weighted average of life expectancy, adult literacy and GDP per head. While Fiji remains above the average HDI value for all medium human development countries, its ranking has eroded over the years.  Fiji was ranked 61st in 1997, but slid to 92nd position out of 177 countries in 2005.

Education
Despite Fiji being on track to meet MDG 2, achieving universal primary education, primary school and net enrollment rates have decreased since 2000, and this trend is more prevalent among the Fijian community.  The 2004/2005 Employment and Unemployment Survey found that 10% of children aged 5-14 years were not attending school.  This may be due to the financial burden experienced by parents in sending their child to school, as well as the reduced incentive to do so. While enrolments to secondary school have been increasing (and higher for girls), this has not been matched by increasing demand for secondary school leavers. Most school leavers therefore have to find employment in the informal sector. Unfortunately, the school curriculum does not provide the necessary job skills for this type of employment. In addition, technical and vocational training is often not relevant to the opportunities that are available.

In addition ethnic differences have been observed in the performance of pupils in major external examinations, with indigenous Fijians tending to lag behind.  A possible reason for this performance may be due to different levels of spending on education by ethnic groups.  The 2002/2003 HIES revealed that Indo-Fijian families spent approximately 116% more per child on education than Fijian families.

Health
Health continues to be a growing and increasingly complex field of competing priorities from all perspectives – from the individuals to governments, businesses, health professionals and the health services system. A healthy and productive population is essential for sustainable economic development.

Health indicators have not improved as expected. Life expectancy has declined. The major causes of death are Non Communicable, or Lifestyle, Diseases. These are best treated by preventative, rather than curative measures.  However, funding for preventative programmes has been limited. The current method of financing of the health care system is not providing sufficient resources. Charges, and health insurance, are options to improve financing but these options could only be implemented if the poorest members of society retain access to health care.

Rising HIV and AIDS infections are a significant threat to the nation’s health. The necessary actions to reduce infections are well known but there has been insufficient resources and public awareness, in part because of cultural and religious barriers to open discussion of sexual practices.

Housing
The need to facilitate the availability of adequate, affordable and formal housing/land opportunities and options for urban and peri-urban living is an area of concern. The rural-urban drift for perceived better opportunities in employment, education and healthcare, coupled with the expiry of land leases, natural population increases, unavailability of accessible housing/land options with the constraints/limitations of urban structures and systems are the main causal factors in the development of informal or squatter settlements.

It is estimated that there are close to 100,000 people living in about 200 squatter settlements scattered throughout Fiji with a substantial number located along the Suva-Nausori corridor (about 82,350 people in 182 settlements – 2003).

TASKS

Education

• Formulating policies aimed at decreasing dropout rates and increasing completion rates at both primary and secondary levels of education. This could include policies on:
• Importance of non-formal and community education;
• Community and parent participation plus parental responsibility;
• Impact and methodologies;
• Training of teachers;
• Rotation of teachers;
• Incentives to teachers in rural areas.
• Assess the advantages and disadvantages of amalgamation of schools to improve efficiency and also to eliminate the concept of education institutions based on race.

Assessing the current methods of financing education noting the inability of many families to afford their children’s’ education.

Health

• Formulate policies to improve the quality of health care delivery which could include:
• Improving existing service delivery mechanisms to address the major health issues in Fiji (including primary health care emphasis, access to villages, community pharmacies, mobile clinic services);
• Options to improve health care financing whilst ensuring the poorest are not excluded from health services;
• Review of legislation covering such areas as hospital charges and fees, doctors and dentists; and
• Improving the terms and conditions of health professionals.

Housing

The working group is to comprise up to 20 members: of whom at least four are NCBBF members plus up to 16 others from government and non-government sectors. At least 10 of the 16 additional members are from the non government sector.  The Working Group would have the power to co-opt additional members as it sees fit.

TIMEFRAME

It is anticipated that the WG will be established and operational within a fortnight.

In consultation with the Head of TASS, the Working Group may request the preparation of literature reviews and commission Issues and Discussion Papers (IDPs) to assist in its deliberations.

The WG shall report back to NTTs at the latest by mid March 08 with its report(s) and recommendation forwarded for the preparation of the State of Nation & Economy (SNE) report.

LITERATURE REVIEW

A number of studies has been carried out in Fiji pertaining to Health, Housing and Education sector in Fiji.

Health
A Mid Term Review was done by the Australian Fiji Health Sector Improvement Programme (AFHSIP) to develop its Strategic Plan 2005-2008, with its goals being used in the revised National Strategic Development Plan for the health sector. AFHSIP is a five – year program of assistance commenced in January 2004. The report briefly summarizes critical issues such as governance, health information, rural health, clinical services, and management training and development.
A Study was also undertaken to assess the importance of implementing compulsory social health insurance scheme. This is due to limitation in the current health financing by government budget. So this new scheme will mobilize additional financial sources for health care.

References

• AusAID. (2006). Australia-Fiji health sector programme – mid term review. Suva: AusAID.
• Bazzola, G. J., Chen, H., Zhao, M., & Lindrooth, R. C. (2007). Hospital financial condition and the quality of patient care. Health Economics.
• Doorslaer, E., O’Donnel, O., & Rannan-Eliyaa, R. (2007). Catastrophic patments for health care in asia. Health Economics, 16, 1159–1184.
• Eggleston, K., Shen, Y.-C., LAU, J., Schmid, C., & Chan, J. (2008). Hospital ownership and quality of care: What explains the different results in the literature? Health Economics.
• Ensor, T. (1997). What role for state health care in asian transition economies? Health Economics, 6, 445-454.
• Jonesa, A., & Lopez, A. N. (2004). Measurement and explanation of socioeconomic inequality in health with longitudinal data. Health Economics, 13, 1015–1030.
• Klavus, J. (1999). Health care and economic well-being: Estimating equivalence scales for public health care utilisation. Health Economics, 8, 613-625.
• Lindelow, M. (2006). Sometimes more equal than others: How health inequalities depend on the choice of welfare indicator. Health Economics, 15, 263-279.
• McKay, N. L., & Deily, M. E. (2007). Cost inefficiency and hospital health outcomes. Health Economics.
• Norindr, S. (2007). Fiji poverty report. Suva: UNDP.
• Onwujekwea, O., Hansonc, K., & Fox-Rushby, J. (2006). Some indicators of socio-economic status may not be reliable and use of indices with these data could worsen equity. Health Economics, 15, 639–644.
• Schneidera, P., & Hanson, K. (2006). Horizontal equity in utilisation of care and fairness of health financing: A comparison of micro-health insurance and user fees in rwanda. Health Economics, 15, 19-31.
• Sepehria, A., Sarmab, S., & Simpson, W. (2006). Does non-profit health insurance reduce financial burden? Evidence from the vietnam living standards survey panel. Health Economics, 15, 603–616.
• Tien, V. (2003). Social health insurance in fiji. Suva.
• Wagstaffa, A., & Doorslaer, E. (2004). Overall versus socioeconomic health inequality: A measurement framework and two empirical illustrations. Health Economics, 13, 297-301.
• Wildman, J. (2001). The impact of income inequality on individual and societal health absolute income, relative income and statistical artifacts. Health Economics, 10, 357-361.

Education
The Fiji Education Sector Programme progress report details succinctly the major projects undertaken under this programme and its outputs. The projects mainly covered areas such as improving the infrastructure, capacity building and enabling environment, quality and adequate resources and materials, effective and efficient processes and mechanisms and community building through education and partnerships.

References

Housing
The Urban Growth Management Plan (UGMAP) prepared under ADB TA 3243 – Fiji by ADB consultants demonstrates the seriousness of the housing problem especially in the greater Suva-Nausori corridor.