Patient choice forms a key part of health service improvement and forms a major determinant in patient health care delivery. At a time when the population of Fiji has access to 24 hour banking services and extended supermarket services, the outpatient services at health centres remained in the eight hour access, from 8am to 4.30pm. The Valelevu, Makoi and Raiwaqa health centres have been providing extension of service hours from 6.30am to 10pm on weekdays and 8am to 4pm on weekends, from 2nd March and 15th April, 2009, respectively. Ths concept is to be extended to all six health centres in the Suva Sub-division from the 31st of January 2011. Decentralization is about making services more accessible to the community, in other words, bringing the services closer to where people reside. A study of the health facilities in the Suva Sub-division are provided with statistical analysis and needs for future expansion of health facilities with the necessary infrastructural improvements or developments, staffi and medical supplies. The report provides recommendations to operationalizing the decentralization process by 46.4%. Th average number of patient arrivals for year 2010 was 7637 patients per month (251 patients/day) and for 2011 it was 4095 patients per month (135 patients/day). In 2010 the trend for patient arrivals has been a plateau whereas in 2011 a gradual decline reaching to a steady state of patient arrivals from September till the month of December was seen.

Objectives: To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15–49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs). Methods: The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995−2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas. Results: Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sen sitivity analyses. Discussion This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO’s Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.

Introduction: Dengue virus serotype-3 caused a large community-level outbreak in Fiji in 2013 and 2014. We aimed to characterize the demographic features of affected individuals and to determine dengue mortality during the outbreak. Methods: All laboratory-confirmed dengue cases and deaths were included in this study. Incidence and mortality were calculated according to demographic variables. Results: A total of 5221 laboratory-confirmed cases of dengue were included in this analysis. The majority of patients were male (54.5%) and indigenous Fijians (iTaukei) (53.5%). The median age was 25 years old. The overall incidence was 603 per 100 000 population. The age-specific incidence was highest among people between 20 and 24 years of age (1057 per 100 000) for both sexes. The major urban and peri-urban areas of Suva and Rewa subdivisions reported the highest incidence of >1000 cases per 100 000 population. A total of 48 deaths were included in this analysis. The majority of dengue-related deaths occurred in males (62.5%) and in the iTaukei (60.4%) population. The median age at death was 35 years old. The overall dengue-related deaths was estimated to be 5.5 deaths per 100 000 population. Dengue mortality was higher for males (6.8 per 100 000) than females. The highest age- and sex-specific mortality of 18 per 100 000 population was among males aged 65 years and older. Discussion Dengue morbidity and mortality were highest among males, indigenous people and residents of urban and peri-urban locations. Effective and integrated public health strategies are needed to ensure early detection and appropriate outbreak control measures.