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.

Nausori Maternity Unit was declared a Baby Friendly Hospital in 2008 and has successfully maintained its status as such thus far. The objectives of this qualitative study was to conduct an internal audit into the BFHI at NMU through interviews, observation and hospital records, and secondly to make necessary recommendations to the Ministry of Health. 51 staf members, 128 mothers and 101 members from the general public were interviewed. The WHO BFHI internal monitoring tool was utilized in analyzing the results of the study. NMU met the criteria for 8 of the 10 steps in the breastfeeding policy. Step 2 requires that there be refresher courses for staf every 2 years; there has not been any refresher course since 2008. Step 10 requires that mothers be referred to breastfeeding support groups upon discharge; again NMU failed to comply. Ths, the overall compliance aftr the assessment came to 92%.

“Reduce Child Mortality” – the fourth Millennium Developmental Goal acknowledges the fact that major causes of child deaths globally is malnutrition and poor access to primary health care and infrastructure. Ths article aims to quantify the magnitude of malnutrition among children 0-5 years of age within the Tavua Subdivision from January 2010 to April 2012.

Patient waiting time is a real problem in Fiji and unfortunately Nadi Sub-divisional hospital is no exception. The objective of this study was to determine patient waiting time in the GOPD and SOPD clinic in the Nadi Sub-divisional Hospital, additionally to gauge patient satisfaction. Time logs were given to patients in order to log the time as the patient went through the diffrent management and investigation. Secondly a questionnaire was given to every 20th patient to measure their satisfaction with the services they received in GOPD and SOPD. The results showed that it took 2 hours and 57 minutes on average for a patient to be attended by a doctor in the GOPD clinic and 2 hours and 7 minutes in the SOPD clinic. 50% of all patients sampled believed that there should be more doctors and 36% complained of the shortage of drugs at the pharmacy. Any improvement to the quality of health care delivery in the Nadi Sub-Divisional hospital needs to include an increase in doctors as well as addressing how to prevent common drug shortages in the pharmacy department.

Suicide is an important public health issue in Fiji and described as a “chronic epidemic”, only recently surpassed by automobile fatalities as the leading cause of death in young people. A total of 1749 people had attempted or completed suicides with an average of 194 per year between 2002 and 2010 as per police records.5 Fiji has maintained one of the highest suicide rates in the world in young Fijian women of Indian descent along the sugar belt areas of Fiji, at one point being cited as the second highest in the world behind rural China8. Ths is a quantitative descriptive retrospective study on all cases of suicide and attempted suicide seen at the Ra Sub divisional Hospital (RSH) from January 2008 to August 2012. Data sources were obtained from the Rakiraki sub divisional hospital mortuary record book, hospital inpatient records and Rakiraki Police Departments’ records of all cases of deliberate self harm were also collected in the study period. Th overall prevalence of suicides and attempted suicides in Rakiraki of 0.12%. Ths is relatively a higher prevalence when compared to the national statistics. Thre is a higher predominance of suicides and attempted suicides in the IndoFijians, the youths, and in males as compared to females. Hanging and chemical ingestion were the commonest methods of suicide and attempted suicide in Rakiraki and these should be the main targets for prevention activities. Indo- Fijian females were reported mainly to have attempted suicides whilst Indo-Fijian males predominantly committed suicides in Rakiraki.

Health promotion is a process of enabling people to take control and improve their health. The concept was adopted by the Ministry of Health in Fiji in 1997, and gave birth to what is referred to as the “new primary health care” – the strengthening of the health promotion capacity of the existing primary health care system. Ths study aims to describe the impact of new primary health care on existing primary health care practitioners in Fijian villages, with the purpose of drawing implications on the processes that may be useful in other indigenous settings in Fiji. A case study was undertaken to reveal the impact of health promotion in a localized indigenous setting. The case demonstrated that indigenous Fijian settings are communally oriented and are affcted by three systems – tradition, Christianity and the Westminster systems of governance – all of which are potential platforms for health promotion. The study depicts that the major impact of the new primary health care on the practitioner pertains to the need to acquire health promotion knowledge, attitude and practice, and related understanding of community development and qualitative research. The acquisition of these knowledge and skills may then enable the practitioner to strengthen the health promotion capacity of his/her primary health care practice. In this way, an integrated and appropriate practice model has more chance of evolving and health outcomes will follow.

Objective: To collect evidence on the exposure, awareness and effct of ‘junk food’ advertising and sponsorship upon children and adolescents in Fiji. Method: A questionnaire was developed and used with a sample 88 primary school students and 103 secondary school students in Suva, Fiji and included questions about participants’ food preferences, nutritional knowledge and advert recall ability. Two free-to-air television channels were recorded for two weekdays and two weekend days from 6am-9pm, and the content analysed for advertised content. The amount of street advertisements in three defied localities was assessed. Sponsorship of events by ‘junk food’ products was assessed over the preceding twelve month period. Results: School children were able to identify multiple food products they had seen advertised. 94% reported that seeing adverts makes them want to try products. Seventy one percent had asked others to buy advertised products for them. There was evidence that food advertising contributed to incorrect nutrition beliefs. Levels of street and television advertising for ‘junk foods’ were high. Fourteen events sponsored by ‘junk food’ products were found to have taken place within one year of the investigation. Conclusions: Children in Suva remember but misunderstand the nutritional value of advertised ‘junk foods’. Their diets are altered detrimentally as a result. Implications: There is a need for a regulatory approach to limit ‘junk food’ advertising in Fiji.