The lasting effects of Fiji’s political upheavals of 1987, 2000 and 2006 on the country’s health system, have been examined in a major research study led by the Fiji National University (FNU), highlighting how disruptions to leadership, institutional capacity and preventive health services continue to shape the sector.
FNU has completed the Health Sector Chapter for the Fiji Truth and Reconciliation Commission’s (FTRC) Final Report, with the research led by the Acting Pro Vice-Chancellor Research and Innovation, Associate Professor Dr Donald Wilson, through the University’s Fiji Institute of Pacific Health Research (FIPHR).
Dr Wilson said the research provided an important opportunity to examine how political instability affected the people, leadership and institutional capacity of Fiji’s health sector, with lessons that remain relevant today.
“This research goes beyond documenting historical events. It examines how political upheavals affected the administration, professional capacity and delivery of health services, with consequences that continue to influence the health system today,” he said.
Completed within a demanding 10 to 12-week timeframe, the team produced a 7,980-word chapter, meeting the Commission’s stipulated 6,000 to 8,000-word requirement. The assignment also included a public summary, an annotated list of key policies and events across the three coup periods, a timeline documenting disruption and recovery, and a presentation for internal review.
The team also secured full ethical approval from the FNU’s College of Human Health Research Ethics Committee within the project timeframe.
The research drew on in-depth, trauma-informed interviews with 11 senior health professionals who held leadership positions during the political upheavals. Collectively, they brought more than 300 years of professional experience across nursing, medicine, allied health, laboratory services and public health administration.
To ensure the findings were robust, the interviews were anonymised and analysed using the framework method, with accounts cross-checked against official records and documentary evidence. The draft chapter also underwent peer review by experts nominated by the Commission before being presented at the public hearing.
One of the most significant findings was that the most enduring damage to the health sector, was largely administrative rather than directly linked to physical violence.
The research identified weakened institutional authority, insecure appointments and the loss of experienced professionals as key factors that disrupted leadership continuity, weakened succession planning and affected the sector’s ability to retain institutional knowledge.
“While positions were eventually refilled, the expertise and institutional knowledge that had been lost were not necessarily restored. This created what we describe as a ‘hollow middle’ in leadership, affecting mentorship, professional development and the long-term sustainability of the health workforce,” Dr Wilson explained.
The study also found that preventive and community-based health services, including community midwifery, zone nursing, outreach programmes and health promotion, were among the areas affected by the upheavals.
Dr Wilson also stated that prevention was often one of the first areas to suffer during periods of political disruption and among the slowest to recover.
Despite these challenges, the research also recognised the commitment of health workers who continued serving their communities through periods of uncertainty and institutional disruption.
“The health system endured because people chose to stay, serve and support their communities, often with limited institutional protection. Our recommendations seek to ensure that this resilience is supported by stronger systems and institutions,” he said.
Dr Wilson acknowledged the contribution of FIPHR staff Ms Avelina Rokoduru, Dr Kesaia Nawaqaliva, Dr Etivina Lovo and Dr Gade Waqa, as well as the senior health professionals who generously shared their experiences and insights.
The health sector chapter will be published as part of the Commission’s Final Report, providing an important contribution to Fiji’s historical record and informing future discussions on protecting and strengthening the country’s health system.
The findings were presented at a public expert hearing convened by the FTRC, attended by the Commissioners and independent reviewers, Dr James Fong and Dr Odille Chang.
ENDS