Exploring the implementation of community health worker program in Fiji: An exploratory qualitative study

Area of Science:

• Public Health
• Health Policy
• Health Systems Strengthening

Background:

• Community health workers (CHWs) are vital for primary healthcare delivery in Fiji, particularly in remote areas.
• A CHW policy exists, demonstrating political commitment to strengthening the program.

Purpose of the Study:

• To explore the implementation of Fiji's CHW program.
• To identify policy-implementation gaps to enhance primary healthcare.

Main Methods:

• Qualitative exploratory study conducted across Fiji's six sub-divisions.
• Data collected through focus group discussions (41 CHWs) and key informant interviews (supervisors, nurse managers).
• Thematic analysis used to analyze qualitative data.

Main Results:

• CHWs perform diverse roles that enhance primary healthcare.
• Positive aspects include political commitment, functional supervision, motivated workforce, and community trust.
• Significant challenges identified: inconsistent governance, varied performance, inadequate training, irregular incentives, nurse shortages, and supply constraints.

Conclusions:

• Strengthening local governance, refining CHW roles, and improving training are essential.
• Consistent incentives, adequate supplies, and enhanced data management are critical for program success.
• Addressing identified gaps will bolster Fiji's primary healthcare system through its CHW program.