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

In Fiji, community health workers (CHWs) play a critical role in providing primary health care, especially in remote and hard-to-reach areas. This study aims to comprehensively explore the implementation of the CHW program and identify policy-implementation gaps that will strengthen the country's primary health care. We conducted a qualitative exploratory study in Fiji's six sub-divisions across the four administrative divisions-Central, Eastern, Western, and Northern. The study included six focus group discussions with 41 CHWs and six key informant interviews with CHW supervisors and nurse managers. Thematic analysis was employed to analyse the data. Participants revealed that the CHWs are engaged in range of responsibilities that improve primary health care in Fiji. The study highlighted a political commitment to strengthen the CHW program, a functional supervision process, a motivated CHW workforce, and high community trust. Despite these favourable findings and presence of a CHW policy, the study identified substantial challenges to effective implementation. These include inconsistencies in governance structure, performance variations across divisions, inadequate CHW training, irregularities in CHWs' incentives, shortage and limited capabilities of the zone nurses, as well as supply constraints affecting the Fiji's CHW program. Efforts to address these challenges within the health system should focus on strengthening the local-level governance, redefining CHW service packages, improving the quality of CHWs' pre-service and on-the-job training, creating consistent and effective incentive strategies, ensuring the provision of adequate supplies, and enhancing the data management system.