title: Services for people with communication disability in Fiji: barriers and drivers of change.
abstract: BACKGROUND
  The World Health Organization's World report on disability calls upon all nations to 'remove the barriers which prevent [people with disabilities] from participating in their communities; getting a quality education, finding decent work, and having their voices heard' (p. 5). People with communication disability (PWCD), as a consequence of their atypical communication, may be more likely to be excluded from society, and denied their basic human rights, than other people with disability. Fiji, a multicultural and multilingual nation in the south-western Pacific Ocean, has limited services for PWCD. Service providers in Fiji include disability care workers, special education teachers, traditional healers, and a small number of visiting volunteer speech-language pathologists. This paper outlines the historical and current barriers to, and drivers of change for, service development for PWCD in Fiji.
  
  
  OBJECTIVE
  Five barriers to service development for PWCD in Fiji were identified. (1) A major structural barrier is the small population size to develop appropriate infrastructure including professional education programs. (2) Geographical barriers include the dispersed geography across 300 islands, low population density, the rural-urban divide, and risk of disaster from cyclones and flooding. (3) Linguistic diversity, while culturally important, can present a barrier to the provision of quality services that are available in the languages spoken by PWCD. (4) Cultural barriers include historical political instability, although Fiji has become more stable due to the recent democratic elections. The social climate affects development of services that are appropriate for different dominant cultural groups. (5) Financial barriers include low gross domestic product, low financial security and low human development index; however, the financial outlook for Fiji is steadily improving due to the change in political stability.
  
  
  CONCLUSIONS
  Three levels of drivers of change were identified. Macro-level drivers included Fiji's endorsement of international policy and increased globalisation (eg tourism). Meso-level drivers of change included receipt of foreign aid and support from international non-government organisations, development of disability-inclusive legislation and policy within Fiji, and strengthening of government policies that support disabled people's organisations. Micro-level drivers of change included establishment of disabled people's organisations by consumers, adoption of disability-inclusive policy and procedures by service providers, and changes in the perceptions of disability within the general community. Fijian prevalence data confirms that there is an underserved population of PWCD in need of specialist services. Significant advocacy work in the disability field by Fijian and international disabled people's organisations has led to the Fiji government signing international policy (eg Convention on the Rights of Peoples with Disabilities), inclusion of disability rights in national legislation (eg 2013 Constitution of Fiji Islands) and localised policy and practice documentation (eg inclusive education policy by the Fiji Islands Ministry of Education). Continued service development is required if Fijians with communication disability are to have their needs met. The drivers of change at all levels are positioned well to overcome current barriers to change; however, a coordinated approach including macro-, meso-, and micro-level drivers is required to ensure the future development of adequate services for PWCD in Fiji.
authors.affiliation: Charles Sturt University, Bathurst, New South Wales, Australia. shopf@csu.edu.au.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Hopf
authors.affiliation: Charles Sturt University, Bathurst, New South Wales, Australia. smcleod@csu.edu.au.
authors.forename: Sharynne
authors.initials: S
authors.lastname: McLeod
mesh_terms: D003147:Communication Disorders / Q000628:therapy*; D003153:Community Health Services / Q000379:methods*; D003150:Community Health Workers / Q000193:education*; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence / Q000534:rehabilitation*; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology / Q000592:standards*; D006801:Humans; D008297:Male; D009936:Organizational Innovation; D011156:Population Density; D019035:Rural Health Services; D012959:Socioeconomic Factors; D014480:United Nations; D000078329:Workforce
keywords: Allied Health; Australia/Pacific; Public Health