title: Decentralisation of Health Services in Fiji: A Decision Space Analysis.
abstract: BACKGROUND
  Decentralisation aims to bring services closer to the community and has been advocated in the health sector to improve quality, access and equity, and to empower local agencies, increase innovation and efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji has attempted two approaches to decentralisation. The current approach reflects a model of deconcentration of outpatient services from the tertiary level hospital to the peripheral health centres in the Suva subdivision.
  
  
  METHODS
  Using a modified decision space approach developed by Bossert, this study measures decision space created in five broad categories (finance, service organisation, human resources, access rules, and governance rules) within the decentralised services.
  
  
  RESULTS
  Fiji's centrally managed historical-based allocation of financial resources and management of human resources resulted in no decision space for decentralised agents. Narrow decision space was created in the service organisation category where, with limited decision space created over access rules, Fiji has seen greater usage of its decentralised health centres. There remains limited decision space in governance.
  
  
  CONCLUSIONS
  The current wave of decentralisation reveals that, whilst the workload has shifted from the tertiary hospital to the peripheral health centres, it has been accompanied by limited transfer of administrative authority, suggesting that Fiji's deconcentration reflects the transfer of workload only with decision-making in the five functional areas remaining largely centralised. As such, the benefits of decentralisation for users and providers are likely to be limited.
authors.affiliation: Health Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand.
authors.forename: Jalal
authors.initials: J
authors.lastname: Mohammed
authors.affiliation: Health Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: North
authors.affiliation: Health Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand.
authors.forename: Toni
authors.initials: T
authors.lastname: Ashton
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D003661:Decision Support Techniques; D005367:Fiji; D018166:Health Care Reform / Q000379:methods*; D006801:Humans; D011057:Politics
keywords: Access to Healthcare; Decentralisation; Decision Space; Fiji; Health Reform; Principal Agent Approach