Fiji Health System, Primary Health Care and Nursing Regulation
Domain 12 - Fiji Health System, Primary Health Care and Nursing Regulation
This domain tests how care is organised in Fiji and how the nursing profession is regulated: the structure of the Ministry of Health and Medical Services, the referral pathway from village to national hospital, the scope of the primary health care approach, and the functions of the Fiji Nursing Council.
Core rules
- The Ministry of Health and Medical Services delivers services through divisional and subdivisional structures (Central, Western, Northern and Eastern), with the Colonial War Memorial Hospital as the national referral hospital and Lautoka and Labasa as major divisional hospitals.
- The referral pathway runs from village health worker and nursing station, to health centre, to subdivisional hospital, to divisional hospital, to national referral. Patients should not bypass levels except in an emergency - bypassing overloads referral facilities and fragments continuity of care.
- Primary health care principles: equity, community participation, intersectoral collaboration, appropriate technology, accessibility and affordability. Most contacts in Fiji happen at health centres, nursing stations and outreach clinics, not hospitals.
- Public sector care is provided free or heavily subsidised at the point of use, including the free medicine scheme, with medicines supplied through the national pharmaceutical and biomedical services; some services and overseas referrals follow separate eligibility and patient travel schemes.
- The Fiji Nursing Council regulates the profession: registration and licensing, scope of practice, standards of practice and conduct, approval of training programmes, disciplinary processes, and continuing professional development for renewal.
- Practising without current registration, or outside your scope, is a regulatory offence regardless of clinical competence.
Worked example
A village health worker reports a 55-year-old man with crushing central chest pain and sweating, two hours from the nearest health centre. Reasoning: this is a time-critical emergency. The nurse at the nursing station assesses ABCDE, gives aspirin 300 mg chewed if not contraindicated, gives oxygen only if SpO2 is below 94%, takes an ECG if available, secures IV access, keeps the patient still, and contacts the subdivisional hospital for urgent ambulance transfer while documenting times and observations. Referral is escalated directly on clinical grounds - this is an accepted exception to the usual stepwise pathway.
Traps
- Assuming free public care means free transport, specialist or overseas care.
- Bypassing levels of care for convenience.
- Practising on an expired licence or beyond scope.
- Treating the nursing station as a mini-hospital rather than a referral and primary care point.