Fiji Health & Nutrition Cluster · Fiji Health & Nutrition Cluster ... Typhoid, Dengue Fever and...

Humanitarian Action Plan Fiji Health & Nutrition Cluster

This document provides a draft action plan for the Health & Nutrition Cluster response to TC Winston.

HAP – HnN Cluster Response to Tropical Cyclone Winston

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HUMANITARIAN ACTION PLAN FOR HEALTH & NUTRITION CLUSTER

Cluster Lead Co-Lead Agencies

Lead: Ministry of Health and Medical Services(MoHMS) Co-Leads: World Health Organization and UNICEF

Cluster Key Partners

MoHMS, NDMO, NFNC, UNICEF, WHO, UNFPA, UNAIDS, UNOCHA, UNWOMEN, FHSSP , IFRC, FRCS, SPC, RFHAF, PCF, SAVE THE CHILDREN, MSP, FNU, DFAT, NZMAT, IPPF, AUSTRALIAN AID, WORLD VISION,

Contact Information

Dr. Eric Rafai (MoHMS) 3306177 [email protected] Vimal Deo (MoHMS) 9904131 [email protected] or [email protected] Dr. Rokho Kim (WHO) 3234100 [email protected] Nahad Sadr-Azodi (UNICEF) 8024180 [email protected]

Budget

Requirement: FJD 29,085,272

Met: FJD 7,343,054

Unmet: FJD 21,742,218

mailto:[email protected]






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Sectoral Needs Analysis

Fiji is an island nation in the south-west Pacific, midway between Vanuatu and the Kingdom of Tonga, and is made up of 332 islands, of which one third are inhabited. Fiji has a land mass covering a total land area of 18333 square kilometres within 1.3 million square kilometres of the South Pacific. Fiji’s health system is based on a three-tier model that provides an integrated health service at primary, secondary and tertiary levels. The Ministry of Health & Medical Services generally delivers its health services through its four administrative divisions under Public Health Programs and Hospital Service. There are 214 health facilities serving an estimated population of about 933,0241.

Table 1 Estimated Population of Fiji by Divisions

Division Estimated Population Central 374,673 Eastern 39,651 Western 387,710 Northern 130,990

Total 933,024 The total workforce of the Ministry of Health and Medical Services is around 4,300 established staff and 1,300 unestablished staff. Fiji is geographically situated in one of the most natural disaster prone areas in the world affected mainly by tropical depressions and cyclones or as part of tropical weather conditions common to the region. Cyclones, Floods and Natural Disasters are a common occurrence to Fiji and the Pacific. The core function of the Ministry of Health & Medical Services (MoHMS) is to provide of health care, that includes ensuring that its resources, health facilities and staff are prepared to execute emerging disease control measures, disaster management plans and mitigate climate change impacts. The National Health Emergencies and Disaster Management Plan (HEADMAP) is the primary policy document for MoHMS during health emergency that is developed to assist health personnel address health emergency and disaster events. There are other plans and documents on disaster risk reduction and disaster management which assist HEADMAP operations for preparedness, response and recovery.

1 Based on MoH Annual Report 2015


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The MoHMS and WHO identified the following priority risks from a rapid public health2 assessment. Immediate priorities post disaster

1. Provision of safe and nutritious food, safe drinking-water, appropriate sanitation, shelter and other essential non-food items including WASH and Hygiene Kits

2. Trauma care for the wounded with tetanus vaccination 3. Provision of medicines and medical supplies to health facilities 4. Establishment of emergency primary and secondary health care services for

medical, surgical and obstetric emergencies 5. Strengthen disease surveillance for early detection of communicable disease

outbreaks expected after a disaster such as diarrhoea, respiratory infection and others

6. Risk communication on important public health events 7. Ensure continuity of care for patients with chronic diseases or infections, such as

diabetes, hypertension, TB and HIV. Short-term priorities

1. Re-establishment of essential health care services (primary, secondary and tertiary health care)

2. Emergency mental health care and psychosocial support 3. Waste management 4. Surveillance and Control of vector-borne diseases

Medium-term priorities

1. Post-surgical care, treatment of infected wounds and management of disabilities 2. Re-establish routine immunization 3. Monitor and respond to health care needs of displaced population (evacuees) 4. Surveillance of nutrition issues and management of acute malnutrition including

medical complications

Long-term priorities 1. Reconstruction of Cyclone Resilient Health Facilities (Build Back Better) 2. Review of HEADMAP processes and guidelines 3. Strengthen Risk Assessment and Early Warning Systems capacities for

HEADMAP 4. Advocate for more resources for HEADMAP

2 A “Rapid Public Health Risk Assessment” will be published jointly by WHO and MoHMS


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Cluster Objectives and Strategies

A Strengthen Coordination, Capacity and Advocacy within health cluster partners

B Provide immediate medical care for trauma and injury

C Assure continuity and re-establishment of medical and public health services through outreach services, rehabilitate and equip health facilities

D Prevention and control of communicable diseases related to water and vector such as leptospirosis, typhoid, dengue, Zika and prevent and manage diarrhoeal incidences

E Provide urgent nutrition support to treat and prevent deterioration of nutritional status of children and pregnant and lactating women (PLW) through delivery of maternal, infant and young child feeding support, treatment of severe acute malnutrition and provision of micronutrients in affected areas.

F Prevent exacerbation of existing non-communicable diseases and other disease threats

G Psychosocial Support and Mental illnesses associated with the traumatic experiences

H Reproductive Health Response including maternal, newborn and adolescent care and Gender Based Violence response

I Provide information and increased access to information education material (IEC) on health messages

J Provide environmental health services to evacuation centres, health facilities, schools, and affected communities including municipal councils and outer islands.


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List of Cluster Activities and Actions

Activity A1

Agency Ministry of Health and Medical Services Description National Cluster Coordination

Sub-national Cluster Coordination Information Management

Objective(s) To Strengthen Coordination, Capacity and Advocacy within health cluster partners (Immediate)

Beneficiaries All the affected people by TC Winston Partners Members of HnN Cluster Budget Requirement F $200,000

Funded F $20,000 MoHMS Unmet F $180,000

Expected Outputs and Impacts

Coordination of the Health & Nutrition Cluster as Lead Agencies

Community mobilization, health, environment and nutrition promotion and capacity building for health staff

Health Outreach programs support in the four divisions in Fiji Consolidation of Information and dissemination to partners

and members Monitoring and evaluation of the HAP projects

implementation Organization of the lessons learnt and debriefing meetings of

the stakeholders Production and dissemination of health and nutrition cluster

bulletin


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Activity B1

Agency Ministry of Health and Medical Services Description Provision of Phase 1 Health Response, which includes medical

care in terms of trauma, injury and urgent medical evacuations Objective(s) Provide immediate medical care for trauma and injury

(Immediate) Beneficiaries All the affected people by TC Winston Partners NDMO, RFMF, Aus/NZ Defense, WHO Budget Requirement F $700,000 Medivac

F $100,000 Transportation Funded F $ 200,000 MoHMS F $ 100,000 WHO (Flash Appeal) Unmet F $500,000


Coordination of the immediate medical care and trauma assistance

Provision & Coordination of medivac assistance Confirmation of Fatalities Provision of acute medical care of population in need Coordination of medical equipment, pharmaceutical and

laboratory supplies needs from facilities providing services Long term rehabilitation for patients with the disabilities

from TC Winston


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Activity C1

Lead Agency Ministry of Works, Transport & Public Utilities & Ministry of Health and Medical Services

Description Minimize impacts on health care delivery through repairs and renovations to damaged health facilities. This project also includes health facilities providing RNMCAH services

Objective Assure continuity and re-establishment of medical and public health services through outreach services, rehabilitate and equip health facilities

Beneficiaries Affected communities who rely on core health services from these damaged facilities

Partners WHO, FHSSP, UNICEF, UNFPA Budget Requirement F $6,150,000.00

Funded F $1,500,000.00 MoHMS F $150,000 FHSSP/DFAT F $650,000 WHO (Flash Appeal) Unmet F $3,850,000


A reconstruction program to ensure that damaged health facilities will have their core services rapidly restored (noting that there will be a delay restoration of some additional services that require more extensive repairs)

Delivery of power and safe water supply Build back better and climate-resilient health facilities

Activity C2

Lead Agency Ministry of Health and Medical Services Description Procurement of essential supplies of medicines, laboratory

consumables, power packs and vaccine cold chain equipment and devices

Objective Assure provision of supplies of medicines, laboratory consumables, power packs and vaccine cold chain equipment and devices to all health facilities

Beneficiaries Affected communities who rely on core health services from these damaged facilities

Partners UNICEF, WHO, Americares, Direct Relief Budget Requirement F $8,500,000

Funded F $1,000,000 UNICEF (Cold Chain) F $ AmeriCares (Medical supplies) F $ Direct Relief (Medical supplies) F $600,000 WHO Unmet F $6,900,000


Power Packs and Cold chain equipment/devices procured, distributed and installed

Essential health equipment and medicines and laboratory and other medical supplies procured and distributed


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Activity C3

Lead Agency Ministry of Health and Medical Services Description Provision of public health/primary health care outreach services

to the affected population Objective Reduce mortality and morbidity from diseases and injuries

related to TC Winston aftermaths Beneficiaries Affected populations of 350,000 Partners WHO, AmeriCares, Direct Relief, AusMAT, NZMAT, RKM, MSP,

FRCS Budget Requirement F $4,000,000

Funded F $100,000 MoHMS F $300,000 WHO (through Americares, MSP and RKM CERF)

Unmet F $3,600,000 Expected Outputs and Impacts

Provision of essential health services and public health outreach to the affected population


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Activity D1

Agency Ministry of Health and Medical Services Description To enhance disease surveillance and early response to prevent

or minimize the impact of outbreaks of communicable diseases of concern, including: Diseases associated with contaminated water and food, such

as leptospirosis, typhoid, and diarrheal diseases Diseases associated with overcrowding, such as acute

respiratory infections Vector-borne diseases, such as dengue, chikungunya and Zika

virus. Objective Prevention and control of communicable diseases related to

water and vector such as leptospirosis, typhoid, dengue, Zika and prevent and manage diarrhoeal incidences - Improve surveillance and minimise the risk and impact of outbreaks of communicable disease associated with post-disaster settings

Beneficiaries All the people affected by TC Winston Partners WHO, FHSSP Budget Requirement F$800,000

Funded F$100,000 (MoHMS) F$ 150,000 FHSSP (DFAT) F$ 400,000 WHO (Flash Appeal) Unmet F$ 150,000


Procurement of medical, technical and non-technical supplies, including laboratory diagnostic consumables and environmental health protection consumables

Strengthened surveillance for the early detection of outbreaks and strengthened outbreak response capacity (EWARS)

Linking with WASH Cluster in ensuring delivery of safe water supply and sanitation, and of personal hygiene supplies

Promotion of health-promoting behaviors, such as hand washing, food safety, cough etiquette, mosquito bite avoidance.


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Activity D2 Lead Agency Ministry of Health and Medical Services Description Protect people in the affected areas from outbreak-prone

waterborne diseases through relevant technical advice and information on prevention and control at the community level including evacuation centres and other hotspots Prevention and Urgent Response to outbreak-prone diseases such as Leptospirosis, Typhoid, Dengue Fever and Zika Virus

Objective Prevention and control of communicable diseases related to water and vector such as leptospirosis, typhoid, dengue, Zika and prevent and manage diarrhoeal incidences

Beneficiaries Health facilities and communities affected by TC Winston Partners WHO, SPC, UNICEF, FHSSP Budget Requirement F $1,500,000

Funded F $50,000 MoHMS F $200,000 WHO (Flash Appeal) Unmet F $1,250,000


Community mobilization and multi-sectoral response to outbreaks

Integrated Vector Control Management approach taken to address vector-borne disease

Immunization of populations at risk of vaccine preventable disease outbreaks

Reduce mortality and morbidity from LTDs and Zika Virus


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Activity E1

Agency Ministry of Health and Medical Services Description Initial nutrition assessment of children U5 in the communities

and evacuation centres. Objective To conduct nutrition assessment of children U5 in the affected

communities and evacuation centres. Beneficiaries Children U5 Partners UNICEF, WHO, SPC Budget Requirement F$80,000

Funded F$5,000 (NFNC) Unmet F$75,000


Baseline assessment report and evidence to inform decision making for appropriate nutrition intervention policies and programs.

Activity E2

Agency Ministry of Health and Medical Services Description Nutrition Communication Package for Disasters and

Emergencies Objective To promote appropriate maternal, infant and young child

feeding practices Beneficiaries Targeted - Children Birth to 6 months, U2, U5, Pregnant and

Lactating Women Partners UNICEF, WHO, SPC Budget Requirement F$150,000

Funded F$5,000 (NFNC) Unmet F$ 145,000


Best practices for maternal, infant and young child feeding Optimal nutritional status of children U5

Activity E3

Agency Ministry of Health and Medical Services Description Promote, protect and support appropriate maternal and infant

and young child feeding Objective Ensure appropriate maternal, infant and young child feeding

practices are observed and practiced amongst care givers of children under five years of age.

Beneficiaries 36,000 children under 5 and 7640 PLWs in affected areas Partners UNICEF, WHO, UNFPA Budget Requirement F$ 30,000

Funded F$5,000.00 (MoHMS) Unmet F$25,000.00


Care givers practicing appropriate infant feeding practices

No violation of the regulated BMS CODE


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Activity E4

Agency Ministry of Health and Medical Services Description Strengthen and scale up management of severe acute

malnutrition (SAM) Objective To strengthen integrated management of SAM at both

community and facility levels Beneficiaries 600 children (SAM cases only) Partners UNICEF & WHO Budget Requirement F$330,000.00

Funded F$10,000.00 (UNICEF) Unmet F$ 320,000.00


Health workers will improve their knowledge and capacity for early detection and treatment of children assessed as moderately or severely malnourished.

SAM cases will receive appropriate care and treatment at both in-patient facilities and outpatient facilities

Activity E5 Agency Ministry of Health and Medical Services Description Protect the health of young children through proven, simple and

cost-effective nutrition interventions including: Vitamin A and deworming – needs no assessment in

emergencies, but boosts immunity of children against infections.

Oral Rehydration Salts – prevents dehydration resulting from diarrhea

Zinc – reduces duration and severity of diarrhea and prevents further episodes)

Multi-micronutrient powders and Albendazole – to treat and prevent anemia.

Deworming for children, pregnant and lactating women Objective To improve U5 children’s immunity against infectious diseases

and prevent further aggravation of micronutrient deficiencies Beneficiaries 36,000 children U5, Partners UNICEF, WHO Budget Requirement F$230,000.00

Funded F$5,000.00 (MoHMS) Unmet F$ 225,000.00


Increased protection of children against infections especially given the precarious water and sanitation environment leading to reduced morbidity and mortality.

Protection against anaemia for women and children.


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Activity F1

Agency Ministry of Health and Medical Services Description Ensure the supply of essential medicines for people in affected

communities with existing non-communicable diseases (NCD), including diabetes, asthma, hypertension, and heart disease.

Objective Prevent exacerbation of existing non-communicable diseases and other disease threats

Beneficiaries National (Entire Population is at Risk) Partners WHO, AmeriCares, MSP, RKM, Direct Relief Budget Requirement F$1,000,000

Funded F$60,000 (MoHNS) F$250,000 WHO (Flash Appeal) Unmet F$690,000


Health facilities and primary care services provided with sufficient supplies of medicines and related equipment to provide for those in the affected population in their areas who have NCDs.

SOPD patients displaced by TC Winston or residing at affected areas are followed up for continuity of care and replenished sufficient medicines and supplies.


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Activity G1

Agency Ministry of Health and Medical Services Description Training for the identification and management of psychological

illness and develop systems for the referral of severe cases. Objective Minimise the risk of psychological harm and mental illness

associated with impact of traumatic experiences through psychosocial support. Advocate for strategies that ensures the communities return to normality.

Beneficiaries Any persons affected by TC Winston requiring psychosocial support.

Partners WHO, UNICEF, UNFPA, Empower Pacific, Ministry of Social Welfare & Women

Budget Requirement F$260,000.00 Funded F$ 40,000.00 Unmet F$220,000.00


Local health care workers trained in rapid psychological assessment of people in affected communities and basic interventions

Establish systems for referral of people from affected areas with more serious psychological impacts, for expert assessment and management

Provision of psychological support to health workforce staff involved in the emergency response

Redeployment of staff from unaffected areas to assist or relieve colleagues that were directly affected


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Activity H1

Agency Ministry of Health and Medical Services Description Assure safe, reliable and secure infrastructure and supportive

infrastructures are in place for reproductive, maternal, adolescent, newborn and & HIV/STI care services as well as services for gender based violence at health facilities in affected communities with special focus on life saving emergency obstetric and newborn care.

Objective 1. Rehabilitate damaged health facilities for the provision of effective obstetric and newborn , child, adolescent and HIV/STI health care services

2. Rehabilitate cold chain supportive infrastructure in all the four medical divisions in Fiji

3. To provide appropriate tools and equipments for the provision of safe RMNCAH services in affected health facilities.

Beneficiaries All the affected people by TC Winston Partners UNFPA, UNICEF, WHO, H4, Pacific Red Cross, REF, MSP,

Empower Pacific Budget Requirement F $1,595,272

Funded F $ 143,054 (DFAT) Unmet F $1,452,218


Health facilities have skilled staff with special focus on responding to obstetric and newborn emergencies and gender based violence and prevention of HIV

Assessment of Health facilities have adequate equipment and devices for reproductive and maternal/child needs

Psychosocial support services available for GBV survivors and affected communities


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Activity H2

Agency Ministry of Health and Medical Services Description Services - Ensure provision of appropriate health services for

reproductive, maternal and newborn/child at health facilities in affected communities with a special focus on emergency obstetric and newborn care.

Objective 1. To provide immunization to all children and to ensure full

immunization coverage for all eligible clients.

2. To reduce the risk of a rise in IMCI and its complications from

delay in accessing health services

3. To ensure timely booking and follow up of all antenatal

mothers

4. To ensure reduction in postnatal complications by ensuring

timely follow up of postnatal mothers and newborn babies

5. To provide counselling and other forms of advocacy and

health promotion to people in the community

6. To ensure services reach all our clients including PLHIV

Beneficiaries All the affected people by TC Winston Partners UNFPA Budget Requirement F $1,000,000.00

Funded F $ 500,000.00 Unmet F $500,000.00


Provision of Dignity Kits in collaboration with the WASH Cluster in supporting sanitation and hygiene

Psychosocial support services available for GBV survivors and affected communities

Provision of supplies commodities and vaccines are supported and improved

Provision of services is maintained and improved including providing mobile clinic services to affected communities who may have difficulties in accessing our facility based services.


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Activity I1

Agency Ministry of Health and Medical Services Description Provision of health risk prevention information, increased access

to information education material (IEC) on health messages, and promote social mobilisation to reduce health risks, such as clean-food safety, mosquito bite prevention and elimination of vector breeding sites

Objective Provide health risk communication messages and IEC material for the affected population to reduce risk of adverse physical and mental health outcomes

Beneficiaries National (Entire Population is at Risk) Partners UNICEF, WHO, Live and Learn, FHSSP, UNFPA Budget Requirement F$460,000.00

Funded: F$ 100,000.00 F$100,000 WHO Unmet F$ 260,000.00


Mobilise communication campaign which includes, media (radio and television), print and social mobilisation to improve the early recovery process and strengthen preparedness at community level.

Deliver a broad range of activities to increase awareness and knowledge among affected communities and behaviour change to reduce health risks, utilizing local resources e.g. village health workers to for social mobilization

Improved knowledge, practice and positive change in behaviour for the population at risk.

Ongoing impact on emergency preparedness and response, leading to improved health status.


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Activity J1

Agency Ministry of Health and Medical Services Description To ensure effective environmental health services are provided to

affected populations, and coordinated at the national and sub-national levels, including effective and timely prevention measures such as sanitary facilities (toilets), vector control, safety drinking water, sanitation, hygiene, housing and building safety, school sanitation, inspection of evacuation centres, waste management, disinfection of villages and settlements, food safety, environmental biotoxins (ciguatera fish poisoning), environmental health impact assessments, and pollution control (land, water, air).

Objective(s) To prevent diseases and health risks associated with environmental hazards

Beneficiaries All the people affected by TC Winston Partners WHO, UNICEF, FHSSP Budget Requirement F $2,000,000

Funded F $600,000 WHO (Flash Appeal) Unmet F $1,400,000


Reduction of water and food-borne diseases Prevention of communicable diseases in the vulnerable

communities Minimized impacts of pollution and wastes on water sources,

food and marine ecosystems Reduction of injuries and infections within communities

arising from environmental communities Strengthened enforcement of building codes on safety and

public health Empowerment and capacity building of EHOs and provision of

essential resources


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Activity Summary Costing: Health and Nutrition Cluster

Objective #

Sub# Required (FJ) Funded (FJ) Unmet (FJ)

A A1 $200,000 $20,000 $180,000 B A2 $800,000 $300,000 $500,000 C C1 $6,150,000 $2,300,000 $3,850,000

C2 $8,500,000 $1,600,000 $6,900,000 C3 $4,000,000 $400,000 $3,600,000

D D1 $800,000 $650,000 $150,000 D2 $1,500,000 $250,000 $1,250,000

E E1 $80,000 $5,000 $75,000 E2 $150,000 $5,000 $145,000 E3 $30,000 $5,000 $25,000 E4 $330,000 $10,000 $320,000 E5 $230,000 $5,000 $225,000 F F1 $1,000,000 $310,000 $690,000 G G1 $260,000 $40,000 $220,000 H H1 $1,595,272 $143,054 $1,452,218 H2 $1,000,000 $500,000 $500,000

I I1 $460,000 $200,000 $260,000 J J1 $2,000,000 $600,000 $1,400,000

Total $29,085,272 $7,343,054 $21,742,218


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Annex

Demography of Health Facilities & Population in Fiji

Health Facility Central Eastern Western Northern Total

National Referral Centre 2 0 0 0 2

Divisional Hospital 1 0 1 1 3

Sub Divisional Hospital (Level 1)

0 0 3 1 4

Sub Divisional Hospital (Level 2)

5 5 3 2 15

Health Centre (Level A) 7 0 4 1 12

Health Centre (Level B) 2 1 6 3 12

Health Centre (Level C) 11 14 17 14 56

Nursing Stations 22 36 28 21 107

Old People’s Home 1 0 1 1 3

Total 51 56 63 44 214

CENTRAL DIVISION Sub-Division Fijian Indian Others Total

Suva 127,288 70,350 19,959 217,597

Serua/Namosi 21,884 6,512 1,192 29,588

Rewa 51,995 31,183 1,694 84,872

Tailevu 21,076 1,198 110 22,384

Naitasiri 19,261 916 55 20,232

Total 241,504 110,159 23,010 374,673

WESTERN DIVISION Sub-Division Fijian Indian Others Total

Lautoka/Yasawa 59,401 68,357 4,627 132,385

Nadi 32,962 55,067 2,781 90,810

Ba 15,366 40,166 611 56,143

Nadroga 33,404 18,716 610 52,730

Tavua 12,988 13,058 330 26,376

Ra 19,443 9,721 102 29,266

Total 173,564 205,085 9,061 387,710


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NORTHERN DIVISION Sub-Division Fijian Indian Others Total

Macuata 31,815 31,720 904 64,439

Cakaudrove 24,464 3,463 5,107 33,034

Bua 13,970 2,214 684 16,868

Taveuni 13,422 2,546 681 16,649

Total 83,671 39,943 7,376 130,990

EASETERN DIVISION Sub-Division Fijian Indian Others Total

Lomaiviti 16,187 0 0 16,187

Kadavu 10,878 26 42 10,946

Lakeba 7,270 24 0 7,294

Lomaloma 3,285 52 21 3,358

Rotuma 124 10 1,732 1866

Total 37,744 112 1,795 39,651

NATIONAL TOTAL DIVISION Fijian Indian Others Total

CENTRAL 241,504 110,159 23,010 374,673

WESTERN 173,564 205,085 9,061 387,710

NORTHERN 83,671 39,943 7,376 130,990

EASETERN 37,744 112 1,795 39,651

GRAND TOTAL 536,483 355,299 41,242 933,024

Fiji Health & Nutrition Cluster · Fiji Health & Nutrition Cluster ... Typhoid, Dengue Fever and...

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