Health system resilience in the Pacific: A scoping review of Fiji’s COVID-19 response

Abstract

In mid-2021, Fiji recorded one of the highest rates of COVID-19-related deaths in the world, amidst a rapidly disintegrating health care system. This scoping review examines Fijian health system responses to the COVID-19 pandemic, exploring both the vulnerabilities and adaptive strategies that emerged during the crisis. Using a systematic search strategy to identify studies relating to how the Fijian health system responded to the COVID-19 pandemic, and what insights could be drawn about adaptive practices and resilience in this context, 71 papers were included. The findings demonstrate that while Fiji experienced significant workforce shortages, infrastructure constraints, and disruptions to routine healthcare, the pandemic response was also characterised by rapid policy adaptations, innovative use of some digital technologies, and strong community-led initiatives. However, challenges with public trust and culturally inclusive governance remain key areas for consideration. By applying a health system resilience framework that explores the tangible and intangible dimensions of health systems, this review offers insights relevant both for Fiji and the region. Strengthening local capacity, investing in sustainable infrastructure, and embedding Indigenous and other local knowledge in public health strategies are crucial steps toward building resilient Pacific health systems and preparing for future crises.