Frayed Rope and Resilient Threads: Fijian Healthcare and the COVID ‐19 Pandemic

ABSTRACT

In April 2021, Fiji faced international scrutiny due to ‘horrific’ hospital conditions, including staff and patients lacking food, non‐operational operating theatres, and critical shortages of beds, medicine, and equipment. After successfully avoiding a major outbreak in 2020, a sudden surge in COVID‐19 cases in 2021 overwhelmed the public health system. This paper develops the magimagi, a culturally grounded health systems resilience framework, and draws from the WHO building blocks for the Pacific and conceptualisations of the health sector as a complex adaptive system (CAS), to examine the impact of COVID‐19 and the Fijian health system's response. Based on talanoa with key informants and document analysis, we find that decades of political instability, recurrent crises, and chronic under‐resourcing frayed the magimagi and limited the system's capacity to respond to and recover from the pandemic. Nevertheless, health system functionality during this crisis was supported by the adaptive practices of local leadership and health workers. These responses were underpinned by intangible resources rooted in solesolevaki and communal cultural values, which may offer a culturally embedded pathway towards resilience‐building in Fiji's health system.