Health in Maldives
Dr Mariyam Shakeela, Minister of Health and Gender, Maldives
Progress on MDGs in Maldives
Maldives is a low lying small island state in the Indian Ocean comprising of 1,190 islands, with a population of 350,000 spread across the 194 inhabited islands. Despite our unique geography and inherent vulnerabilities, the island nation of Maldives has, in the past four decades, shown progress and incredible improvements in its health indicators. The country’s health system is custom designed based on the size of the population and geographical location, offering targeted levels of service. Every inhabited island has a primary health facility, while comprehensive secondary level health services are made available within every atoll and tertiary level health services available at the capital of the country. This structure, coupled with public health programmes, has further facilitated the progress that Maldives has made in the health sector. Future plans exist to develop regional tertiary facilities.
The resilient nature and commitment of the people of Maldives has placed Maldives as the only ‘MDG Plus’ country in South Asia, having achieved five out of the eight Millennium Development Goals (MDGs) well ahead of the agreed timeline of 2015. Maldives is showing potential to go beyond the MDG targets, especially in the health related MDGs 4, 5 and 6 to address the reduction of child mortality, improvement of maternal health and combating of HIV/AIDS, malaria and tuberculosis. Maldives also revels as the only country in the South-East Asia region to eliminate malaria (in 1984) and to have sustained that achievement for 30 years. It is worthy to state that remarkable progress has also been made towards the achievement of the remaining three MDGs: MDG 3, achieving gender equality and women’s empowerment; MDG 7, ensuring environmental sustainability; and MDG 8, developing a global partnership for development.
While we are proud of our achievements, sustaining them poses numerous challenges to the Maldives. Geographical limitations, lack of economies of scale, heavy reliance on an expatriate health workforce and dependence on imports of all medical consumables, pharmaceuticals and other medical products has a profound effect on health expenditure, accessibility and availability of quality health services within the country. The unique nature of Maldives also makes it extremely susceptible to unprecedented climate change events that will unduly affect the already vulnerable and marginalised (often women and children) and thereby intensify existing inequalities.
Furthermore, these extreme weather events are set to impact on the incidence of non-communicable diseases (NCDs), vector borne disease and basic conditions necessary for health development, including access to safe drinking water, food security, shelter and sanitation infrastructure.
The rapid progress in socioeconomic development and lifestyle changes has also prompted a prominent transition to a NCDs morbid situation. Alarmingly, NCDs accounted for an estimated 78 per cent of all mortality in Maldives in 2012. The chronic disease burden has become a huge challenge to health care provision and health expenditure. In today’s interconnected world, Maldives is not and will not be free from risks of emerging and re-emerging communicable diseases, and thus this area should remain a priority.
Despite the difficulties, the primary health care approach to health services, its commitment to ensuring that the Maldivian people continue to enjoy good health and quality of life, has brought systematic reforms to the health sector and enabled Maldives progress towards its health sector achievements. The health system has been undergoing fundamental changes of reform, in relation to legislative and policy aspects, and continues to evolve to meet emerging challenges. Such reforms include the introduction of urgent and appropriate public health measures, with special health programmes targeting adolescents and the prevention of cancer, chronic diseases and non-communicable diseases. Strategies to improve utilisation of enabling platforms such as telemedicine, e-health programmes and the initiatives for increased financial health protection are of equal importance.
Besides these initiatives, Maldives is in dire need of new investments in health promotion, disease prevention, infrastructure, technology and human resources, and availability of medicines to make us better prepared to combat health challenges and continue growth in the health sector.
There is also an urgent need to accelerate the strengthening of the health care system to meet the increasing health care demands and the challenges of social determinants of health amidst financial and resource shortages. Maldives’ position as a country graduating from ‘least developed country’ status and its geography poses unique development challenges.
Nevertheless, Maldives hopes for a brighter future and an improved health care system if global collective will and resources are dedicated towards this goal.
Hence, it is with this vision that Maldives wishes to engage in post-MDG framework discussions and reiterate that health is not only crucial to sustainable development, but is a beneficiary of and a contributor to development. Maldives supports the global aspiration towards universal health coverage and control of NCDs at the heart of post-MDG discussions. It is our dearest hope that the developments of sustainable development goals (SDGs) are viewed as a continuation of MDGs and not in isolation with the progress that MDGs have made.
As a country that is extremely challenged by climate changes and unavoidable health risks, it is our wish that SDGs and climate change are jointly addressed, keeping in mind that the links between the two are central to reducing poverty, increasing economic security, enhancing social development and achieving better health for all.
The Republic of Maldives lies in the Indian Ocean, some 670 km west-south-west of Sri Lanka. The 1,190 coral islands, 200 of which are inhabited, are a double chain of 26 coral atolls. The archipelago is 823 km long and 130 km at its widest.
The islands are divided into 20 administrative units, called atolls (although they do not necessarily correspond to geographical atolls).
Each is known by a letter in the Maldivian alphabet in addition to its geographical name. The geographical atoll Huvadhu, for example, is divided into two administrative units: Gaaf Alif and Gaaf Dhaal.
Climate: Maldives has a hot tropical climate. The rainy south-west monsoon season is April-October; the north-east monsoon December-March. Average annual rainfall is 1,654 mm. The temperature ranges between 25°C and 30°C, but generally stays around the average 27°C. Gales occur during the monsoon. In May 1991, abnormal tidal waters caused great damage throughout the archipelago.
Environment: The most significant issues are: depletion of freshwater aquifers threatening water supplies; global warming and sea level rise; and coral reef bleaching.
Population: 320,000 (2011); 41% lives in urban areas, mostly in the capital Malé, which was in the mid-1990s doubled in area by land reclamation; growth 1.8% p.a. 1990-2011; birth rate 17 per 1,000 people (40 in 1970); life expectancy 77 years (50 in 1970).
Economy: Maldives is classified as an upper-middle-income economy by the World Bank.
Joined Commonwealth: 1982
Population: 320,000 (2011)
GDP per capita growth: 5.8% p.a. 1990–2011
GNI per capita: US$5,720 (2011)
UN HDI 2011 ranking: 109 out of 187 countries
Life expectancy: 77 years (2011)
Under-five mortality rate (per 1,000 live births): 11 (2011)
Maternal mortality ratio –reported (per 100,000 live births): 140 (2007–11)
Maternal mortality ratio –adjusted (per 100,000 live births): 60 (2010)
Largest contribution to mortality: Non-communicable diseases
HIV prevalence rate for people aged 15–49 years: <0.1% (2011)
Government health expenditure: 5% of GDP (2010)