Future of Health Care
The health care infrastructure may be better in the Maldives than many other countries but there is still a long way to go.
This year marks the 50th anniversary of the Maldives as a member of the United Nations. To commemorate this historic occasion, the UN in the Maldives unveiled its “UN50 photo exhibition” capturing the development journey of the Maldives over the past five decades, especially health, and how the World Health Organization (WHO) has been a crucial partner through the years. The photos and narrative exhibition captured the Maldivian government’s engagement with the WHO to promote socio-economic development, advance the health agenda, protect the rights of children and advocate gender equality and women’s empowerment.
Recent years have seen a major
expansion of health service delivery in the country with more focus on curative health care. The Maldives has one of the best doctor-to-population ratios amongst its neighbors and other small island countries. In 2005, there were 379 doctors with a doctor-to-population ratio of 1:775, while in 2010 there were 525 doctors with the doctor-topopulation ratio of 1:609, making the physician density (per 1000 population) as much as 1.642.
Back in the 90s, the Maldives’ medical establishment consisted of a central hospital for males, four regional hospitals and 21 primary healthcare centers. The situation since has changed, given that the life expectancy in the country has gone up to 71 years for men and 72 years for women. The Maldives has also worked hard to meet the Millennium Development Goals (MDGs) because of which several immunization programs have been introduced there. As a result, the infant mortality rate has decreased over the past years. Previously, 70 per cent of infant deaths were neonatal deaths since a large number of births were premature. Today, however, infant mortality has considerably declined since tremendous priority is given to maternal health. The Ministry of Health has conducted various health programmes such as the safe motherhood programme to control the Maternal Mortality Ratio (MMR).
The biggest challenge today is the presence of Non-Communicable Diseases (NCDs), in terms of the number of lives lost due to ill-health, disability and early death. NCDs require specialized and expensive services, including health experts, machines and infrastructure. There is a major disparity in the quality of services available to address NCDs between the capital, Malé and the islands. Many islands have impressive buildings but the health resources are missing. The quality of service is largely constrained by the lack of competent doctors and nurses available and their willingness to reside in the islands. Other issues include the lack of maintenance of infrastructure and machinery in the health facilities on the islands.
An important issue is the fairness or equality of the country’s health financing arrangements. The amount people pay for health care through the various sources of financing, out-ofpocket payments, private insurance, social insurance, and taxes — affects the amount of money they spend on things other than health care. The Maldives has seen health expenses rising through the decades, as the trends in health expenditure for households suggest and household expenditure has increased at a much faster pace than government expenditure. As a result, out-of-pocket expenditure for Maldivian households in 2011 reached 49 per cent of the total health expenditure in the country.
The growing cases of NCDs and the ageing population trends pose a major financial burden for the national health account. To address ongoing financial constraints in the health sector and potential pressures in the future, experts recommend that innovative financing schemes and the use of technology be explored. Innovative financing can be explored through establishing partnerships with the private sector. ‘Health tourism’ is already established in South Asia and the Maldives has the potential to tap its natural beauty, pristine environment and serenity to establish itself as a future destination for wellness and health tourism. This can reduce the leakages in the health sector caused by medical care sought abroad by the local people themselves. Another option to address health financing is to explore the use of technology in service delivery. One such channel is telemedicine, which can help to extend consultations and service provisions to remote locations. Unfortunately in the Maldives, despite heavy investments, telemedicine has not been operationalized.
Many experts believe that the strong foundations of primary health care, which have been successfully established in the Maldives over the past three decades, are disintegrating as primary health care is no longer the focus of the health sector. It is important to strengthen and develop management capacity in the health sector with improved reporting and accountability mechanisms. There is a need to develop a common vision among health professionals, policy makers and service providers on the priorities of the health sector. Furthermore, the health system needs to take into account the emerging health risks in the population. Climaterelated health risks demand enhanced community action and prevention. It is therefore critical that preventive health care be considered a priority and that public health services and professionals be reoriented to address the emerging health issues in the Maldives. The writer is a freelance journalist who contributes regularly to various leading publications.