HEALTHCARE SCENARIO IN MALDIVES

Posted on 5 Jul 2022

HEALTHCARE SCENARIO IN MALDIVES

Are you interested in venturing or investing into the healthcare sector of Maldives? Are you keen on knowing about the healthcare scenario of one of the most visited tourist sites in South Asia?

Hospacxx Healthcare Consultancy, brings you key insights about the current status of Maldives, including their healthcare status and the progression made so far.

OVERVIEW OF THE COUNTRY

Maldives, officially called “the Republic of Maldives”, is an archipelagic country in the Indian subcontinent of Asia, situated in the Indian Ocean. It lies southwest of Sri Lanka and India, about 750 kilometers from the Asian continent’s mainland. Maldives is formed by a chain of 26 atolls stretching from Ihavandhippolhu Atoll in the north to Addu Atoll in the south (across the Equator).

Thus, Maldives is one of the world’s most geographically dispersed sovereign states and the smallest Asian country, wherein it is enclosed by a territory extending roughly 90,000 square kilometers including the sea, with a land area of all the islands comprising of 298 square kilometers. It is one of the smallest Muslim-majority countries by land area and, with around 557,751 inhabitants, the 2nd least populous country in Asia. Malé is the capital and the most populated city, traditionally called the “King’s Island” where the ancient royal dynasties ruled for its central location. Dhivehi is the regional language of Maldives, while English & Arabic are the most common languages spoken.

GOVERNANCE

Maldives is a presidential constitutional republic, wherein the president heads the executive branch, and appoints the cabinet which is approved by the People’s Majlis (Parliament). The current president as of 19 October 2021 is Ibrahim Mohamed Solih. According to the Constitution of Maldives, the judges are independent, and subject only to the Constitution and the law. When deciding matters on which the Constitution or the law is silent, judges must consider Islamic Shari’ah.

ECONOMY

Maldives’ economy is mainly dependent on their tourism and fisheries trade, while other sectors like agriculture and manufacturing, play the least role in contributing towards the economic growth. Imports normally exceed exports, which are varied and include food, electronics, machinery and transport, construction materials and equipment, oil and petrochemicals, and other products.

DEMOGRAPHICS

Since the 1950’s, Maldives had a steady population growth, with 73, 712 people, until the year 2018, wherein the population count grew to 530,953 people, which indicates 86% growth rate in the population. Since 2019, there has been a decline in the growth rate due to the pandemic. Currently, the population stands at 540,985, which indicates a 0.48% decline in the growth rate from the population during the year 2021 at 543,617 people.

KEY HEALTH INDICATORS

According to the United Nations- World Projections,

Total Fertility Rate: Until 1983, there has been a steady increase in the fertility rate. Since 1984, the fertility rate began to decline gradually at 7.139 births per women. As of the year 2022, the total fertility rate is at 1.795 births per women, which indicates a 1.16% decline from the fertility rate of 2021 at 1.816 births per women.

Infant Mortality Rate: There has been a steady decline in the rate of the Infant mortality rate since the 1950’s. Currently, the Infant Mortality Rate is at 5.568 deaths per 1000 population, which is a 5.11% decline from the Infant Mortality Rate for the year 2021 at 5.868 deaths per 1000 population.

Life Expectancy at birth: Over the years, there has been a gradual increase in the life expectancy age. As of the year 2022, it is noted that the life expectancy age is 79.61 years, which is a meager 0.36% increase from the life expectancy age of 2021 which was 79.32 years.

Mean Mortality Rate: Since the 1980’s, there has been a steady decline in the mortality rate. Currently, in the year 2022, the mean mortality rate is 2.76 per 1000 population, which is a 0.65% decline from the mortality rate in 2021 which was 2.78 deaths per 1000 population.

HEALTHCARE SCENARIO IN MALDIVES

The delivery systems of healthcare services are comprised of a three-tier system with island level primary care centers, a higher level of health facilities with respect to provision of maternal, newborn care and specialty care at an atoll/regional level and tertiary care at a central/regional level. The regional or atoll hospital in each atoll, acts as the main coordinating body in providing general and specialty health care in that atoll with each atoll covering a population of 5,000 to 15,000 people.

According to the data compiled by The National Spatial Plan (Ministry of National Planning Housing and Infrastructure 2020), there are a total of 430 healthcare establishments across Maldives, out of which, about 240 privatized health facilities such as Resort Clinics, Allopathic Clinics, Alternative Clinics, Dental Clinics, Optical Clinics, Laboratories, Psychotherapy & Social Service Centers, Hospitals, E.N.T Clinics & Physiotherapy Clinics. While there are 190 public health facilities like Primary Health Centres, Hospitals and Allopathic Clinics.

According to the Health Statistics Report by the Maldivian Ministry of Health, as of 2020, there is a total of 3,720 facility beds, out of which 2,581 was inpatient beds. The total number of inpatient beds were 2,411 in 184 atolls health facilities, while the Greater Male’ Region has 1,309 beds in 8 health facilities. It was also reported that majority of the radiological services provided were Ultrasound and X-ray, while there was no report of MRI & CT services being provided in any of the health centres and atoll hospitals.

The total outpatient visits to 192 government health facilities in Maldives are 2,00,929 in 2020, from which 63% were from Atolls. Out of the Outpatient visits in Atolls, most of the outpatients (32%) visited health centers followed by tertiary hospitals (25%). A total of 41,800 inpatients were admitted in public health facilities and hospitals of Maldives. Out of the total number of Inpatients admitted, majority of the admissions were to public hospitals (33,971 inpatients), in comparison to private hospitals (7,829 inpatients).

According to the Health Statistics Report by the Maldivian Ministry of Health, as of 2020, there were a total of 11,093 health professionals working in Maldives, out of which, majority of the health professionals were the Maldivian localities which were a total of 8,092, while 3,001 professionals are foreigners. Out of the total number of Health professionals, there are 1,084 medical professionals, 2,987 nurses, 2,257 allied health professional and 4,765 non-medical staff. there were 935 doctors and 2,859 nurses.

According to a report by the World Bank, the physicians of Maldives increased from 0.07 per 1,000 people in 1990 to 1.71 per 1,000 people in 2018 growing at an average annual rate of 36.86%. Though the country has fulfilled the WHO criteria of 1 doctor for every 1,000 population, there is still a deficiency for the equal availability and accessibility of good quality healthcare services.

Some of the Atoll-based Hospitals in Maldives are: –

Haa Alif Atoll Hospital
Kulhudhuffushi Regional Hospital
Shaviyani Atoll Hospital
Noonu Atoll Hospital
Ungoofaaru Regional Hospital

Baa Atoll Hospital
Lhaviyani Atoll Hospital
Alif Alif Atoll Hospital
Alif Dhaalu Atoll Hospital
Vaavu Atoll Hospital

Muli Regional Hospital
Faafu Atoll Hospital
Dhaalu Atoll Hospital
Thaa Atoll Hospital
Gan Regional Hospital

HEALTHCARE FINANCING

According to a WHO report in 2018, Maldives government spent about 9% of their GDP on the healthcare sector, with the average expenditure of 3.4% of the healthcare fund. According to the Health Statistics Report for 2020 by the Maldivian Ministry of Health, the government health spending skyrocketed in 2020 due to COVID-19 pandemic. Thus, in total more than 16% of the government expenditure was on health.

Currently, The Maldives has universal health insurance that covers various primary care services. The country’s health scheme is called Husnuvaa Aasandha and the state-owned company Aasandha runs it. Husnuvaa Aasandha means “healthcare for all without a ceiling protection limit” according to the Aasandha website, and it receives funding from the Maldives’ government. The plan pays for citizens to go abroad for certain medical treatments if the treatments are not available in the Maldives.

National Master Health Plan (2016-2025) guides the health work in the country. It supports the Sustainable Development Goals and is being implemented through a multisectoral and one health approach. With access to health care for everyone, everywhere realized in the country, attention has shifted to quality of care.

Quality of Care Framework for assessing and improving health facilities have been rolled out, another key step to ensuring universal health coverage. The multi-sectoral NCD prevention and management plan and Mental Health Strategic and costed action plan are part of the strategic agenda. Through multisectoral strategies all health outcomes are being perused. Improving access to health care for the migrants and prevent resurgence of diseases is a major area of work that is being undertaken.

Though the country has one of the highest health fund allocations amongst the South East Asian Countries, it still struggles to make provision for the possible optimal quality healthcare services, due to the following factors: –

1) Insufficient availability of healthcare resources: Most of the resources like medicines, and equipment have to be imported. Thus, it comes with an expensive cost to acquire such resources. As a result, for the amount of healthcare funding, the quality of healthcare services provided is inadequate to fulfill the healthcare needs of the public, especially with the prevalence of non-communicable diseases like respiratory diseases, cancer, diabetes and cardiovascular diseases which are the most common causes for deaths in the Maldives.

2) Inefficient operation of Primary Health Centres: Though Maldives is one of the countries that has achieved the “Health for All goal” with the provision of basic primary healthcare facilities that and equally distributed across all the inhabited islands, the primary health centres have been reported to be functioning in an inefficient manner, due to the lack of adequate medicines, equipment and healthcare professionals. The transportation across islands is improper, which makes it more difficult for critical patients to avail secondary & tertiary care services.

HEALTH INFORMATION SYSTEMS

The Maldivian Ministry of Health, in collaboration with the World Health Organization (WHO) introduced a District Health Information Software Version 2 (DHIS2) as a statistical software in 2017. However, this system started to roll out only in July 1, 2019 at a national level in all public health facilities and private hospitals and in the year 2020, the software was full rolled out of the system in the country.

It was predicted that DHIS2 would assist in better data management, analysis, monitoring & evaluation of key health indicators for informed and/or evidence-based decision making. Currently, the software also works on data of number of outpatients, bed, health workforce, surgeries and observations.

The Ministry of Health has committed to ensure the effective utilization of DHIS2 in order to strengthen the national health information management system of the country. Currently, there are ongoing efforts of more data collection for further emphasis on integration with other existing systems and also for the introduction of specific modules related to immunization and reproductive health to capture relevant routinely collected data from health facilities.

Apart from DHIS2, there are numerus health information systems, as mentioned below, that are fragmented and working individually in the country: –

▪ GEMEN – Population module which captures all the births and deaths of the country.

▪ Online/excel based information sheets collated by the departments of Ministry of Health: surveillance, mainly pharmacy, pharmacists, thalassemia and public health data.

▪ Other specific health related information systems used by stakeholders (eg: Aasandha – Vinavi system).

CONCLUSION

Maldives is best known for the enriching tourism experience, well enjoyed by foreign tourists. Although, their local citizens still deserve the quality of healthcare services that can be offered in the best way by the high healthcare funding from their government. Thus, there is a huge scope for foreigners and upcoming private companies to make use of this opportunity to invest into the Maldives Healthcare sector.

Hospacxx Healthcare Consultancy provides their expertise across Indian & International states in services like Planning & designing with project management consultancy, Operations Management consultancy, financial management and more. For more information, you can visit the company website on www.hospaccxconsulting.com or contact us directly.