C ommo nwe a l t h memb e r c o u n t r i e s All pharmaceutical products in Maldives are imported, mostly by the private sector. Apart from a specific category of hospital drugs and controlled drugs, all drugs must be bought by patients at private pharmacists. There is no mental health act or plan and mental health is not mentioned in general health policy. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Maldives to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 31 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at ten deaths per 1,000 live births and measles immunisation at 99 per cent, so the country has already surpassed its under-five mortality target and is on track to increase immunisation to 100 per cent when the 2015 data is analysed. Consequently, it is very likely to achieve MDG 4. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Maldives, maternal mortality should fall to 208 cases per 100,000 live births. In 2013 Maldives had an adjusted maternal mortality ratio of 31 deaths per 100,000 live births (this figure was estimated at 60 deaths per 100,000 by UN agencies/World Bank in 2010) so this target has already been surpassed. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2013 this figure stood at 99 per cent, so this target is likely to be achieved. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. Prevalence rates of major communicable diseases, such as malaria, HIV/AIDS and tuberculosis, are low or declining. Accordingly, with continued progress, the country is likely to achieve MDG 6. The 2013 World Health Organization (WHO) country co-operation strategy for Maldives reported that the country has largely achieved all the health-related MDGs ahead of the 2015 deadline. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Less than half of all health care in Maldives (45 per cent) was government funded in 2012. The remaining 55 per cent was paid for by patients or funded by other non-governmental entities, such as private insurers, charities or employers. Total health expenditure constituted 8.5 per cent of GDP in 2012. Expenditure by government amounts to US$253 per capita. Health care in the Maldives has improved drastically in the last few decades, due to improved coverage in the islands and the introduction of free treatment. All Maldivians are covered under a universal health insurance scheme financed by the government, which provides free medical care. The Maldives Demographic Health Survey 2009 found that 93 per cent of children aged 208 Commonwealth Health Partnerships 2015 between 12 and 23 months had received all recommended immunisations. The delivery of services is challenging on the most remote islands. The government has decided that it is not cost effective to have hospitals or health centres on every island as the population sometimes numbers only a few hundred. Consequently, it has had to improve public transport between islands in order to ensure effective provision of these services, incurring high operational costs. Accordingly, providing health care services to the islands – in terms of increased facilities and improved transport – has almost doubled the cost of health services delivery. Maldives was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 2006 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: Around 17,000 people in Maldives are over the age of 65 – five per cent of the total population (2013). At the age of 60 a person living in Maldives can be expected to live for an additional 21 years, on average (2013). Maldives’ Old-Age Basic Pension system dates back to 2010. Today, monthly pension credits are paid by the state at a rate of US$130 per person (2007–12) on a pensions-tested basis. Overall, public pension spending is equivalent to 0.2 per cent of the country’s total economic output (2012). Population over 65 5% The Ministry of Health is the government agency responsible for the elderly in Maldives. All Maldivians over the age of 65 have insurance coverage for medical care in hospitals, and medical and pharmaceutical benefits through the government-administered Madhana Health Insurance programme. Many families also care for older relatives and there are several programmes and support systems in place for the elderly from non-governmental organisations. Limited opportunities for residential care for the elderly are available at the Home for People with Special Needs, the only psychiatric facility in the Maldives. Further information Ministry of Health: www.health.gov.mv Commonwealth Health Online: www.commonwealthhealth.org/health/asia/maldives
Commonwealth Health Partnerships 2015
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