1. Current status of NCDs in Maldives
Second International Seminar on Epidemiology and Public Health Aspects of Noncommunicable Diseases, Lausanne, August 2010
Current status of NCDs in Maldives
Ubeydulla Thoufeeq
Deputy Director and Head, NCD Division
Center for Community Health and Disease Control
Ministry of Health and Family Maldives.

2. Contents
Health system
The problem
The response
The lessons
The future

3. Maldives Island nation state 1900 islands 198 inhabited islands
33% under the age of 15 years and 5.1% over 65 years old.
Life expectancy at birth increased dramatically 58 years in 1990 to 73 years in 2007

4. Health care institutions (service delivery & regulatory)
Health System
MoHF
CCHDC
MFDA
DDPRS
Health care institutions (service delivery & regulatory)
NSPA
DGFPS
Private HC inst
Tertiary Care
Secondary Care
Primary Care
IGMH
Hospital
Grade 1,2,3
Health center Grade 1,2,3
Referral system

5. The problem- Epidemiological
Magnitude and spread- STEPS survey 2003,
Demographic Health surveys,2009, indicates High Smoking prevalence
Multi Indicator Cluster survey ….indicates low exclusive Breast feeding
Malnutrition <5yrs persistently high

6. Mortality due to NCDs

7. Burden of NCD risk

8. The problem- Social Economic Determinants
Widening income disparities
The underlying factors. Social determinants, behavioral determinants
Migration to capital to seek jobs. Families left behind.
Urbanization: 198 inhabited islands. 33% of population on one island

9. The problem- Health systems
Benefits of economies of scale not achieved at island level. Hence, cost of providing health care is much higher
High referral/ transport costs
Current reform: regulatory and service delivery demarcations with formation of Health care corporations

10. The Problem-Challenges in delivery of Primary Health care
Changing role of community health workers assuming more managerial functions with formation of Healthcare corporations
Weak working links between Center for community Health and Public health units at atoll levels

11. The problem-Additional health system issues
Historically no guidelines for managing NCDs
NCDs a domain of the “specialists”
Difficult to institutionalize good practices due to reliance on non-local doctors and their high turnover
Lack of access to essential medicines due to absence of pharmacies in smaller islands
Lack of trained human resource and funds

12. The response
Policies- 7th National Development Plan, Health Master plan , MDP Govt Manifesto, NCD Strategic plan
Health system development
Infrastructure ++
Human resources –few public health specialists
Programs: Implementation at Central and atoll levels
Civil society involvement-mixed success

13. Recent changes to the health system
Government has called for revitalization of primary healthcare in Maldives.
? Motivated by difficulty in sustaining the current medical oriented model
Introduction of a National social protection scheme
Introduction of user fees under Health corporations
Telemedicine NCD project in 4 atolls

14. The lessons Belated recognition of NCD burden
Mismatch between service development and needs…HR, as well as services
Difficult to sell ‘prevention’.
Lost momentum in key areas Tobacco control
Not tackling Burden of substance abuse
Social determinants and disparities …MSDH report: needs shift from focus on the overall national health improvements to close in equity gaps within and between communities
Need gate keeping, referral systems and care standards

15. The future Policy to revitalize primary health care
Safety net including free health care for the elderly
New treatment and rehabilitation for drug users
Protocols and standards of care [WHO PEN]
Tobacco Law passed.
Institutional mechanisms for NCD P&C being strengthened
Networking mechanism strengthened. [NTobCCte, Health PromotionNet ]

16. T h a n k y o u