Current Status of Noncommunicable Diseases in Maldives

1. Second International Seminar on Epidemiology andPublic Health Aspects of Noncommunicable Diseases, Lausanne, 10-18 August 2010 UbeydullaThoufeeq Deputy Director and Head, NCD Division Center for Community Health and Disease Control Ministry of Health and Family Maldives. Current status of NCDs in 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 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 2006-15, 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