Good afternoon to all of you.
It is indeed a very good afternoon for me to be with all of you, at this impressive Faafu Atoll Demonstration site, in such wonderful surroundings.
- Here in the Maldives, 11% of your GDP and 22% of your Budget are allocated to health care. This is indeed commendable and impressive. However, the national health spending on preventive interventions is only approximately 1%.
- There is a disproportionate focus on high-cost interventions aimed at improving hospital care. Unfortunately, this neglects important areas such as health-promoting environments and workplaces, primary prevention, nutrition education, antenatal and postnatal care, physical activity promotion, smoking prevention, and social policies influencing health literacy, quality of life and community well-being.
- The health care achievements are due to the dedicated efforts of the public health system. These impressive achievements include the successful elimination of malaria, filaria, measles and rubella; mother-to-child transmission of HIV and syphilis; and the interruption of transmission of leprosy.
- The primary health care (PHC) system serves as the bedrock of this nation's health care framework, aiming to ensure fair and accessible health services across these scattered islands. It has a strong emphasis on community-based care, and integrates preventive, promotive, curative and rehabilitative services, targeting the health needs of the population at the grass-roots level.
- Structured around a network of health centres on every inhabited island, complemented by atoll hospitals offering advanced care, this decentralization allows for the delivery of crucial services close to communities.
Presently, the focus of PHC services leans towards traditional priorities, such as reproductive, maternal, newborn and child health (RMNCH), as well as addressing prevalent communicable diseases and providing regular outpatient care.
NCD Burden
- The burden of noncommunicable diseases (NCDs) unfortunately accounts for 84% of all deaths in the Maldives. This significant impact is attributed to enhanced socioeconomic development and lifestyle changes within the population.
- There was an absence of systematic efforts to tackle NCDs, including common cancers and mental health. Recognizing this, it became evident that the country required a systematic approach to effectively address both current and future health challenges.
- This required a holistic transformation and reorganization of the PHC landscape in the country.
Prioritizing PHC
This transformation and reorganization took place across several distinct stages, each leading to incremental progression towards the end objectives.
- WHO Technical assistance
In 2022, the Government requested technical assistance from WHO to revitalize PHC services, by scaling up NCD and mental health prevention, control and integration. This aims to reduce the burden on secondary and tertiary care by enhancing primary care capabilities. The lack of investment in PHC has directly increased tertiary care costs and congestion. This is a significant concern as many uncomplicated cases can be managed at the primary care level.
2. Faafu Atoll Demonstration Site
The Ministry of Health selected this site - the Faafu Atoll - as a Demonstration Site for planning and implementing integrated PHC interventions, with the goal of rapid expansion to other atolls.
3. Reorientation of PHC
The reorientation of PHC includes population-level screening for NCDs, lifestyle counseling, cancer and mental health. It encompasses early identification and referrals, service delivery model revision, training, supportive supervision, monitoring and evaluation.
4. Stepwise Process
A Stepwise process was planned, beginning with a baseline assessment to evaluate the status of PHC service provision in areas such as governance, workforce development, information systems, service delivery, essential medicines and more. This assessment informed the creation of a holistic strategy to integrate health system elements and disease priorities, ensuring care provided is close to communities.
5. Primary Health Care Registry
The Primary Health Care Registry was developed by the WCO team and used at the demonstration site for screening and monitoring of the community to establish an Island Health Profile database.
6. Step-by-step guide for PHC (that we have just launched)
This guide provides the learnings of the experience of implementing this Faafu Atoll PHC Demonstration site. It also embeds the entire set of tools, guides, formats and templates that had been used, and the learning materials that had been developed for the Faafu project. It has been developed by WCO Maldives to ensure clarity and consistency in getting the PHC revitalization initiative implemented and rolled out across all atolls by health-care providers and managers.
As you can see, this Faafu Atoll Demonstration Site did not happen by accident. It is the result of a careful, deliberative and well-thought-out process. It is an excellent example of a true partnership between a progressive and responsive government and the technical excellence of the WHO.
I am pleased and proud of the results of this partnership, and extremely happy that the learnings from this experience will live on in the Step-by-step guide for PHC for others to benefit from.
Thank you to all who have made this possible.
The President pledge:
Prioritize a comprehensive primary healthcare system that encompasses preventive care, annual checkups for selected age groups, focused elderly care, access high-quality and safe healthcare services and medicines, and establishing mental health helpline, to ensure the overall well-being of the population.