The Maldives has recorded significant
achievement in human development. The infant
mortality rate which was 63 in 1986 is now 30
per 1 000 births (1996) and the overall
mortality rate (crude death rate) which was 17
per five 1000 in 1971 is now five per live 1000.
The crude birth rate, which stood at 49 per 1000
in 1985, has fallen to 26 per 1000 in 1996,
showing a decline of about 40 percent. In 1995,
the average life expectancy at birth had
increased to 70.6 years. This meant about 20
years have been added to the life expectancy of
a Maldivian at birth since 1980.
Notable achievements have also been made in the
control of communicable diseases. There has been
no indigenous case of malaria seen for the past
ten years. At the end of 1995, incidence rate of
leprosy was 0.1 and the prevalence rate was 0.3
per thousand. Thus, the Maldives is very close
to achieve zero transmission status, with
respect to leprosy. Tuberculosis, which had a
prevalence of 35 cases per thousand in 1974, had
declined in 1995 to about 0.66 per 1000.
Childhood TB (under 5 years) is almost nil for
the past three years due to the high rate of BCG
vaccination. By the end of 1996, a total of 57
TB cases were under treatment.
The progress recorded in the field of health is
thus quite significant. In order to meet further
health targets and provide better health
services, the Ministry of Health held
discussions in December 1996 to formulate a
ten-year health master plan.
General Health Services
Health services in the Maldives are organized
and promoted through the Primary health care
approach, which emphasizes the overall health
needs of the community. These services are
Provided through a countrywide referral network
of Family Health Workers at least one in each
inhabited island, 27 Atoll Health Centers, four
Regional Hospitals and a central level hospital
in Male'.
In effect, there is one doctor for every 1400
Population, 1.1 Family Health Workers for every
1 000 Population, 0.2 Community Health Workers
for every 4000 Population. All the inhabited
islands also have resident midwives.
Indira Gandhi Memorial Hospital.
Tertiary level medicine services are focally
located in Male' at the Indira Gandhi Memorial
Hospital (IGMH).
 |
|
Indira Gandhi Memorial Hospital |
The 200-bed hospital, which was inaugurated in
1994, is a well-equipped medical service
facility providing a wide range of secondary and
tertiary need of the total population of the
Maldives. There are about 15 specialists in IGMH.
In 1996 there were 32 specialists and 39 general
duty doctors, along with 113 staff nurses and 69
general nurses employed at IGMH.
Besides the Indira Gandhi Memorial Hospital in
Male' there is a 40-bed private hospital which
provides a wide range of preventive, curative,
surgical and other specialized services. In
addition to the hospitals in Male', there are
four regional hospitals located in the north,
south and the central regions of the country.
These hospitals play a major role in extending
the quality of health services in to the rural
population. The four regional hospitals are in
Addu Atoll –Hithadhoo (southern atolls), Haa
Dhaalu Kulhuduffushi, Raa Atoll Ungoofaaru
(northern atolls) and Meemu Atoll Muli (central
atolls). The regional hospitals provide
secondary health services as well as some
specialist care. By the end of 1996, the four
hospitals had a total bed capacity of 125 and
have 34 doctors and 107 nurses.
In addition to the existing regional hospitals,
the government has begun constructing a fifth
regional hospital to be located in Gaafu Dhaalu
Atoll. The foundation stone for this hospital
was laid on Thinadhoo on 13 November 1996, The
hospital is expected to be completed shortly.
At the general level, Atoll Health Centers
provide health services in the 19 atolls where
physicians and paramedical personnel are
stationed. At the island, level the very basic
essential preventive and the Family Health
Workers meet primitive needs of the community
especially in the areas of family health and
childcare.
Specific preventive services include
immunization given to children, pregnant women
and women of child-bearing age, promotion of
family planning, control of communicable
diseases such as tuberculosis, malaria,
filariasis, dengue and diarrhoea, and health
education to the masses on the preventive and
promotive aspects of health. A combination of
strategies is implemented in a combined manner
to tackle these problems at the community level.
Emphasis is placed on providing holistic care
with the community and Government health
delivery system working in close co-operation.
The vaccination programmes for mothers and
children particularly immunization for children
have been completed throughout the archipelago
in one year, earning the commendation of both
UNICEF and WHO. As part of a regular programme,
vaccination is carried out twice a week on
rotation at the Indhira Gandhi Memorial Hospital
and Male' Health Centre. This is a year-round
programme. Mobile teams also cover the atolls in
regular intervals in order to maintain the
national vaccine coverage above 95 percent.
Water Supply and Sewerage
In The Maldives the main source of fresh water
is the aquifer that floats on saline water about
two meters below ground level. The soil being
generally porous and most of the islands being
small, the available ground water supply in the
island aquifer is particularly susceptible to
pollution mainly due to the absence often
environmentally-sound sewerage disposal systems.
Therefore water-borne disease, a major cause of
illness and death in The Maldives, had sometimes
reached epidemic proportions in the overcrowded
islands. This was especially true in Male', the
capital which houses a quarter of the country's
population. However, since Male' received a
sound sewerage disposal system in 1988, this was
no longer a serious problem.
Under the Male' Water Supply and Sanitation
Project which was completed on August 1988 ' a
total of 46,387 meters of sewer pipes were laid
and nine pumping stations were constructed in
Male', by 1997, a total of over 50,000 meters of
sewer pipes have been laid in Male'.
As a major step to provide the people of Male'
safe drinking water and a hygienic sewerage
disposal system, the Male' Water Supply and
Sanitation Project was initiated in July 1985.
The West German Government and the European
Economic Union funded the project. In addition,
the government also obtained a loan from Saudi
Fund.
Under Danish Government aid, work was also begun
to install desalination plants in Male', The
first operated through reverse osmosis process
had a capacity of 200 cubic meters per day. Two
more plants were installed under the Danish aid.
A fourth plant was installed under the French
assistance.
In order to manage the Male' water and sewerage
works in a cost effective manner, in April 1995,
the government established the Male' Water and
Sewerage Company Ltd. (MWSC). MWSC a joint
venture of the Maldivian government and a Dutch
company has now installed desalination plants
that have a capacity to produce 2000 tones of
water per day. Under a separate project to
provide safe drinking water which commenced on
20" October 1996, the new company has enabled
the people of Male' to have fresh water piped to
their homes.
The Maldives Water and Sanitation Authority (MWSA)
is also undertaking a nation-wide project to
provide safe and environmentally sound sewerage
systems to the atolls. The project covers 40
islands selected on the size and density of the
population. So far three islands namely Vaavu
Atoll Rakeedhoo, Raa Atoll Kandhothudhoo, and
Lhaviyani Atoll Hinnavaru have been provided
with sewerage systems. MWSA is already laying
down pipes in three other islands namely Baa
Atoll Thulhaadhoo, Shaviyani Atoll Komandoo and
Gaafu Dhaaiu Atoll Thinadhoo.
Under the programmes implemented to improve the
sanitation in the atolls, now more than 86% of
the population in the outer atolls have access
to safe drinking water.
Health Services Training
The Institute of Health Sciences (IHS) trains
the required Para-professional health personnel
for all the inhabited islands including Malé. IHS conducts a three-year diploma course in
nursing and midwifery. The first course
commenced in September 1991. The Institute has
so far trained 32 people under its Diploma
Programme. By mid 1997, IHS has trained 524
Family Health Workers, 112 Community Health
Workers, 276 Nurse Aides, 586 Traditional Birth
Attendants, 34 Auxiliary Nurses Midwives, 90
Pharmacy Assistants and 348 First Aides. On 7
July 1996, the IHS has started a new three-year
diploma course in primary health care.
The institute of Health Sciences has also
conducted a traditional medicine course where
personnel were trained in the ' use of herbs to
prepare medicine. A diploma course in laboratory
technology is also planned to train personnel in
this field. The Institute also provides regular
in-service training and Library services for the
health personnel. IHS is also the nucleus for
the health education activities in the country.
In addition, it runs both Male' and atoll-based
primary health personnel training programmes
with an emphasis on bringing about a strong
match between skills and the services provided
to the community.
|
