Health

Expenditures on the health sub-sector have increased in nominal terms, from $14.6 mill in 1995 to an estimated $69 mill in 2009. The increase, however, has not been uniform with the growth rate, which dropped between 1999 and 2001, and then grew steadily after that until 2006. Since 2006, growth rates of health expenditures have been volatile. Health expenditures increased on average at about 10.7% per year during 2000-2004. Following the tsunami, health expenditures began to grow at an annual average of 19.7% – most of the increase being accounted for by planned budgetary expenses of about $69.0 million in 2009 compared to $53.8 million in 2006 (Figure 8).

Per capita expenditures on health have risen steadily from about $60 in 1995 to an estimated $200 in 2007 (there was, however, a dip in the year 2001). Most of the increases took place in recent years after the tsunami, with per capita spending doubling to an average of $211 during 2005-2009 from an average of $97 for the years 2000-2004 (Table 8). Expenditures made include upgraded buildings for island health posts, and additional staffing, especially in 2008 and 2009 (partly in connection with election year).

 

Improvements in the health sector, which are possibly attributable to increasing budgetary inflows, have contributed to better health services, inter alia, by financing an increased dispersion of doctors, nurses and paramedical staff and a reduction in the number of patients per hospital bed (Table 8). Outcomes that may be attributed to the expenditures include a) increased life expectancy for both males and females: life expectancy at birth rose from about 71 and 72 for males and females in 1998 to about 72 for males and 73 for females by 2006, b) decreasing infant mortality (Table 1) which fell to a low level of 10 in 2007 compared to 24 in 1998. However, these efforts need to be sustained to ensure that all Maldivians, including those living in small island communities and economically disadvantaged regions in the country, have equal access to primary health care. This can be achieved by ensuring that each inhabited island has at least one health facility, by setting-up better and faster transportation systems to provide outreach and emergency care services, and by ensuring functional health system monitoring infrastructure to identify pockets of vulnerability and poor service quality. This initiative is under way but needs to be reemphasized.

In health, MDG targets that emerge as potentially more problematic are in nutrition, health and water: halving child malnutrition below the age of 5; halving the proportion of the population not having access to safe drinking water; reducing by three-quarters the maternal mortality ratio; and slowing the rate and reversing the spread of HIV/AIDS. Other issues on the government’s agenda include health education, efforts to lower the average costs of healthcare, and sanitation. Being dependant on expatriate skills, the health care sector has been incurring high costs. Expanding the national contingent of health professionals is required in order to ensure retention in the health sector and avoidance of shortages of necessary human resources. Major challenges faced by this sector are to sustain high absolute and per capita levels of health expenditures to meet the needs of the large child population and to address ageing population, especially the elderly poor, who are especially vulnerable to health shocks. In addition, the distressing rates of drug use are becoming a serious public health problem and have major budgetary implications.

The devastation caused by the tsunami has had adverse impacts on the provision of health services in some of the health centres and atoll and regional hospitals. Although some of these services are functioning, this is at a very minimal level, with very little equipment and shortage of supplies. It is critical to restore and expand these facilities to meet the needs of the people.

_{Source : UNICEF ROSA (2009)}

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