Contributing to the development of the Maldives: IHP's contributions to health and social policy research

The Maldives, Sri Lanka's immediate neighbour, enjoys close links and relations with Sri Lanka. Today, IHP contributes to further strengthening of those links and common understanding through its work in support of more informed policy development in the country, and by sharing IHP's own expertise, skills and research capacity. With its rapid economic advances in the past two decades, there have been dramatic transformations in Maldives's economic and social sectors.

In the case of health, indicators have seen a dramatic improvement, with life expectancy and child mortality rates now amongst the lowest in the developing world, and akin to those in Sri Lanka. This has been achieved by substantial expansions in healthcare delivery, supported by significant increases in public investment and living standards. Correspondingly, there has been a dramatic change in the Maldives epidemiological burden, with communicable diseases giving way to a mortality pattern dominated by non-communicable diseases.

IHP researchers and student intern, John Harding, have been working on understanding these mortality trends by analysis of mortality data in the Maldives, alongside other IHP research looking at mortality trends in Sri Lanka. The Maldives has relatively good death certification, and so analysis of the cause of death as recorded in death certificates provides a good profile of the morbidity burden facing the country. These show that NCDs now account for the largest share of overall deaths, and that the balance between NCDs, communicable disease and other causes of death is increasingly mirroring patterns in more developed countries in Europe. Amongst the NCDs, heart disease is predominant, and the results of IHP's initial analysis indicate that levels of ischemic heart disease mortality may be even higher than in Sri Lanka. Project info>>

As NCDs increase in importance, health systems everywhere need to respond not only through primary prevention, but also with expanded secondary prevention and treatment. The recognition of the need for developing countries to also strengthen treatment has only recently become accepted, as for example in the latest work of the World Bank. In this respect, the Maldives has taken the lead in South Asia with its pioneering effort to rationalise the treatment of NCDs in its government hospitals. IHP staff, led by Dr Shanti Dalpatadu, together with other international experts from the UK, Australia and Sri Lanka are working though a project led by HPRA and PriceWaterhouse to produce and introduce standard treatment protocols for several major NCDs, including coronary artery disease, asthma, COPD, diabetes and hypertension. These are to be implemented at island and atoll hospitals, and will be supported by a set of standard operating procedures and a computerised online support system to assist frontline clinical staff. Project info>>

As the Maldives has developed economically, its social protection systems and social policies are also being updated. In recognition of the importance of assessing and monitoring the level of social protection in the country, the Maldives is participating in a major ADB project to compile social protection indices for all ADB member states. This SPI index is also intended to aid cross-country comparisons and future policy development. IHP researchers, led by Ruwanthi Elwalagedara are responsible for this activity, and are working with Ahmed Sahli, IHP's Maldivian counterpart, in compiling the necessary data and analysis to quantitatively assess coverage by programs ranging from healthcare and education to pensions coverage. Project info>>

One of the markers of the expansion of social services in the Maldives and increases in living standards has been the changes in levels of access to social services. In work for the WHO Commission on Social Determinants and Health, IHP is analyzing recent survey data from the Maldives to examine the factors explaining inequalities in specific health outcomes, including stunting in young children and use of overall health services. Project info>>

.