WHO report says ‘urgent’ need to review Aasandha

The Maldives’ health insurance scheme needs to be reviewed urgently so it is coherent and sustainable, the World Health Organization has said.

Its Country Cooperation Strategy 2018-2022 report said the Husnuvaa Aasandha scheme “appears to be very complex with inadequate coordination.”

“A coherent and efficient model needs to be developed urgently for sustainable health protection system in the country,” the report said.

Aasandha was introduced in 2012 and revised in 2014 to Husnuvaa (unlimited). It is a non-contributory scheme, without an annual individual financial limit, and can be used in some hospitals abroad.

The 27-page report also found there was a high dependency on overseas confirmation of medical tests due to the absence of a laboratory policy, strategy and plan.

“There is an urgent need to develop laboratory surveillance, surveillance for hospital-acquired infections and accordingly develop a quarantine facility.”

It praised the country’s achievements in the past two decades including the increase in life expectancy, improvements in infant, child and maternal health and the control of communicable diseases.

Polio, neonatal tetanus, whooping cough, diphtheria are non-existent in the Maldives and the country eliminated measles in 2017 and malaria and filaria in 2016.

But tuberculosis “continues to persist with high risk of transmission” due to overcrowding and poor housing conditions in the capital, and lax screening processes for the country’s migrant population.

The report also stressed the need to address new challenges, such as the increase in non-communicable diseases and the reliance on foreign health professionals.

“The country is facing newer challenges such as growing rates of noncommunicable diseases accounting for more than 80% of total deaths.”

Dengue was underlined as a serious “public health problem” and respiratory infections like influenza and diarrhea noted as “emerging public health problems.”

The report says 1,890 dengue cases and six deaths were reported in 2015 and that 1,931 cases including three deaths occurred in 2016.

Six Zika cases transmitted in the country have been reported since 2016, and between 4,000 and 6,000 respiratory infections are being reported every week.

A total of 277 H1N1 cases and six attributed deaths have been reported since March 2017. At least 270 cases of diarrhoea have been reported every week since 2015.

The WHO’s fourth CSC report forms the basis of strategic direction and policy support to the government and health development initiatives in the Maldives over the next five years.

It was officially launched last month by Health Minister Abdulla Nazim and WHO representative Dr Arvind Mathur.