Maldives is a high-middle income country of just over one half a million people with a life expectancy at birth of 80 years. The poverty level in the country has declined from 31% in 2003 to 2.1% in 2023. The infant mortality rate stands at 6 per 1000 live births and the maternal mortality rate is 53. The immunization coverage has been about 98% for decades and the incidence of vaccine preventable diseases is low. Communicable diseases persists at the local level, and the prevalence of HIV and tuberculosis is very low.
Aging population and noncommunicable diseases challenge Maldives
Despite many health achievements, the health system of Maldives is facing significant challenges because of the growing rates of noncommunicable diseases (NCDs). NCDs now account for more than 80% of total deaths. The aging population places increasing demands on the health system, which also heavily relies on expatriate health professionals.
With a large increase in health financing over the years, the government was able to expand health coverage among the population through its own multi-tiered health system and purchasing services, known as Husnuvaa Aasandha. It is a universal, tax-funded health insurance system that finances public and private health care providers.
High government health expenditure checks out-of-pocket spending
The National Health Accounts 2015-2017 states that current health expenditure as a percentage of GDP remained at 9% in 2017, with government expenditure contributing to nearly four fifths of all health spending. As a result, only one fifth of all spending in the country is reported as out-of-pocket payments. Nearly three-fourths (73%) of all spending was used by the elderly population while expenditure on children accounted for 3% in 2017.
In Maldives, sustaining the current levels of public spending is critical to maintaining the momentum of achieving universal coverage, especially after the COVID-19 pandemic. In the future, significant additional allocations must be ring-fenced to primary care with health promotion and disease preventive services that can relieve health systems from unnecessary and irrational spending. The National Master Health Plan (2016-2025) supports the Sustainable Development Goals and is being implemented through a multisectoral and “one health” approach.
