International Symposium on Volunteering 18-21 November 2001, Geneva

Role of Volunteering inHealth in Maldives

Presented by Mohamed Zuhair

Country Setting

Island Nation with about 1200 small islands, and 200 dispersed communities

Unique geographical features inhibiting transportation and mobility

Small land mass (less than 1 % of geographical area)

Total population of around 300,000 people Fragile environment

Country Setting

Wide dispersion of population, and the small size of the communities: on average a community has a population of around 800 people; only two communities have a population exceeding 10,000 people

Excessive congestion in some communities, and over stretching carrying capacity in terms of housing and water; the capital Male’ has a population of 70,000 with an area of about 2 sq.km

Country Setting

Economy characterized by two dominant sectors of tourism and fisheries, and almost full dependence on import

Difficulty in attaining sustainability in service delivery due to dis-economies of scale

Excessive dependence on expatriate labour (at present more than one fourth of the labour force comprises expatriates)

Country Setting

Traditionally, communities had very limited support from the public sector in providing basic services, including health and education

Close to universal literacy with high school enrolment at primary level, and strong commitment for education

Country Setting

Dynamic population growth experienced from early 1960s to early 1990s

Sudden decline in mortality experienced during mid 1980s

Current Life Expectancy at birth is around 70 years for both sexes

Difficulty in further reduction in MMR; though the number of cases remains low

Country Setting

Success in maintaining socio-economic progress for about three decades

Five-fold increase in GDP per capita in two decades

High cost of living Lead in HDI among the South Asian

countries Absence of absolute (visible) poverty

Country Setting

A culture demanding establishment of all services on each individual community irrespective of physical and population size - some communities have a population of s less than 200 people

Modern health facilities introduced only in late 1950s

Facilities established in the rural areas (or the Atoll region) became effectively functional only in the 1980s

Issues Related to the Health Sector Excessive unit costs for establishing most

services, due to geographical dispersion of communities and import dependency

Difficulty in ensuring accessibility due to wide dispersion of communities and transportation constraints

Limited local health personnel, and the need to recruit expatriates even for unskilled work

Issues Related to the Health Sector Government policy supports in establishing

a service network that is accessible to every community within two hours by using normal sea transport

Service network comprises national-level facilities in the capital Male’, five regional hospitals, and Atoll-level hospitals and health posts

Issues Related to the Health Sector Under utilization of most facilities

established in the Atoll region Limited motivation to join the health

profession by locals Services not effectively accessible to most

communities Significant proportion travelling abroad for

medical treatment

Issues Related to the Health Sector High divorce rate and consequential pressure to

have more children High fertility Malnutrition and poor food habits; inadequate

food security Limited variety of locally available food items Limited knowledge and awareness on health

matters

Issues Related to the Health Sector High proportion of adolescent and youth Lack of family life education within the

family and in schools Dependence on extended family norms

Issues Related to the Health Sector High prevalence of some genetic disorders;

especially thalassaemia - at present Maldives has the highest carrier prevalence rate (18%)

Increasing risk of HIV/AIDS problem due to worsening situation in the South Asia Region

Uncontrolled expansion in substance abuse

Issues Related to the Health Sector Shift of morbidity towards life style related

problems; high blood pressure, diabetes, cancer

High incidence of kidney failures High incidence of ARI related problems Possible increase in mental health problems

Issues Related to the Health Sector Some preferring unreliable traditional

treatment options Popular demand for medication, Complacency in following and completing

dosage

Issues Related to the Health Sector Tourism related risks (HIV/AIDS) Increasing dependence on expatriates health

personnel Need to travel abroad for medical treatment

Scopes and Responses of the Voluntary Sector Geo-physical environment demands strong

community participation in development In times of crisis (famine or natural disasters),

difficult to seek outside support due to constraints in accessibility

Strong tradition of voluntary support at the grassroots level

Formal recognition of voluntary service by the Government; annually since 1979

Scopes and Responses of the Voluntary SectorVoluntary support has traditionally remained

prominent in following areas: Basic literacy Health treatment (traditional medicine) Religious and cultural functions Welfare / security Transportation (sea travel)

Scopes and Responses of the Voluntary SectorAt present, volunteers and NGOs remain active

in the following fields: Sports, recreation and entertainment Education (pre- and primary school) Utilities, especially in providing electricity to

small communities Environment Welfare and security

Scopes and Responses ..... NGOs remain active in ... Global development agendas - eg. gender

and environment Promotion of environmental issues Community development Awareness raising on HIV/AIDS Health improvement

Volunteers Contributions to the Health Sector Advocacy Health Promotion and Awareness

Raising Infrastructure and Service Delivery Prevention and Treatment Consultation Counseling

•Contributions....- Advocacy Role of gender in health Importance of establishing island

level facilities Government policy now supports

expansion of infrastructure Posting of doctors in the field along with

paramedics

•Contributions....- Advocacy Implication of the high prevalence

of thalassaemia Reservation in addressing the

problem till 1990s NGO efforts led to the launching of a

national programme and establishment of the National Thalassaemia Centre

Acceptance for PND/MTP

Contributions....- Advocacy

Reproductive Health De-sensitization of child spacing methods First Family Planning Clinic Popularization of condom use

Contributions....- Promotion Dissemination of print materials on crucial

topics - HIV/AIDS, Substance abuse, nutrition

TV and Radio spots and programmes Training of peer educators to raise

awareness among adolescent and youth

Contributions....- Promotion School visits and group discussion Public meetings Help-lines (reproductive health, HIV/AIDS,

diabetes) Organization of Health Festivals Fielding of mobile teams for health education

and facilitating access to medical consultation

Contributions....- Infrastructure Construction of Island Health Posts that are

managed by the community or Community Based Organisations

Island Health Posts directly managed by NGOs (one at present)

Facilities for disabled people

Contributions....- Prevention and Treatment... Nation wide thalassaemia screening

programme - targeting 10,000 per year at a cost of US $ 13.5 per test

Securing funds for costly treatment abroad (bone marrow and kidney transplantation, and cancer) - costs of a bone marrow transplantation for a thalassaemia major exceeds US $ 30,000

Contributions....- Prevention and Treatment... Donation of pumps and injections required

for iron chelation - thalassaemia major requires daily treatment

Donation of filters required for blood transfusion for thalassaemia majors

Contributions....- Prevention and Treatment... Blood donation, especially for thalassaemia

majors who require transfusion on a monthly basis to stay alive

Regular financial support for medical treatment

Provision of free drugs to attract people for awareness raising programmes conducted in rural areas

Contributions....- Prevention and Treatment... Free treatment by those practicing traditional

medicine Physiotherapy for disabled people Teaching the sign language Teaching children who are deaf or having

other disabilities Supporting the parents of disabled children in

taking care of their children

Contributions....- Consultation Doctors participating in field trips, without

any remuneration Routine free consultation by those practicing

traditional medicine Accompanying those go abroad for medical

treatment Guiding the patients who visits the hospital

for consultation and treatment

Contributions....- Counseling General counseling support through telephone Face to face counseling (family problems, drugs,

HIV/AIDS) Genetic counseling for thalassaemia carriers Providing guidance and counseling for parents of

thalassaemia majors Providing counseling for those opting PND/MTP

Thank you for your voluntary time!