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Comment: A paradigm shift in health care

More than a quarter of the global population lives in eleven countries in South-East Asia. These eleven countries which include Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Thailand, Sri Lanka and Timor-Leste also bear 28 percent of global disease burden. Government expenditure for health is lowest in this Region compared to all other  WHO Regions.

This means that people in these countries have the highest out-of-pocket expenditure on health. Health care in these countries drives people into poverty and the poor into a vicious poverty trap.

How can South-East Asia maximise resources and ensure that their people remain healthy and productive? This would require a paradigm shift in health policies in favor of preventive care and public health services.  Countries have the power to prevent disease through effective public health interventions. Unfortunately most countries invest heavily on Medicine and curative care in institutions – all of which focus on the person after they develop an ailment. Countries need to empower  people  through health education and preventive care to enable them to  protect themselves from disease and maintain good health.

In these times of economic crunch, focusing on development of positive health while dealing with negative health would be a long term and cost effective intervention.  Instead of waiting for people to get sick we need to reorient ourselves to protecting the health of people, especially those who do not yet show obvious signs of disease.

Community health workers can be the catalysts for such a shift. These are workers come from the communities and act as agents of change for promoting healthy behaviors and reduce health inequities at a relatively lower cost. Nations need to review and redefine the role of these community health workers and make them an integral part of the referral chain within the health system.

Every year millions of children’s lives can be saved by vaccination. Immunisation prevents diseases and contributes to the quality of life. Access to safe and effective vaccines is a basic right of all children. Yet about 10 million vulnerable children in these countries do not receive Diphtheria, Tetanus, Pertussis (DTP3) vaccination during their first year of life. While each year an estimated number of 1.5 to 2 million children die due to vaccine preventable diseases world wide; 25-30% deaths occur in these South-East Asian countries.

Every minute one child under the age of five dies of pneumonia in WHO’s South-East Asia Region. Diarrhoea kills 6-7 under-five children every 5 minutes. These lives can be saved through simple interventions. By improving child nutrition, exclusive breastfeeding up to the age of 6 months, continued breastfeeding, zinc supplementation, expansion of immunisation coverage, promotion of hand-washing and provision of safe drinking water and sanitation can prevent these diseases and deaths.

Seventy percent of the world’s malnourished children reside in WHO’s South-East Asia Region. Most of them suffer from anaemia, including deficiency of iron and Vitamin A.  While many children die due to severe malnutrition, a larger number of deaths occur among the less severely malnourished. The consequences of malnutrition are inter-generational and besides health it can affect intellectual capacity and work capacity in adulthood.  Unfortunately the same countries also suffer from unhealthy diets, obesity and a higher risk of chronic non communicable diseases. The cost of medical care for these diseases will impoverish their populations further.. .  Countries need to bring together sectors like education, agriculture, fisheries, food processing, media and members of parliament to successfully meet nutrition challenges.

The disease burden in our countries can be effectively prevented through public health programs that strengthen primary health centers to educate communities about prevention.

Not all of the disease burden can be prevented. We are talking about a proactive health strategy. We are talking about a positive health approach. We are talking about a well informed public that know how to prevent, protect and maintain good health.

Countries in South-East Asia need to achieve a better balance between preventive and curative care. This balance in health care will reduce health-care cost and ensure better health and better quality of life of all people.

Dr Samlee Plianbangchang is the Regional Director of the World Health Organisation for South-East Asia

<em>All comment pieces are the sole view of the author and do not  reflect the editorial policy of Minivan News. If you would like to write  an opinion piece, please send proposals to [email protected]</em>

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RaajjeTV condemns newly formed PPM for barring journalist from press conference

Private broadcasting television RaajjeTV has condemned the newly formed Progressive Party of Maldives (PPM), led by former President Maumoon Abdul Gayoom, after senior officials of the party denied entrance to  a journalist from RaajjeTV to a press conference held by the party yesterday.

In a statement, RaajjeTV said that the action of PPM senior officials was undemocratic and uncivilised, and claimed that the PPM has boycotted the TV channel.

‘’To date, Raajje TV was never invited to any event organised by PPM, and has constantly refused to provide any information to us,’’ the statement said. ‘’It is questionable whether a party formed for the benefit of the citizens would do something that would destroy democracy while it is still in its infant stage.’’

RaajjeTV said that it would try to bring “true news” to the citizens of the Maldives, despite the situation.

The TV channel also called on the former President and his family to share information to the media equally and to be consistent in its words and deeds.

MP Ahmed Nihan, who is the current Media Coordinator of PPM, today told Minivan News that he knew about the incident last night and said that it was regrettable.

‘’We do not have any issues with the TV channel, but there might be some individuals in the party that have issues with it,’’ Nihan said. ‘’We have not made any decision to boycott RaajjeTV.’’

Nihan said he personally had given two live interviews to RaajjeTV and has been sharing information equally.

‘’We give very high priority to the media because it is the fourth pillar of democracy,’’ he said adding that the reports broadcasted on RaajjeTV were “usually against former President Gayoom”.

‘’Although they air such reports, we do not have any issue with that as long as they keep to the laws,’’ Nihan said.

Spokesperson of PPM Ahmed Mahlouf did not respond to Minivan News at time of press.

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Transparency asks authorities to investigate MPs for bribery over committee allowance justifications

Transparency Maldives has strongly condemned remarks by MPs justifying their newly inflated allowances by claiming that large portions of their salaries were spent on meeting demands from constituents.

MPs from both major parties have previously admitted that a large, usually undisclosed proportion of their salaries is spent on medical treatment, education and other requests from their electorate – a symptom of an enduring culture of patronage that persists in the Maldives – and confessed that ignoring these demands in such a culture of expectation is extremely difficult.

However, “Transparency Maldives believes such actions fall under article 3 of of the anti-corruption law and article 13 of the Anti-Corruption Commission Act regarding bribery,” Transparency said. “If such acts have taken place Transparency Maldives calls upon the relevant authorities to conduct investigations and take legal measures.”

The statement notes that 16 MPs have so far informed parliament’s secretary-general that they did not wish to take the Rf 20,000 (US$1300) allowance.

Today a group of citizens concerned about parliament’s committee allowances gathered in front of the Finance Ministry and presented a petition signed by more than 1000 people to the ministry, later intercepting President Nasheed as he left the Ministry.

The President spoke with the gathered activists and was requested to sign the petition himself, but asked why he should sign a petition that was to be presented to him anyway.

President Nasheed reportedly told the group that the government had no other choice but to issue the funds for the committee allowances as it had been already approved by parliament. The Rf20,000 allowance was initially approved on December 28, 2010 as part of a pay scale recommended by parliament’s Public Accounts Committee.

Nasheed explained that it was not a matter of whether he supported the allowance, but that “when parliament makes it legally binding the government does not have any discretion [to overrule the parliament’s decision].”

Project Cordinator of Transparency Maldives Aiman Rasheed told Minivan News that the campaign against the committee allowance will continue and there was hope for success.

”Today we presented the Finance Ministry 1365 letters signed by concerned citizens and eight cabinet members, plus high-profile people across the country,” he said.

”We have made plans to continue the letter campaign and to make the citizens aware of the impacts of this committee allowance.”

MP salaries have increased 18-fold since 2004, according to a graph released by the NGO.

The committee allowance was Rf18 million, Rasheed said. ”In comparison, the budget to combat drugs is Rf 14 million, the budget subsiding the fishing industry is Rf12 million, medical services Rf18 million and the budget for small and medium businesses is Rf16 million,” he said, adding that these areas would be impacted by the increased expenditure on MPs.

Opposition Dhivehi Rayithunge Party (DRP) MP Dr Abdulla Mausoom on his Facebook page said receiving the allowance made him feel like “Robin Hood”. Responding to criticism that such a justification would taint future elections by making them unfair for political challengers, he replied that “when the President appoints ‘directors’ for paper-companies and pays millions in public money to promote MDP…. that’s very unfair too. Why don’t we see any protest on that? This is my way of ‘protest’ for irresponsible ‘politically aligned’ spending of the government.”

The government has previously contested that expenditure on the 244 political appointees in the executive branch represented only two percent of the state’s wage bill, or Rf99 million (US$6.4 million) a year, a figure DR Mausoom has previously claimed represents “the tip of the iceberg”.

“The whole country was corporatised,” he explained. “There’s a roads corporation and all sorts of corporations. The people appointed to the boards of these corporations are all purely political appointees. They were appointed directly by the President to promote a political agenda.”

Dr Mausoom told Minivan News today that the moment he received the allowance he would start spending the same amount on his constituency for social projects.

“There is no benefit for the people in keeping the money in the government’s treasury because they will spend it all on political appointees,” he said.

“The real issue is that one institution has too much power. Parliament should not have the power to set their own salaries.”

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Gayoom’s new party to be called Progressive Party of Maldives

Former President Maumoon Abdul Gayoom announced today that the new party formed under his leadership is to be called the Progressive Party of Maldives (PPM).

Speaking at a live press conference at private broadcaster DhiTV, Gayoom revealed that the party’s charter has been drafted and registration forms would be submitted to the Elections Commission (EC) today.

“We are forming a new political party to achieve very important national purposes,” he said. “That is to strengthen Islam in the country and maintain Islam as a religion that we all love and respect, to fully protect our independence and sovereignty, to establish a strong democratic system in the Maldives, ensure happiness and prosperity to the people, to reform the country to make it a place where people would want to live, uphold public order, peace and stability, and facilitate equality opportunity for everyone to advance.”

Gayoom explained that he resigned as ‘Honorary Leader’ (Zaeem) of the main opposition Dhivehi Rayyithunge Party (DRP) yesterday because his efforts to reform the party over the past several months were unsuccessful.

Gayoom invited experienced politicians, “capable and educated youth” and skilled professionals to join the party. The former President expressed gratitude to those who assisted and supported the formation of the Progressive Party.

Asked repeatedly by reporters if he intended to contest in the party’s presidential primary, Gayoom stressed that he had not made a decision and would do so “when the time comes.”

“My answer is that the time [for a primary] has not come and we’ll know when it does,” he said, refusing to rule out a possible bid for the presidency in 2013.

On whether his role as leader of the new party contradicted an announcement in February 2010 that he was retiring from active politics, Gayoom said he made the decision based on the assurance that the DRP would function “according to certain principles.”

“At the time and even up till yesterday, I was at the most senior post of one of the largest political parties in the country,” he said. “So how can it be said that the person in the highest post of a political party is not involved in politics? Up till yesterday I was in politics. Today I am forced to create a new party because of the state of the nation and because it has become necessary to find another way for the country.”

As “a lot of citizens” had pleaded with him to form a new party, said Gayoom, he made the decision as “a national obligation.”

In his letter of resignation submitted yesterday, Gayoom said he was “forced” to leave the party he had formed on July 21, 2005 because the DRP had become “politically toothless” and DRP Leader Ahmed Thasmeen Ali was “acting dictatorially” and violating the party’s charter and democratic principles.

“And you [Thasmeen] keep saying clearly in the media that you do not need my counsel,” reads the letter shared with local media. “The consequence of that was the loss of hope citizens had in this party. And DRP getting the bad name of the party that gives way to the government while remaining in name a responsible opposition party.”

DRP Leader Ahmed Thasmeen Ali however dismissed the main points raised in Gayoom’s letter yesterday as “baseless claims” offered to defend his decision to resign.

The Zaeem-faction’s activities hampered DRP’s efforts to hold the government accountable, Thasmeen wrote in response, and would be “written in Maldivian political history as a shameful [episode].”

Thasmeen asserted that Gayoom decided to leave the party because he could not influence the party’s day-to-day management and functions in his ‘honorary’ role.

“Since the party’s charter does not give you that role, the fact that you tried to get your way together with a few people within the party regardless of what happened to the party is evident for all to see,” Thasmeen’s rebuttal reads.

The minority leader of parliament noted that three former DRP deputy leaders – former Attorney General Hassan Saeed, former Finance Minister Gasim Ibrahim and current Independent MP Ahmed ‘Sun Travel’ Shiyam along with other cabinet ministers – left the party to form new parties and compete against Gayoom in the 2008 presidential election.

Gayoom meanwhile said today that he had not received the letter and could not comment on its contents: “There are no personal problems between me and Ahmed Thasmeen Ali,” he insisted.

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Government plans to sell alcohol at Fuvahmulah city hotel, claims Adhaalath

The government has declared two areas of Fuvahmulah uninhabited islands for airport and tourism development in order to allow the sale of alcohol at a city hotel, yet to be opened on the island, the religiously conservative Adhaalath party has alleged.

President Mohamed Nasheed signed decrees on Friday declaring the “Bilhifeyshi” and “Thoon’du” areas of Fuvahmulah – two strips on opposite ends of the island – as uninhabited islands to be utilised for tourism purposes.

At a press conference yesterday, Sheikh Mohamed Shaheem Ali Saeed, Adhaalath Party spokesperson, said that the decrees were part of a “Satanic plot” to sidestep legal prohibitions to selling alcohol in inhabited islands.

“We are not opposed at all to building a city hotel for the development of Fuvahmulah,” he said. “But you don’t have to sell alcohol at every city hotel. Adhaalath party sees the declaration of uninhabited islands within Fuvahmulah as an absurd move, as an act of madness.”

The decision was “disrespectful” in light of the public’s opposition to the sale of alcohol in inhabited islands, Shaheem continued, referring to a large demonstration in February 2010 that forced the government to withdraw controversial new regulations that would have allowed sale of alcohol to non-Muslims from city hotels.

Fuvahmulah“If the government wants us to let them hear the voice of the people again, we are ready to do it,” Shaheem said, calling on citizens of Fuvahmulah and the public to “raise your voices against this decision by the government.”

President’s Press Secretary Mohamed Zuhair however dismissed Adhaalath’s allegations today as intended to “seek political recognition and cast the government in a bad light.”

Zuhair said the Adhaalath’s claims were “very insincere” as the party did not make any inquiries, request a meeting with the President to express concerns or “even sent a letter to relevant authorities before giving a press conference and making these claims in the media.”

The remarks by Adhaalath leaders were “regrettable,” Zuhair added, as the party remains a coalition partner of the ruling Maldivian Democratic Party (MDP) and its senior members included the Minister and State Minister for Islamic Affairs.

Meanwhile at yesterday’s press conference, Adhaalath Party Vice President Dr Mauroof Hussein claimed President Nasheed “pressured” Fuvahmulah councillors to approve a resolution for developing the city hotel.

Dr Mauroof argued that the President’s decree set a disturbing precedent: “Tomorrow they can announce that President Nasheed has decreed the inner walls of Holiday Inn [now Trader’s Hotel] is an uninhabited island. Or the plot west of the army headquarters is an uninhabited island and demolish the Islamic Centre to build a bar there,” he said.

The government was pursuing an agenda to “spread irreligious activities” in the Maldives, Dr Mauroof warned.

Economies of scale

Speaking at a function in Fuvahmulah on Friday, President Nasheed expressed confidence that the construction of an airport in the island would be completed by November 10.

Nasheed said that the government understood the people’s longstanding desire for an airport but insisted that the investment should be sustainable.

In addition to operating costs, said Nasheed, about Rf500,000 would have to be spent “on interest [payments] alone.”

“It is not clear to me that we can recover this money with about 30 people flying to Fuvahmulah from Male’ every week,” he explained. “With development, especially national development, we have to consider that every project has to be sustainable, well-rounded and feasible.”

In order to ensure financial sustainability for the airport, he continued, the government intends to build a tourist hotel in Fuvahmulah in collaboration with a business partner.

“We don’t want to criticise, meddle and try to profit [from the hotel] in Male’,” he said. “When the facilities are used for your development, the whole population of the Maldives will benefit from it. A number of things that can be done to ensure feasibility of the airport can be seen in the environment of Fuvahmulah, in its natural resources.”

President Nasheed said the decision to declare the two areas non-inhabited was made following deliberations by the cabinet and consultation with Fuvahmulah councillors.

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President awards Mark ‘Occy’ Occhilupo Four Seasons Maldives Surfing Champions Trophy

World Champion Surfer Mark Occhilupo has won all three divisions of the inaugural Four Seasons Maldives Surfing Champions Trophy, defeating longboard champion Josh Constable in the final and taking home US$19,000 in prize money.

President Mohamed Nasheed presented the trophy to Occy on board the Four Seasons Explorer, a luxury three-storey catamaran anchored near the Sultans surf break.

“We are people of the sea. We grow up with the elements around us, and the sea is never very far away. We are taught to swim from a tender age,” Nasheed said.

“44 percent of our workforce are fishermen, who spend more than half their lives on the sea, and many Maldivians looked up to famous surfers while growing up,” he said.

Nasheed dancing Bodu Beru with the surf champions

The relative seclusion of the country’s surf breaks compared to more famous surfing destinations such as Hawaii and Indonesia was not necessarily a bad thing, Nasheed said, “because we are not always clear about how to manage our resources. We have to use them wisely to benefit everyone.”

Nasheed told Occy that the Maldivian cabinet was not unfamiliar with the water, having conducted a cabinet meeting underwater in 2009. Occy asked if that was “the same as a cone of silence”.

Occy dedicated the champion’s trophy to Tony Hussain Hinde, the Australian-born surfer who pioneered modern surfing in the Maldives after becoming shipwrecked in the country, and who died in 2008.

Following the prize presentations, the six surfing legends, together with the President, Press Secretary Mohamed Zuhair, cabinet ministers and several MPs of the Maldivian Democratic Party (MDP) erupted into a spontaneous traditional Bodu Beru dance.

Final day of the competition

The six surfers, including two-time world champion Damien Hardman, four-time world champion Mark Richards, world longboard champion Josh Constable, 1966 world champion Nat Young and seven times female world champion Layne Beachley competed in one-, two- and three- fin divisions over the three days.

On the last day the Sultans reef break served up consistent four-foot right hand waves. During the final event, Occy required an 8.10 score to reclaim his lead, and waited patiently for a wave on which he delivered a 9 with full rail-to-rail maneuvers.

“I made a couple of mistakes, including losing priority, and I had to tell myself to just calm down,” Occy said of his performance.

“So I cleared my head and moved up the point where I needed to be and then a gem of a wave came through and I surfed it as good as I could and got that nine. I didn’t have one heat where I felt I was not under pressure. All those memories of being on tour came back and I had to rely on my instincts to win this event and now that I have, I am over the moon.”

Constable praised Occy as a “solid competitor”.

Reehan surfing with Layne Beachley

“I just couldn’t get him. He was on his game all week. I felt solid in the final and I had a good score but couldn’t get that back up so hats off to Occy.”

Sole female competitor Layne Beachley came close to taking the single fin division title from Occy in the final of the first day, and was only narrowly defeated.

“It’s been surreal competing against five male world champions and being a contender,” said Beachley, noting that such match-ups were rare in the surfing world due to the anatomical disadvantages women faced: “our hips get in the way.”

“I knew it was always going to be challenging but I stepped it up and gave them a run for their money,” she said.

Four-time world champion Mark Richards was forced to withdraw from the final day of the competition after suffering a hamstring injury, opening the way for Maldivian surfer Ali Reehan Mohamed to take to the water as a wildcard entry.

Grinning, the 18 year-old described that surf as “the best experience of my life.”

Confessing to an attack of nerves at being out among the world champions, Reehan said “I did my best to show them something.”

"Best experience of my life" - wildcard entry Reehan

“It was very friendly, we were sharing waves,” he said.

Reehan has been surfing for two years, after upgrading from “fighting the white water on a body board”. He has since made his hobby into his work, freelancing as a professional surf guide.

“I stopped my last trip just to come here – I gave it to someone else,” he said.

General Manager of the Kuda Huraa Four Seasons Resort, Sanjiv Hulugalle, said the HSBC, Billabong, Wataniya, Surfing World and Singapore Airlines-sponsored event would return next year.

“The aim was to showcase the Maldives as a world-class surfing destination,” Hulugalle said, “and the international media has broadcast it all over the world.”

Reehan agreed: “With the media here, Maldives surfing is only going to get bigger,” he said.

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GST will prioritise wholesalers, but requires administrative tax regulations

Maldives Inland Revenue Authority (MIRA) has said it will give priority to levy the Goods and Services Tax (GST) from merchants who import and sell goods at wholesale prices, reports Haveeru.

The GST bill, which was ratified by President Mohamed Nasheed last Friday, is required to be implemented within a month from ratification.

Commissioner General of Taxation, Yazeed Mohamed, told Haveeru that tax deductions from wholesalers will be the second major source of income. He said certain industries such as construction, food and entertainment would be given higher priority.

Yazeed said the act will be fully implemented in three months, but that administrative tax regulations had to be amended as well, Haveeru reported.

GST payers will be asked to register at MIRA.

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Conde Nast rates magazine rates Maldives world’s second most popular destination

Condé Nast Traveler magazine has rated the Maldives the second most popular island destination in the world.

The magazine’s 14th annual Readers’ Travel Awards also recognised the Kuda Huraa Four Seasons Resort as ‘The Best of the Best in the World’s Top 100’ resorts. The resort was also named ‘Best Overseas Leisure Hotel in the Middle East, Africa and Indian Ocean’.

Resort General Manager Sanjiv Hulugalle traveled to London last week to receive the award on behalf of the Four Seasons.

“This award is a testament to an amazing joint effort and we’re incredibly grateful to everyone who voted for us,” Hulugalle said at the ceremony. “We’re constantly looking to raise the bar.”

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President meets outgoing UNESCO director, Honorary Consul

President Mohamed Nasheed, Vice President Dr Mohamed Waheed and Chief of Staff Ahmed Mausoom yesterday met with Outgoing Director of UNESCO and Former Minister of Education of Mauritius, Amroogam Parsuramen, to discuss strengthening collaboration in the areas of higher education, trade and economic development.

During the meeting Parsuramen also congratulated the Maldives for its promotion of the values of democracy, human rights, and efforts to seek regional cooperation in an international arena.

Nasheed also met yesterday with the Salisbury-based Honourary Consul of the Maldives and Friends of Maldives founder David Hardingham, and discussed providing overseas volunteers to assist in areas of development and trade.

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