Aasandha health insurance scheme – Minivan News

Vice-president announces unlimited health insurance from January 1

Vice President Dr Mohamed Jameel Ahmed has announced the government’s intention to introduce unlimited health insurance – ‘Husnuvaa Aasandha’ – on January 1.

Speaking at the launch of the government’s 100 day manifesto for the Ministry of Health, Jameel promised that the government’s pledge to provide a General Practitioner for every family would also be introduced in the new year.

One month on from the inauguration of President Abdulla Yameen, the government has produced similar 100 day roadmaps in a number of departments, including transport, immigration, and the security forces.

The current scheme – introduced under the administration of President Mohamed Nasheed – set a limit of MVR100,000 (US$6,485) annually for health services for all Maldivian nationals from hospitals and health centres operated by health corporations as well as private hospitals and clinics.

The initial scheme soon proved costlier than the government had envisioned, however, with hundreds reaching their entitlement limit within just a few months. Rocketing demand for services saw a reported 7000-8000 people using the scheme every day, at a cost of up to MVR3 million (US$194,552).

Caps were subsequently introduced on medicines and certain services provided in private clinics and hospitals as well as fees introduced for services at private clinics.

Vice President Jameel said last night called on the private sector to aid the government in providing affordable healthcare.

A recent World Bank report noted that a total of 276,033 citizens – around 84 percent of the population – had used the Aasandha service in its first year, representing about 2.8 percent of 2012’s GDP.

“Overall, a total of about 3.6 million transactions were recorded in the first year that represented an average 13.2 transactions per patient, a relatively high figure for a country with a predominantly young population and limited availability of medical service providers,” said the World Bank.

The same report – the ‘Maldives Development Update’ – described the country as “spending beyond its means”.

At present, public debt stands at an “unsustainable” 81 percent of GDP, the report stated projecting the debt will rise further to about 96 percent by 2015.

The World Bank saw the fiscal sustainability of the Aasandha scheme as its major challenge, offering a series of recommendations to achieve this.

“Substantive savings could be achieved without significantly compromising coverage and quality of services by re-designing the scheme with a focus on provider incentives.”

The World Bank went on to suggest that the bulk purchase of essential and generic drugs could reduce the costs of the scheme, as could tighter controls on overseas treatments.

Jameel has previously acknowledged that a lack services has forced many Maldivians to live abroad for medical purposes, pledging chemotherapy in the public Indira Ghandi Memorial Hospital, as well as nine dialysis units.

He has also promised that screening to diagnose cervical cancer would be introduced under a government insurance scheme.

Jameel had previously stated that the specifics of the government’s health proposals would begin “as soon as we get the budget for it”. The details of the 2014 budget continue to be discussed in the Majlis, with the final draft due to be presented to the full chamber at the end of the week.

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Statistics show just MVR 45 million left in Aasandha’s budget

Universal health insurance scheme Aasandha has MVR 45 million (US$2.9 million) left of its MVR 720 million (US$46.7 million) budget since its introduction on January 1 2012.

Records from the company show that from 1 January to 31 October 2012, MVR 675 million was used by 261,410 people – over 80 percent of the population.

Forty-five percent of the MVR 675 million was spent on government hospitals, whilst 22 percent went to private clinics and hospitals, and 9 percent to foreign clinics and hospitals.

Fifty-five percent of Aasandha’s budget was spent on the public sector, while 36 went to the private sector.

Free health care of up to MVR 100,000 was initially available to citizens under Aasandha.

Changes to the system were made by the government in August for the private sector, after concerns the scheme would run out of money.

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Maldives no longer “tolerable” for foreign doctors, expatriate medical officer claims

Expatriate medical professionals working in the Maldives regularly face intimidation, fraud and “substandard” treatment from patients, health authorities, local staff and the country’s courts, a foreign medical officer working in the country has revealed.

The expatriate medical professional, who has worked in several posts across the country since 2009, revealed that along with widespread reneging on contracts and failing to deal with intimidation of expatriate medical staff, health officials had, in certain cases, not even checked whether foreign doctors were registered to practice medicine.

“Earlier there was a system of asking doctors for the registration of their basic medical degree (graduation degree) in their own country so as to register them in Maldives,” he told Minivan News. “This law was so compromised over the last two years that in one atoll alone, four unregistered doctors are to my knowledge still practising their absent skills here. Frankly speaking, they can kill anybody just by their lack of knowledge, but some get caught on occasion.”

Medical authorities have claimed they were aware of a number of concerns regarding doctor registration, a situation currently being reviewed in conjunction with the Maldives Medical Council. However, the Ministry of Health and Family denied that a fall in the number of doctors coming from India to practice in the Maldives was related to alleged treatment by authorities and patients on islands – instead noting improved pay rates currently offered in their home country.

However, raising concerns over a “deterioration” in the quality of healthcare being provided in some atolls during the last two years, the expatriate medical officer – who asked not to be identified – also detailed a number of issues over the treatment of foreign workers in the country.

According to the whistle-blower, there were growing concerns among skilled expatriates working in medicine and education in the Maldives that was losing the country its reputation as a “tolerable working place”.

Fewer doctors from India were coming to the Maldives year-on-year, the source observed, in part to what he called “public intolerance” of an imported non-Muslim work force.

“The overall behaviour of the Maldives Ministry of Health and Family and government has been negative. [There is also] an lack of availability of US dollars and the Bank of Maldives (BML) has banned issuing international ATM cards to expatriates,” he said. “Meanwhile, there has been an increase in the exchange rate of the US dollar, but no increase in the salary structure in Maldivian rufiya (MVR), meaning salaries are less than before. There are also instances in which the lawlessness of this country has led to the lack of punishment of Maldivian nationals even for heinous crimes like rape if the victim is an expatriate.”

“Violence”

Taking the example of Gaafu Alif (GA) Atoll, where the medical professional has had experience of working, he alleged “constant fear” and intimidation were regularly experienced by foreign healthcare professionals.

“Increasing instances of violence against expatriates is being reported from everywhere in Maldives,” he said.

On the island of GA Villingili, the medical professional claimed that one paediatrician from Pakistan working on the island was physically assaulted after failing to provide a referral letter demanded by some of his patients.

“I myself was on duty, so we had to make the legal documents for him. Afterwards nothing happened and [the doctor] left after just two days without the intention of continuing their contract. [The doctor] is still working in the Maldives, but somewhere else now,” he said.

“[Another doctor] from Uzebikstan also left GA Atoll because some local teenagers beat her two children. The matter became worse when she and her husband reacted with anger towards these boys. People were singing ‘We will kill you…’ on the roads whenever they came out. Ultimately [the doctor] requested for a transfer and is now working in Faafu Nilandhoo Atoll.”

The medical officer added that from his own experiences, skilled expatriate workers across the Maldives faced intimidation and sexual harassment on the islands, with cases such as expatriate teachers having to defend themselves in their own homes.

“I myself have heard some patients calling me or my colleagues their servants and threatening to do what he/she tells to, or else,” he said. “Interestingly, local staff never help in these situation a because they think we they will not be affected much because we don’t know Dhivehi. The situation becomes much more painful as many of us understand the language quite well. These are just glimpses only. And only of [GA] Atoll. Imagine what will happen if we collect together all the things which have gone wrong across the Maldives.”

The medical professional claimed there were also concerns about how authorities were treating doctors in the country, particularly in regards to contractual obligations such as agreements on wages and accommodation.

According to the source, a number of doctors had shared concerns about amendments made to their contractual agreements without their consent or knowledge once they arrive in the country – both in terms of salary and housing.

“When a doctor lands in Male’, only then [do authorities] reveal to him or her that actually this offer letter is an old one and now the salary structure is a little different. It is always like that. So many times they have done it that now people know about it unofficially and openly and make fun of it,” he claimed.

“Authorities write in their offer letter about free residence while working here. It is mentioned in this form of providing free residence or as much rufiya through a housing allowance, plus their people will help you find a place. They don’t, of course,” he said.

The medical officer claimed that he was personally provided with a housing allowance of MVR 3,000 ruifiya (US$195), assistance in finding accommodation had not been given.

However even upon finding accommodation, a former expatriate paediatrician from South Asia, who was living and working in GA atoll, was alleged to have been evicted from a property on one island by its owners with less than 24 hours notice after they found a tenant willing to pay better rent for the accommodation. The doctor left the island he was assigned after a month and a half due to being unable to find accommodation.

The medical officer added that authorities were ultimately failing to support skilled expatriate workers in favour of local staff who often had no medical or management training.

“It is an everyday story in this hospital and everywhere else in Maldives. Even at Indira Gandhi Memorial Hosptial (IGMH) [in Male’],” he claimed. “Far lower qualified local staff are working with a salary on par with far better qualified expatriate staff, and doing nothing on duty. It frustrates expatriates every single minute. It is not justifiable but local administration support it.”

The expatriate healthcare worker pointed to his own experiences in an atoll hospital, where he claimed trained nurses were having to clean the nappies of elderly patients due to the refusal of local sanitation staff – known as sweepers – to do so.

“This work is for local sweepers, but they often refuse to do it, forcing the staff nurses through equally arrogant management to perform the actions,” he claimed. “They don’t understand that a staff nurse, who has to administer injections and medicines to patients, will get their dress soiled by the excrement if they clean the stool of these patients, and in turn some patient only is going to receive it in returb as a hospital born infection.”

Healthcare provision

Beyond the treatment of expatriate health professionals, the medical officer highlighted a number of concerns about the operations of the nation’s hospitals, such as the impact of the launch earlier this year of the Aasandha universal health scheme.

The medical officer claimed that Aasandha had in fact led to a growing trend of pharmacies bringing in low cost “garbage” medicine to the country, on the grounds that the Aasandha budget was insufficient to acquire medicines from what the medical officer called “standard companies”.

“This in turn is is playing with the health of people by bringing introducing antibiotic resistance or uncompensated chronic diseases due to irregular and uncontrolled dosing of drugs,” he said.

“With the pricing of drugs, we write the number of tablets to be 12. The pharmacy gives seven or eight. Patients don’t know about these things. And as a result they come back to us with partial recovery and antibiotic resistance.”

The medical officer said that in order to try and overcome the limitation, doctors were having to recommend larger prescriptions to ensure a sufficient number of tablets were provided by the pharmacy, before asking patients to return to them to amend the amount they should be taking.

“This way the patient gets the needed amount of medicine, the dosing of which I correct myself after calling him/her back to me with the medicines. This practice is risky but at least I succeeded in managing my patients successfully,” he said.

According to the medical officer another key problem with Aasandha was the lack of public understanding concerning the scheme and entitlements of the public.

“They become very angry when we tell them that this or that medical condition is not covered by Aasandha. A lot of times they force the management to force us to fabricate a medical condition just to get Aasandha approval,” he revealed.

Soon after the scheme had been launched in January this year, Health Minister Dr Ahmed Jamsheed – then Chief Operating Officer at Male’s ADK hospital – said limited information on Aasandha’s financial structure had led the public to exaggerate their medical needs. He urged for a greater sense of public responsibility to prevent overwhelming the country’s health service.

However, calls to limit Aassandha have so far proved divisive in parliament and the present coalition government. Ahmed Thasmeen Ali, head of the government-aligned Dhivehi Rayyithunge Party (DRP), has previously been an outspoken critic of limiting the provision of universal healthcare at private premises.

The medical officer added that national healthcare provision had also been affected by the launch during the previous government of seven provincial health corporations designed to try and decentralise health care and budgets.

According to the expatriate medical officer, the establishment of the corporations was seen as an attempt by the former government to ensure the work of the Health Ministry was being controlled by government rather than opposition supporters already working within healthcare.

“Splitting the [work] of the Health Ministry into corporations was not a bad idea although it was more motivated by ability to acquire financial control rather than anything else,” he claimed. “The local governance had one thing positive; we could at least address our problems with our employers easily. They were accessible. Although they seldom made any difference, at least there was no frustration that I could not even talk to the authorities. Nowadays, no one can talk to the Mnistry of Health people as most of the time either they simply don’t pick the phone or you cannot connect to them.”

The medical officer said a growing sense of frustration and the shared of experiences of expatriates and healthcare professionals from across the South Asia region had seen the Maldives’ reputation as place to practice medicine tarnished in recent years.

“All these stories do reach [places like] India and I don’t feel that people will tolerate this much more. That’s why there is a constant decline in the number of people coming from somewhere like India to work here in whatever form,” he observed.

Indian High Commission concerned

Earlier this year, Indian High Commissioner Dynaneshwar Mulay raised concerns over the treatment of expatriates from across the South Asia region – particularly by the country’s police and judiciary.

Mulay claimed that alongside concerns about the treatment of some Indian expatriates in relation to the law, there were significant issues relating to “basic human rights” that needed to be addressed concerning immigrant workers from countries including Sri Lanka and Bangladesh.

Addressing the claims, Zaufishaan Abdulla Kamaludeen, Director of Human Resources for the Health Services Corporations, which is currently run under the Ministry of Health, said that while expatriate doctors had traditionally been sourced from India, it had become increasingly difficult to bring them to the Maldives.

Kamaludeen stressed that this change appeared mainly to be a result of more competitive rates of pay for medical staff in India compared to the Maldives

“There have been spikes in the salary packages being offered to doctors from India. This is maybe a reason why since about March 2012, when I joined the Health Ministry, we have been having difficulty getting Indian doctors to work here,” she claimed. “We have been getting many applications from doctors from Pakistan,” she added, stressing that medical personnel were also being sourced from countries like Myanmar to cover demand in the country.

Kamaludeen added that it was traditionally difficult to place expatriate doctors on islands in the country’s outer atolls, a situation he claimed was complicated by the tendency of healthcare professionals to network about their experiences.

However, she denied that the difficulties and complaints recevied staff were a result of intimidation or the attitudes of local staff and patients to foreign workers. Kamaludeen claimed that requests for transfers for most often related to “personal issues”.

“Mainly we get requests for transfer from islands relating to personal problems. These vary on a number of issues such as the availability of vegetarian food,” she claimed. “We also get requests from doctors wishing to work close with other doctors, so they don’t feel isolated on arrival.”

Kamaludeen added that another challenge with placing doctors had come from the set up of certain health corporations to pay skilled medical staff more than if they worked in another region.

“Doctors at times would demand to work for the corporations offering the highest pay,” she said. “Right now, a board has been established to try and harmonise salaries for staff working in different atolls.”

Addressing allegations that there had been issues with the registration of some expatriate medical staff to practice in the Maldives, Kamaludeen said that the ministry had been made aware of instances of doctors working with improper registration.

However, she said that in such cases the Maldives Medical Council had been immediately informed and a review was presently taking place on the issue.

Kamaudeen claimed the issue appeared to have arisen over a lack of awareness of the type of licensing required to practice n the Maldives.

“We have understood this to the result of a lack of information being provided from recruitment groups and agencies,” she said.

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ADK says co-payment will be available from next week

ADK hospital has announced that it will take co-payment from next week after the government decided to charge a co-payment from the national health insurance scheme, Aasandha, from private hospitals and clinics.

The company had previously stated that such services would be available from August 1.

The hospital’s Managing Director, Ahmed Afaal, told Haveeru today that, whilst negotiations with the government regarding collection of the payment were ongoing, the price of services at the hospital would not change.

The Aasandha company has said that that agreements for co-payment has been reached with eight other clinics although it has yet to release a price list, reported Haveeru. Over 60 private healthcare providers have applied for Aasandha coverage.

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Patients to be charged at private clinics under Aasandha from August 1

Treatment from private hospitals and clinics will be covered under the “Aasandha” universal health insurance schemes from August 1, with an agreed amount to be charged from people going to those clinics.

According to a statement released by the Aasandha Company on Sunday, private clinics are being included in the scheme after they agreed to a revised price list for health services with the National Social Protection Agency (NSPA).

The scheme will cover the treatments from those private clinics based on the revised price list, while the clinics are allowed to charge their patients to cover any additional costs.

“Therefore, patients will likely have to share the costs of outpatient care and other services,” the company adds.

The authorities have not revealed the amount to be charged, but State Health Minister and National Social Protection Agency (NSPA) Board Chairman Thorig Ali Luthfee told local media that the “charge will not be a burden to the patients.”

“In addition to what is being (covered) from Aasandha, they might charge a small amount from the patient. Once they agree to the price with us, they cannot alter that price,” Thorig told Haveeru.

According to Thorig, four clinics have so far agreed to the prices, and Aasandha services will be offered at the clinics as soon as the agreements are signed.

Price negotiations with several other clinics are still reportedly pending as over 60 private healthcare providers have applied for Aasandha coverage.

According to the Aasandha website, the scheme currently covers treatment from IGMH, ADK Hospital, IMDC Hospital in Addu and other hospitals and health centres currently operated by state-owned health corporations.

Thoriq observed that privately-owned ADK, the second largest healthcare provider in the country, will also have to confirm the revised prices agreed with NSPA to keep providing Aasandha services from next month on wards.

Under the parliament-approved scheme which commenced in January, all Maldivian citizens will receive government-sponsored coverage up to Rf100,000 (US$6,500) per year, including further provisions to citizens who require further financial assistance. Expatriate workers are also eligible for coverage providing their employers pay an upfront fee of Rf1,000 (US$65).

MDP’s critical response

Following the decision to charge patients at private health premises, the former ruling Maldivian Democratic Party (MDP) which initiated the universal insurance scheme, under its affordable healthcare pledge, contended that the government’s decision reflects attempts to “restore the tradition of begging to afford health care services”.

According to the statement released by the MDP, the agreement signed between Aasandha company and the government explicitly states that no amount can be charged from the patients.

“The agreement signed by the Finance Ministry, Health Ministry and Aasandha Company explicitly states that no amount should be taken in fees or as any other charge from the people,” the statement reads. “Therefore, we condemn the coup government’s attempts to charge people a fee for healthcare services.”

The party also accused the government aligned Progressive Party of the Maldives (PPM) and coalition alliance of deliberately attempting to sabotage the health insurance scheme.

The MDP noted that while the party was in power it had regularly made the payments to Aasandha company as per the agreement, however, the incoming government of President Dr Mohamed Waheed Hassan Manik had not made the payments, pushing the scheme to the brink of collapse.

Aasandha is a public-private partnership with Allied Insurance. Under the agreement, Allied splits the scheme 60-40 with the government. The actual insurance premium is paid by the government, while claims, billing and public awareness is handled by the private partner.

Aasandha Managing Director Mohamed Shafaz told Minivan News last week that the government had failed to cover weekly premium payments as agreed under the Aasandha contract since March 2012.

He alleged that while the scheme was continuing to run, the shortfall in state funding was creating some difficulties for service providers such as hospitals and pharmacies both in the Maldives and outside the country in the wider South Asia region.

Without detailing specifics, State Health Minister Luthfee said that the government was presently involved in consultations to clear outstanding bills. He added that a target of 30 days had been set to try and settle outstanding debts to creditors.

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Government pledges Aasandha health scheme “will not collapse”

The government remains committed to running the Aasandha universal health insurance programme initiated in January, claiming the scheme “will not collapse” despite the present economic difficulties facing the country.

State Health Minister Thoriq Ali Luthfee told Minivan News that there was “no cause for alarm” about the future of the scheme, following the revelation that it has yet to settle four months of unpaid premium charges it owes to cover medical treatments.

Aasandha is a public-private partnership with Allied Insurance. Under the agreement, Allied splits the scheme 60-40 with the government. The actual insurance premium will be paid by the government, while claims, billing and public awareness will be handled by the private partner.

Aasandha Managing Director Mohamed Shafaz has claimed that the government had failed to cover weekly premium payments as agreed under the Aasandha contract since March. He alleged that while the scheme was continuing to run, the shortfall in state funding was creating some difficulties for service providers such as hospitals and pharmacies both in the Maldives and the wider South Asia region.

Thirty day target

“The important factor is the scheme is continuing,” he said. “The country is going through a difficult time economically and ongoing consultations are currently taking place to clear our bills. We are trying to do this right now. The system is not going to collapse.”

Aasandha’s MD Shifaz said that several general meetings had been held with the government about the issue of back payments – charges he claimed were not contested by authorities.

“I’m not sure the reason for the delay, but the outstanding amounts have not been disputed. It appears they are having difficulty in making payments,” he said.

He did not reveal the exact amount of premium charges presently owed by the government.

When questioned on the impact that failure to pay debts might have on the scheme’s stability, Shafaz claimed that Aasandha’s future was directly tied to service providers such as hospitals and pharmacies, particularly smaller enterprises in the outer atolls.

“The difficulties right now are for the service providers. If they can accept the credits terms we are offering right now, then perhaps they can manage,” he said.

Shafaz said that pharmacies and medical centres on smaller islands were more likely to suffer as a result of failure to secure government payments for the scheme. He added that certain hospitals in Sri Lanka and India also affiliated with Aasandha would need to cover expenses accrued under the universal health system.

Privatised concerns

Back in April, Parliament’s Finance Committee proposed ceasing the provision of universal health care in private hospitals, stating that the scheme would not be economically viable unless private hospitals were excluded.

The proposals were made in a report published by the committee, that recommended the Aasandha service only be made available at the state-run Indira Gandhi Memorial Hospital (IGMH) and other government health centres and corporations around the country.

Calls to limit Aassandha have so far proved divisive in the Majlis and the coalition government. Ahmed Thasmeen Ali, head of the government-aligned Dhivehi Rayyithunge Party (DRP), has previously been an outspoken critic of limiting the provision of universal healthcare at private premises.

Thasmeen told local media at the time that the amendments forwarded by the parliamentary Finance Committee were not the “right way to go” to bring about changes to the scheme, alleging they could undermine parliament’s role in holding the government to account in future, Haveeru reported.

He added that should amendments to the scheme need to be made, he did not want to see the cessation of free healthcare to the public.

Both Thasmeen and DRP Deputy Leader Ibrahim Shareef were not responding to calls by Minivan News at the time of press today.

The Aassandha service was initially intended to cover emergency treatment, including treatment overseas if not available locally, along with all inpatient and outpatient services, domestic emergency evacuation, medicine under prescription, and diagnostic and therapeutic services.

However, Aassandha Managing Director Shafaz said that consultations were set to take place over the possibility of amending the main contract signed between the government and the health scheme’s provider to include an extended number of private practices under the project.

He stressed that there remained “huge concern” at present that such an extension would actually serve to exacerbate the present shortfall in government payments.

“Deluge”

Despite these extension talks, one private doctor not affiliated with Aasandha raised concerns that an apparent “deluge” of patients to IMGH and the private ADK hospital in Male’ were overburdening hospitals linked to the universal coverage scheme.

Conversely, the same doctor contended that large numbers of other health centres and laboratories had seen patient numbers plummet, endangering their long-term existence.

Dr Ahmed Razee, a former Director General of IGMH hospital presently serving as an internist with special interest in diabetes and kidney diseases across Male’ , alleged that under the current agreement, Aasandha had served to create a “grossly unfair monopoly”. Dr Razee added that the scheme had created an environment where even established practitioners were losing regular patients to an “inferior behemoth”.

“When ADK and IGMH pharmacies give you free drugs, why would go to any other pharmacy? I am afraid only Aasandha registered prescriptions are honoured,” he said. “These are available only at IGMH and ADK. Who will go any further – and pay also in the bargain – to another pharmacy?”

Dr Razee contended that when the scheme was launched during the administration of former President Mohamed Nasheed, government promises of a fair share of service provision for private health centres saw a number of enterprises – not just ADK – investing millions of rufiya in health provision.

“With the current monopoly that the government has created, these clinics, pharmacies and labs – representing over a thousand jobs – are going bankrupt,” he claimed. “The deluge of patients on ADK and IGMH is creating too much work for staff and is reducing standards and causing mistakes and making the waiting period entirely too long, and thus expensive, for people from the islands.”

Budgetary factors

Beyond the implications for healthcare, the Maldives has also come under increasing pressure from international organisations to make widescale cuts to state funding.

While recent Maldives’ Inland Revenue Authority (MIRA) figures for May showed national revenue had increased f 9.5 percent compared with the corresponding month in 2011, the figures were not substantial enough to shrink the present national budget deficit.

Governor of the MMA Dr Fazeel Najeeb recently stated that the Maldives was “in a dangerous economic situation never before seen in recent history.”

The International Monetary Fund (IMF) has expressed its concern over the country’s dire balance of payments situation which has been estimated by the Majlis’s Financial Committee to be 27 percent of GDP this year.

The 2012 budget was initially estimated to be around 9.7 percent of GDP, but in May was revealed to be much larger after significantly reduced expenditure and increased expenditure was taken into account.

Spending unaccounted for in the 2012 budget following the controversial change of government of February 7 has included the promotion of a third of the police force, lump sum payments to military personnel, Rf100 million (US$6.5 million) in fishing subsidies, reimbursement of Rf443 million (US$28.8 million) in civil servant salaries following cuts by the previous administration, the creation of two new ministries, and the hiring of international PR firms to counter negative publicity.

Former President Mohamed Nasheed had previously criticised President Waheed and his government for attempting to introduce fees for Aasandha, claiming the administration had squandered funds marked for development on the police and military.

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We need to focus on the development of key population centres in order to live within our means: Dr Hassan Saeed

“The public’s thirst for improved local facilities and services such as harbours for our islands or free healthcare seems to be unlimited,” writes Dr Hassan Saeed for local newspaper Haveeru.

“There is nothing wrong with this. We do need to listen to people’s hopes for the future. However we also need to recognise that we cannot do everything at once,” adds Dr Saeed, currently the leader of the Dhivehi Qaumee Party (DQP) and Special Advisor to President Dr Mohamed Waheed Hassan.

“Like any household or business, our country also needs to live within its means. However up until last February our government was portrayed by some as a provider of unlimited funds often provided through international donors. Irresponsible politicians were happy to make the most of this with no thought for the future.

We were and continue to be in the position of a typical Maldivian who goes from one businessman to another businessman asking for help with medical treatment. This is exactly what the Maldivian government has been doing for years with international donors and the development institutions.

This generosity has been good for us; just as at a local level a Maldivian will be very grateful for the support for that medical condition I described. However the government and that person has to be aware that the generosity may not last forever.”

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Thasmeen refuses to back Commonwealth withdrawal bill

Dhivehi Rayyithunge Party (DRP) leader Ahmed Thasmeen Ali has told local media that his party would not support a bill submitted to parliament this week calling for the Maldives to renounce its membership in the Commonwealth.

Thasmeen told reporters from several of the country’s major news outlets that he deemed the bill – forwarded on Sunday (April 29) by Progressive Party of the Maldives (PPM) MP Ahmed Ilham and Dhivehi Qaumee Party (DQP) MP Riyaz Rasheed – as “not responsible”.

The DRP leader was also reported to be critical of amendments proposed by parliament’s Finance Committee to the country’s universal healthcare scheme.

The DRP, which serves in President Mohamed Waheed Hassan’s coalition government alongside the PPM and DQP, has said he believes the motion to leave the Commonwealth may “negatively affect the country and its people”, the Sun Online news agency reported today.

The Commonwealth Ministerial Action Group (GMAG) has increased pressure over the last month on the Maldives government to revise the composition and mandate of an independent commission established to ascertain the nature of the controversial transfer of power in February.

CMAG said that “stronger measures” would be considered against the Maldives over the next month if it failed to enact changes to the Commission of National Inquiry (CNI) to ensure it was more “credible” and “independent”.

Despite not welcoming the calls to withdraw from the Commonwealth, Thasmeen added that the DRP did not support all of the CMAG’s calls since February’s controversial transfer of power. He was notably critical in regards to the exact details of CMAG’s demand for more independent representation on the CNI.

“We notice that CMAG’s comments regarding the inquiry commission are not very clear. So we have to find out what Commonwealth wants exactly – whether they would accept if foreign technical assistants were included in the Commission. Right now we are hearing different things. These things have to be clarified,” Sun Online reported Thasmeen as saying.

Meanwhile, Haveeru reported Thasmeen as claiming that neither Ahmed Ilham, Riyaz Rasheed or representatives of their respective parties had consulted the DRP on forwarding the motion to the People’s Majlis.

Yesterday, a PPM MP speaking to Minivan News on condition of anonymity said that he had not been aware of any discussions within his own party about seeking parliamentary approval to renounce the country’s Commonwealth membership in parliament.

“From my view it is not something that has been discussed within the PPM yet,” the MP said yesterday. “I have previously expressed my concern that [leaving the Commonwealth] is not the best way to solve this issue. It is not really a choice we can take,” he said. “I would still say that there is a chance to sit down together and discuss this matter.”

Aasandha proposals

Aside from the CMAG issue, Thasmeen was also reported to be critical of amendments proposed by parliament’s Finance Committee to the country’s universal health care scheme, Aasandha.

Should parliament pass the amendments proposed in the committee’s report, the Aasandha service would only be available in the government’s Indira Gandhi Memorial Hospital (IGMH) and other government health centres and health corporations around the country.

Thasmeen claimed that the provision of amendments by the parliamentary Finance Committee was not the “right way to go” to bring about changes to the scheme and could undermine parliament’s role in holding the government to account in future, Haveeru reported.

DRP leader Thasmeen added that should amendments to the scheme need to be made, he did not want to see the cessation of free healthcare to the public.

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Finance Committee proposes ceasing Aasandha scheme in private hospitals

Parliament’s Finance Committee has suggested ceasing the country’s universal health care scheme Aasandha in private hospitals, citing that the scheme would not be economically viable unless private hospitals were excluded.

The decision to do so will only be confirmed after parliament passes the committee’s report. If the parliament does pass the report, the Asandha service will only be available in the government’s Indira Gandhi Memorial Hospital (IGMH) and other government health centers and health corporations around the country.

However, medical services that are not currently available in IGMH would still be available from private hospitals and clinics, but the new arrangements would require a doctor’s referral to use such services, according to the report.

The Finance Committee’s report, compiled last week, also suggests that in order to reform the scheme, all political positions including parliamentarians and those for which parliament sets the salaries be excluded from the scheme, and that Auditor General conduct a complete audit of the scheme to ensure the absence of any fraudulent transactions.

Earlier, the Health Ministry suggested to the Finance Committee that a co-payment mechanism be introduced to the scheme in order to mitigate the system’s spiraling costs.

However, members of the committee were keen not to impose any fee on the public, and insisted that the focus of efforts should be on reducing costs and introducing controls that will reduce demand over time.

The scheme came under fire after the new government of President Mohamed Waheed Hassan came to power in February 7, which claimed that the scheme’a current rate of expenditure threatened to reach Rf1 billion (US$64.8 million) on an approved budget of Rf720 million (US$46.6 million).

The government has anticipated its annual spending will be Rf2 billion (US$129.6 million) over budget this year, after the International Monetary Fund (IMF) warned that economic growth and stability in the Maldives were unlikely to be maintained “in the medium term” unless the government substantially cut its spending.

The President’s Office claimed two weeks ago that figures showing that 150,000 people had used the healthcare scheme a total of 250,000 times indicated that something must have gone wrong with the system.

Minivan News tried contacting Minister of State for Health and Family, Thoriq Ali Luthfee for his comments on the report, but did not respond at the time of press.

Health Minister Dr Ahmed Jamsheed was also not responding at time of press.

Opposition Maldivian Democratic Party (MDP) MPs, MP Mohamed Shifaaz, MP Ilyas Labeeb and MP Imthiyaz Fahmy criticised Finance Committee’s actions alleging that since the parties supporting the current government have a majority in the Finance Committee, the committee was trying to find excuses to stop the scheme.

The MPs stated that the party would take “all necessary measures” to prevent the government from manipulating the scheme.

Aasandha is a public-private partnership with Allied Insurance. Under the agreement, Allied will split the scheme’s shared 60-40 with the government. The actual insurance premium will be paid by the government, while claims, billing and public awareness will be handled by the private partner.

The service was initially intended to cover emergency treatment, including treatment overseas if not available locally, along with all inpatient and outpatient services, domestic emergency evacuation, medicine under prescription, and diagnostic and therapeutic services.

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