Tag: Health

Civil Court issues injunction against Male City Council’s public referendum on the reopening of Fantasy Bakery

The Civil Court has issued an injunction to halt a public referendum planned by the Male’ City Council concerning the reopening of Fantasy Bakery, which was closed by health inspectors in October 2011 for selling expired food products.

The court’s injunction said if Male’ City Council held a public referendum that was not stipulated in any laws or regulations, it will hurt the business as well as making the public lose confidence in any verdict the court may deliver in Fantasy’s countersuit.

The Bakers Fantasy Private Limited had requested the court issue the injunction to halt the referendum, the Civil Court said.

The Civil Court’s injunction was delivered by Judge Abdulla Adheeb and a copy of the injunction was sent to Male’ City Council, Bakers Fantasy Private Limited and the Maldives Food and Drug Authority.

Male’ City Council was sued by Bakers Fantasy Private Limited following a decision of the council to withhold the license of the company to sell food products.

The company has claimed that they have paid the Rf 6500 (US$420) fine imposed on the company and have corrected issues noted by the council.

When Minivan News contacted Bakers Fantasy, the receptionist said no one was present who could speak with the media and would not provided a contact for management.

Last year when the issue came to light, police conducted an operation to close down the bakery and remove expired items from the store.

Police involvement came after the store disregarded orders from Community Health Services which had the legal authority to close food outlets.

The police at the that time went to the administrative office with a search warrant, but the staff refused to open the door stating that they did not have the authority to do so, according to police. Police called senior management, but they did not answer calls. Police waited outside for two hours before Fantasy management came to open the doors.

The Fantasy store was popular among locals as well as foreigners living in Male’, and was widely patronised.

Bakers Fantasy was closed by Male’ City Council on October 28. The council subsequently inspected three storehouses and Aioli Restaurant, which is also owned by Fantasy Pvt Ltd.

Male’ City Council’s head of health section Hassan ‘Jambu’ Afeef told local media at the timethat  expired products were found in two of three storehouses, and that storehouses were not properly lit. All expired products were destroyed, he said.

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Maldives “lagging behind” on tackling malnutrition

The Maldives is “lagging behind” in addressing malnutrition, a senior medical expert has said, as the country continues to work towards meeting the UN’s Millennium Development Goals for health.

Public Health Programme Coordinator for the Center for Community Health and Disease Control (CCHDC), Dr Fathmath Nazla Rafeeq, told Minivan News that malnutrition in the country was “quite alarming” considering the number of medical advances made in the country over the last few years.

Her comments, made on World Health Day, relate specifically to fears over the national promotion of healthy diets, including issues of vitamin deficiency in expectant mothers and children, to the consumption of high-calorie junk food and energy drinks by young people.

According to figures published in 2009 by the World Health Organisation (WHO), 17.8 percent of children under five years of age were found to be underweight in the Maldives according to international standards for ascertaining health in young people. The same figures found that 6.5 percent of children were classed as overweight in the country. 20.3 percent of children in the same age group were found to be suffering from ‘stunting’, a term describing children suffering growth retardation as a result of poor diet and infection.

Hunger for information

Co-founder of the NGO Advocating the Rights of Children (ARC), Zenysha Shaheed Zaki, believes parents and schools across the Maldives require greater access to trained nutritionists, reflecting a demand for education on healthy eating.

ARC is focusing on overcoming a widespread cultural prevalence for convenience foods in the country by promoting healthier lifestyles – particularly among younger people.

Dr Fazla said that the government continued to rely on NGOs to helping to promote healthier lifestyles across the country’s atolls.

“The state cannot do this alone. Therefore we welcome the support of NGOs to improve health across the country,” she said.

Though not all educational programmes relating to nutrition in the country in recent years have succeeded, the CCHDC claimed in certain cases children were able to teach their own parents about the need to cut down on junk food like french fries and other dietary offenders, as a result of their own learning.

Dr Fazla said there was also a strong concern about the amount of high-calorie junk food being consumed by school-age children.  She also said that the number of expectant mothers suffering with anaemia – a condition that can have health impacts for children later in life – also needed to be addressed.

Energy drinks

Dr Fazla stressed that beyond just dealing with food intake, the government continued to be concerned about a growing trend among parents providing children with caffeinated energy drinks. There was, she said, a common misunderstanding that such drinks were the same as sports drinks designed for rehydration after physical activity.

“We understand that some parents are under the misconception that sports drinks are the same thing as energy drinks,” she said. “Right now we are looking to address concerns about giving energy drinks to children.”

Rather than solely treating nutrition as an education issue, Dr Fazla claimed that wider national issues of food security and supply were also important to the debate about the quality of the nation’s eating habits.

Supply issues

Supply issues are hampering efforts to encourage healthy eating in the Maldives, said Dr Fazla.

“There is a perception among some people that when we encourage people to eat fruits, these be products like apples and oranges – things grown in in other countries, rather than locally available produce like papaya,” she added.

“We also have to think about affordability. I can go to tell someone to buy vegetables, but for products grown on farms say in India there are a lot of variables like shipping costs that impact the prices of such goods.”

Dr Fazla stressed that projects were underway to try and encourage a wider variety of agriculture, but issues of food security and availability should not be understated.

She was ultimately optimistic the country could succeed in fostering a culture of healthier eating among young people, and the rest of the nation.

“We should be able to overcome the challenges of how to feed our young properly,” she claimed.

Awareness issues

ARC yesterday launched a new website for its HEAL campaign, originally launched in April last year, designed to introduce young children to a five-point program designed to promote healthier lifestyles.

According to ARC co-founder Zenysha, the NGO is educating parents and schools to replace fast foods and flavoured soft drinks with fruits and vegetables, water and a generally more active lifestyle. Efficient promotion of ARC’s message remains a major challenge, she said.

“Raising awareness [of healthy eating] among young people is a key challenge we face right now. There are a few nutritionists in the country, but the ARC has had to get two nutritionists from New Zealand to help with our work,” she said. “There is a lot of demand among parents and pre-schools for dietary advice and information. We have had nutritionists meeting with parents at pre-schools in Male’, Hulhumale’ and Villingili – events that were popular, but people are still demanding more advice.”

Children were often wary of being taught lessons, Zenysha said, so ARC was attempting to combine education with games and activities to raise awareness about the importance of healthier eating.

The HEAL plan emphasises the importance of healthier snacking, such as yoghurt or dried fruits and nuts, eating a mix of different coloured fruits and vegetables, avoiding processed foods like sausages and burgers, and aiming for at least an hour a day of physical activity.

Drinks are also included, with parents being asked to reduce their children’s consumption of added-sugar drinks such as packaged juices and flavoured milk, by favouring bottles of water and lower fat or skimmed milk.

Though the HEAL campaign was launched back in April 2011, the launch of the new website this weekend represents an ongoing collaboration with nutritionists to promote a national discourse on the need for healthy eating.

Zenysha said information on the website was at present solely provided in English, though attempts were underway to provide Dhivehi translations.

ARC said it was also looking to schools to try and have a single day each week where children are invited to bring lunches and snacks consisting solely of fruits and vegetables.  Water would also be encouraged in place of added-sugar drinks.

Meanwhile, ARC said it had been invited by a large number of groups and organisations around the country to attend events in order to promote the HEAL campaign, providing games and activities to help parents and children better understand the need for nutrition.

After a festival held last year to promote its nutrition message, Zenysha said the NGO was now looking to hold a similar, much larger event to promote child nutrition in 2012.

ARC had now been in operation for two years and was seeing strong support from government, fellow NGOs and the private sector, though difficulties were still felt in attracting active volunteers, she said.

“While we have lots of interests in our campaigns, we are a relatively small team, so getting trained volunteers for our projects can be difficult,” she said.

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Universal health insurance scheme under review

The government’s universal health insurance scheme ‘Aasandha’ is currently being reviewed by the authorities to introduce a measure to  share the cost of  healthcare services covered under the scheme.

The discussions follow concern from the government over the scheme’s sustainability, as the demand for healthcare continues dramatically increase, costing the country millions.

The newly-appointed Chairman of the National Social Protection Agency (NSPA) and State Minister of Home Affairs Thoriq Ali Luthfee recently suggested in the local media that the Aasandha scheme “cannot continue to operate without interventions to control the demand.”

He alleged that the scheme was introduced “for political motives” without any proper planning.

Subsequent to the remarks, members of the public raised concerns over a possible cancellation of the scheme and loss of access to free healthcare. The new administration of President Dr Mohamed Waheed Hassan has shut down some initiatives introduced by his predecessor, including the  Maldives Volunteer Corps and the Second Chance Program for inmate rehabilitation.

However, in an interview to Minivan News on Tuesday, Aasandha Private Limited’s Managing Director Mohamed Shafaaz confirmed that the scheme will go forward although measures will be taken to control the rising demand for health care.

According to Shafaaz, since the inception of the Aasandha scheme on January 1, over 138,000 individuals have sought health care under the scheme – which accounts for almost 40 percent of the total population.

Meanwhile, on a daily basis almost 7000-8000 people are using the scheme, totaling a daily cost of the scheme of up to Rf 3 million (US$194,552), he further noted.

“We expected the demand to increase initially with the inception and hoped it would reduce later. but the trend has not changed. Demand is still increasing,” Shafaaz explained. “There are some people with serious illnesses like cancer, heart conditions and kidney problems etc, but most people are going for consultations just because it is free,'” he added.

Therefore, he noted that the current discussions focus on introducing a co-sharing model to share an extent of the healthcare cost with the people, instead of sole coverage by the state.

Currently the ‘Aasandha’ scheme, a public-private partnership with Allied Insurance, provides free coverage of up to Rf100,000 (US$6485) annually for health services for all Maldivian nationals.

“The problem is it is completely free. People do not have to pay anything. But if we bring a small change like levying a charge of  around Rf 10 (US$0.65), people going for unnecessary consultations will be discouraged,” Shafaaz noted.

However, he noted that “nothing has been finalised” yet and the changes will hopefully be decided and made public this week.

In a previous article Minivan News explored the Maldivian public’s prodigious appetite for medical care following the inception of the scheme and the subsequent challenges to the health sector.

Aasandha appears to prove the business rule that low prices attract public interest applies even to medical services – many Maldivians talk about being encouraged to go to the hospital simply because treatment is free.

Medical professionals have also commented on what they describe as the population’s reflexive hypochondria.

Dr Ahmed Jamsheed, Chief Operating Officer at Male’s ADK hospital at the time and currently the Minister of Health, observed in a personal blog entry, that ‘the launching of Aasandha has challenged the two hospitals in Male’, pushing them to their limits with frenzied ‘patients’ (or should I call them customers?) flooding and packing the hospitals.”

Observing that ADK has seen a 50 percent increase in specialist consultations and a 100 percent increase in demand for basic services, Dr Jamsheed describes the hospital as “overwhelmed.”

“In the absence of an ongoing epidemic, statistically and epidemiologically speaking, it is unlikely that so many people would be sick needing health care simultaneously,” he said.

He also echoed similar concerns over the financial implications in sustaining the scheme and suggested that a scheme where patients co-shared the cost would be more ‘useful in limiting unnecessary hospital visits and prescription charges.’

He also alleged
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President Waheed abolishes Maldives Volunteer Corps

President Dr Mohamed Waheed has abolished the Maldives Volunteers Corps (MVC) and its work has been reassigned to the Ministry of Human Resources, Youth and Sports.

“The Maldives Volunteers Corps was abolished because a number of its functions are performed by the Ministry of Human Resources, Youth and Sports,” the President’s Office said in a statement.

The Ministry is now overseen by Mohamed ‘Mundhu’ Shareef, spokesperson for former President Maumoon Abdul Gayoom.

The Maldives Volunteer Corps was established in 2009 under the Ministry of Human Resources, to increase the participation of youth volunteers in various national and regional level social and economic programs.

Its international branch, the International Volunteers Programme (IVP), places international volunteers in positions within the health and education sectors in the country and was established in partnership with the Salisbury-based Friends of Maldives (FOM) NGO, and coordinated by the Maldives High Commission in London.

FOM recently announced a travel advisory concerning four resorts whose owners it alleged were involved in the ousting of the Maldives’ first democratically-elected President.

“Since the first free and fair presidential elections in the Maldives in October 2008, FOM has worked on promoting social issues and other development programs, primarily in Health and Education Sectors, with the International Volunteer Programme (IVP), the Maldives Volunteer Corps (MVC) and the Maldives High Commission (London),’ FOM said in a statement on its website.

“This activity has been jeopardised due to the violent removal of the democratically-elected government on February 7, 2012. Where health workers and teachers are able to stay, without danger to their safety, they will continue to work to benefit the Maldivian people.

“Unfortunately, this situation is becoming increasingly fragile as Maldivian people have been beaten, hospitalised and imprisoned across the country, and FOM’s focus is required to revert to protecting human rights and promoting social justice until safety and democracy is restored.”

There are 28 volunteers with the IVP program based across the Maldives for the current academic year.

MVC was the program’s local counterpart with the role of taking care of the volunteers, provide their induction and orientation, and liaise with the Ministry of Education throughout the academic cycle, explained former head of MVC, Mariyam Seena.

“The IVP was designed to meet the shortfall of skilled personnel in the academic sector and if the program is shut down, then it will be the children and the schools that will suffer,” she said.

“The schools that have IVP volunteers rely on them a lot – not only with teaching the students but running English programs for the local teachers as well.

“In late 2010 MVC received close to 100 requests for volunteers from schools all over the country which shows the urgent need for British volunteers.The program is into the third year and beginning to make a huge impact on the education system, so shutting it down would be a huge injustice for Maldivian students from the islands,” she concluded.

In an email to the IVP volunteers currently working in the Maldives, FOM founder David Hardingham advised them to register with the British High Commission in Colombo, “and please leave the country if you feel you are in any danger at all.”

“Friends of Maldives are now no longer official stakeholders in the program and following the events in Male and now in Addu, we are now resorting back to our former role as a human rights NGO,” he said.

Volunteers choosing to stay were advised to “follow their instincts”, “steer clear of gatherings”, and “don’t express an interest in one side or the other.”

“Things are unlikely to improve, at least in the short term,” Hardingham wrote. “The military coup and the subsequent crackdown on the huge Male demonstration has caused a lot of concern amongst progressive Maldivians who remember the heavy-handed former dictatorship. There is a lot of pain and anger out there and if demands are not met for elections then things could spiral for the worse.”

The Maldives Volunteer Corps was inaugurated in 2009 by Dr Waheed and then-President Mohamed Nasheed.

In a statement following the inauguration, Dr Waheed “noted the importance given by the President in establishing the Volunteers Corps.”

“Further, he said that Maldivians, in all walks of life, have been known for their helpfulness and kindness to each other. Speaking in this regard, the Vice President said that purpose of the Maldives Volunteers Corps included strengthening the spirit of cooperation and solidarity among the people and to increase interest in voluntary services.”

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Smokers react to dramatic rise in price of cigarettes

Ahmed Lizneen was just 14 when he first smoked. What started as an “experiment for fun” has now become a habit – he has struggled to quit over the years, but to no avail.

“It was my friends who gave the cigarette to me first. I had it for fun. Then I also started buying. Not the whole pack, but a few cigarettes at a time as it was cheaper. Slowly it became an addiction. I tried to stop many times, but just could not,” Lizneen explained.

Alarmingly high tobacco consumption

Statistics reveal an alarming proportion of the Maldivian population – especially youth – have succumbed by one of the biggest public health threats the world has ever faced: the tobacco epidemic.

The Center for Community Health and Disease Control (CCHDC) estimates that the 44 percent of the total population use tobacco, mainly by smoking.

According to the Maldives Demography and Health Survey (MDHS) 2009, 42 percent of people in the age group 20-24 are smokers while 20 percent of 15-19 years age group smoke.

Similar findings in a 2007 Global Youth Tobacco Survey (GYTS) showed that nice percent of the surveyed students are either smokers or have smoked in the past – while 48.7 percent students are exposed to second-hand smoke at home and 69.4 percent of students are exposed to it elsewhere.

A worrying trend has been observed with rising numbers of girls becoming smokers.

Statistics show that overall tobacco use prevalence is high compared to international standard with 57 percent of men and 29 percent of women having used some form of tobacco.

Based on customs data, in 2010 alone 346 million cigarettes were imported into the Maldives at a cost of Rf124 million (US$8 million) – a disproportionate figure considering the 350,000 populace. In 2009, Rf110 million was spent to import 348 million cigarettes – mostly included well known brands such as marlborough, camel, and mild seven.

Based on those figures, the average Maldivian smoker consumes 2312 cigarettes a year – six a day.

Leading public health experts have raised their voice on the issue.

Former Director General of the CCHDC Dr Ahmed Jamsheed wrote on his blog in July 201 that the “available statistics on smoking in the Maldives are alarming”.

“The Maldives still seems to be on the rising curve of the tobacco epidemic (we can still change this) and it will take several years to peak and show the full health impact of smoking and tobacco products. There is a lag of many years between the health effects of tobacco and the time people start smoking,” he wrote.

Meanwhile Ahmed Afaal, a public health service manager and tobacco prevalence researcher, says much needs to be done to control the growing “menace”.

“To protect the majority of the smoking Maldivians from death before they reach their potential life expectancy, strong laws are needed to reduce the supply and demand for tobacco,” he wrote on his blog in October 2011. “We are way behind!”

Tobbaco products price increased

In a bid to control the rising demand curve, legislation was passed in 2011, increasing the 50 percent import tariff on cigarettes by four fold.

With the increase of import tariff by 200 percent the price of cigarettes doubled, subsequently raising complaints from “tobacco addicts”.

Unlike many countries which already impose strict supply controls and high prices on tobacco products, the Maldives has long enjoyed cheap rates with a pack easily available from shops between Rf18-25 (US$1.16-1.62), subject to brand, while a single cigarette costs one rufiya.

Following rise in import duty in the Maldives, the cheapest brand is available at almost Rf35 (US$2.27) and a single cigarette costs almost two or three rufiya.

By comparision, a pack of cheap cigarettes costs the equivalent of Rf66 in the USA, Rf112 in the UK and Rf158 in Australia.

To understand how the smoking habits have changed since the price hike, Minivan News interviewed five smokers aged between 18-40.

Every respondent claimed the daily number of cigarettes smoked remain unchanged, although one who is 20 years old claimed to have reduced it a “little”.

“I finish a pack [almost 20] everyday,” a 35 year-old said. “It is really difficult since the price has increased but I can’t control it. Sometimes I smoke secretly because my wife does not like it”

However, during the interview which was conducted at a café’, the man cancelled an order for a cigarette pack after the waiter mentioned the price. “It’s way too costly at the restaurants,” he says.

Lizneen, 24, also claims his smoking habits still remain same – almost 10-20 cigarettes per day.

However, he revealed an interesting trend among the smokers: “We don’t share anymore,” he explained. “There are some smokers who take one or two from others, but because it’s expensive now most who buy cigarette packs hide it or do not smoke in front others who ask for smokes. I do that. My friends too”.

Meanwhile, another 28 year-old who spoke to Minivan News said the change in price “brought no change to my demand and habit”.

“I started smoking at the age of 15 to make my Dad angry for abandoning us while we were still studying. I tried to quit for my wife because she did not like it. But I gave up trying because she left me,” he said.

An 18 year-old, who similarly started smoking at a young age, claimed he would “continue to smoke even if the price increases to Rf100”.

“I can’t stop even if I want to. So why try? There is nowhere I can go to get help. I don’t even know where I can get the help,” he said. “Nobody even cares. It’s all politics now.”

Fight continues

Deputy Director at the CCHDC Hassan Mohamed, who also heads the Tobacco Control Unit, observed that tobacco use is  a “global menace” which has been rooted in the Maldives “since our forefathers’ time.”

Laws have been passed to control tobacco use over the generations, with the first to be enacted in 1942, while the latest Tobacco Act passed through the existing parliament in 2010.

However, Mohamed argues that “law itself does not solve the issue” and it is the implementation, collaboration and taking initiative that will help to make the Maldives “tobacco free”.

Acknowledging that the existing Tobacco Control Act is “weak” and has “limitations” that have to be bridged by legislation which are now under review, he pointed out that the laws are adequate and the fight against tobacco can be continued.

He added that the rise in cigarette prices has been a “positive move” and will reduce demand in the long run, acting as a heavy barrier to the recruitment of new or potential smokers.

“Affordability is the key factor that determines smoking habits. When the price increases, depending on the threshold, research has shown that smokers do tend to quit,” Mohamed observed. “Since the price hike, we have received phone calls from the islands and to our office from people asking for help to quit smoking.”

Meanwhile, he said that the introduction of four pieces of legislation currently under review would provide more control over the tobacco supply chain, with zero advertising, strict packaging guidelines and heavy penalties in addition to enhanced protection of second-hand smokers with the banning of smoking in stated public areas.

“The legislation would prohibit sale of single cigarettes,” he claimed, pointing out that Health Ministry requires support from other authorities as it had limited jurisdiction over businesses.

He observed initiatives to treat tobacco addicts are limited and an increased effort is required through civil society and community.

Work is also underway to provide quit smoking services, targeted to begin this year. “We have already trained some people. We will soon open a cessation clinic in Male’ and run a four month pilot project,” Mohamed added.

However, he says the Maldives  is facing a “global menace” with multi billion dollar multinationals deliberately exploiting consumers health and well-being to make profits.

“We must keep in mind that in the Maldives we are also fighting against a multi-billion dollar industry. There will be pressures from the global arena and from factors exclusive to Maldives,” Mohamed said. “But we can fight it.”

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Male City Council begins Primary Health Care program

President Mohamed Nasheed has today launched the “Primary Health Care Program” of Male City Council, which aims to facilitate immunization and other health services to children below five years of age.

In its first step the program will conduct a survey to determine the total number of children below five years of age living in capital Male’, Mayor Maizan Ali Manik said during the program launch at Vinares house in Machangoalhi district.

To inaugurate the program, President Nasheed visited that house and helped the children living there fill out primary health care forms.

City council officials are expected to visit every household in Male’ during the survey.

Speaking to the press, the President said the 11-seat council, which consists of nine ruling Maldivian Democratic Party (MDP) councillors, is now mandated with the important task of managing primary health care in Male’.

The primary health care program has not been “managed properly” in Male’, though the islands have been running the program successfully, he added.

Under the program, the council will be responsible for recording children’s height, weight, and other health indicators, the President observed.

Mayor Manik reiterated the importance of the initiative, adding that the council has decided to open Primary Health Centers (PHC) in Male’s four districts, as well as nearby Villingili and Hulhumale.

He added that the centers will help “reduce the current pressures faced by the hospitals” as parents can take their children to the paediatricians at the health centers instead of going directly to hospitals.

“The parents can bring the children here. The doctor at the center will recommend if further consultation is required from hospitals”, the Mayor explained.

He added that centers will provide immunization, vaccination and free consultations, among other health services.

The program follows the implementation of the Aasandha universal health insurance scheme, under which Maldivians will receive up to Rf100,000 of free health care per year. Government officials have said the scheme now holds the government to a higher standard of health care.

During the primary school admission process last year, the Ministry of Education observed that an increasing number of children were not properly vaccinated.

Parents are required to submit a vaccination report with the school application form when their children enroll in grade one, at the age of seven.

Following the Ministry’s observation, public health experts stressed the importance of a comprehensive primary health care initiative to ensure proper immunisation of children.

Speaking today to Minivan News, Public Health Programme Coordinator for the Center for Community Health and Disease Control (CCHDC) Dr Fathmath Nazla Rafeeq welcomed the city council’s initiative as an important move to provide easy access to vaccination  and monitoring.

She noted that the Maldives already has a record high vaccination coverage rate in the region, adding that the health centers will help “sustain the coverage”.

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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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NSPA says Madhana won’t cover new clinic rates

National Social Protection Agency (NSPA) Director, Ibrahim Waheed, has told Haveeru that the Madhana health insurance scheme will not cover increased fees at private clinics. The government lifted control of clinic charges this week.

Earlier this week, an informed source told Minivan News that the clinic fees were likely to stay within the scope of the Madhana’s program.

NSPA reported said the Madhana program only covers the rates currently charged at hospitals and clinics. Any excess charges after the current Madhana rate will have to be paid for by the patient.

Haveeru News reports that some clinics have agreed to keep their current rates, to protect their clients. However, those clinics that want to increase their prices will be required to stop providing insurance services.

Clinics are still required to give the government a month’s notice before implementing price changes.

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Dengue task force to hand control to Health Ministry as outbreak calms

The Ministry of Health is expected to once again take the reins of the national response to a dengue fever outbreak linked to the deaths of eight Maldivians this year, after last week handing control of the focus to a task force appointed to bring island management of the disease under a single body.

A spokesperson for the task force, which has attempted to combine the efforts of the Maldives National Defense Force (MNDF), government ministries and NGOs, said the body expected its work to be “wound down” today, with the Ministry of Health once again taking control of efforts after infection rates were said to have fallen.

The task force had initially been budgeted to operate from within the social centre at Maafanu School in Male’ for seven days. However, despite initial optimism that the outbreak – which has been labelled by the government as an “epidemic” – would be under control in this time, doubts arose later during last week about the likelihood of meeting such a deadline.

Speaking to Minivan News today, a media spokesperson for the task force said it once again expected management of the virus outbreak to revert back to the Health Ministry, after having itself overcome a number of difficulties allegedly including collaborating with recently established local councils.

“We are seeing the number of confirmed cases dropping once again and I expect we will be winding up our work today,” the spokesperson added. The spokesperson claimed that Male’s Indira Gandhi Memorial Hospital (IGMH) was itself now returning to normal operations after adapting several wards and surgeries specifically to coping with dengue during the outbreak.

On Thursday (July 7), several Male’-based hospitals including IGMH said that although they were busy continuing to deal with a significant numbers of patients suspected of contracting the virus, the situation was said to be under “control” by some senior management staff.

Deputy Education Minister Dr Abdulla Nazeer, who has spoken on behalf of the taskforce created by President Mohamed Nasheed to combat the outbreak, said he was “glad to say the situation is under control and we are winding up our work and will transfer it to the Health Ministry.”
During its work the taskforce had identified several factors that contributed to the difficulty of managing dengue outbreaks, he noted.
“Number one is a lack of proper communication between the Health Ministry and local councils,” he said. “The second was that they did not have the capacity to resolve the issues.”
“Councillors on some islands thought it was not in their mandate to follow the requests of the task force,” he added. “The MNDF and local authorities had to intervene, and the councillors realised it was a matter of national safety.”

Government view

In addressing the work undertaken as part of a collaborative approach to disease control , Press Secretary for the President Mohamed Zuhair claimed that the initiative’s work in identifying and focusing on regional and island prevention measures would ensure the government was better prepared in the future for similar outbreaks.

“The government’s main focus has remained targeting mosquito breeding grounds, particularly areas such lakes and stagnant water collections,” he said. “However, we have also been working on community focal points where we have focused many types of control measures.”

Zuhair claimed these control measures had been focused specifically on trying to put more emphasis on focusing on island communities to identify possible difficulties with dengue, despite reports from the dengue task force of initial coordination problems in working with the local councillors.

A spokesperson for the opposition Dhivehi Rayyithunge Party (DRP) was unavailable for comment at the time of going to press over its views of the government’s response in dealing with the dengue epidemic” of recent weeks.

Yet over the course of last week DRP Spokerson Ibrahim ‘Mavota’ Shareef, reiterated his belief to the press that the government had “bungled” their response to trying to control dengue fever. Shareef added that although the DRP welcomed and would cooperate with the government in efforts to try and limit the spread of the virus, he said that authorities had acted too slowly in trying to deal with the outbreak.

“From what we have seen the government is just not doing enough. We don’t believe they have been willfully negligent, but there has been negligence in their approach [to dengue outbreak],” he claimed. “They have not responded fast enough, which could be inexperience on their part. But I think this will be a wake-up call for them to change policy in dealing with these type of situations.”

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