Doctors raise concerns over medicine shortages

Medical doctors, for the second time in 2012, have publicly expressed concern over medicine shortages in the Maldives.

In addition to official routes of raising concerns with relevant authorities, doctors have brought the issue of essential drugs shortage to the public’s attention and appealed to the government and the legislature through social media.

Dr Abdulla Niyaf, Chief Medical Officer and Senior Pediatric Consultant at ADK Hospital, has repeatedly expressed concern about the issue, specifically noting the recurrent problem of stock shortages in essential drugs such as neostigmine and phenobarbitone.

“As a paediatrician, we go in after each birth or cesarean to check on the newborn, full of concern that something might happen to the baby. If, say, the child’s heart malfunctions, and we are out of adrenaline, then there is nothing more that even us doctors can give,” explained Niyaf to Minivan News.

Niyaf said that the systematic issue of running out of stock of critical drugs was very serious, posing risks to the lives of many. He said that it is a huge concern as a doctor that he would be unable to provide immediate medication to patients who are in crucial need of specific medicines, due to complications with stock renewal.

Niyaf further said that he had previously sat down to discuss the matter with the State Trading Organisation (STO), the sole company licensed to import controlled drugs, and other relevant authorities. The answer had always been that the suppliers were facing issues of licensing, permits, delays in customs and so on.

“For how long can we, as doctors, keep listening to these justifications? All I want is for the issue to be resolved and for patients to have the chance of getting the best possible medical attention,” Niyaf said, expressing concern that the relevant authorities had so far not been able to resolve the issue.

Dr Faisal Saeed, another practicing doctor, told Minivan News that the matter was “a very real concern”.

“It is true that many medicines are often out of stock, but that doesn’t lessen the gravity of the problem. I don’t believe it is an option to be ever out of stock. What will any patient do if a critical medicine is unavailable at the time they most need it?”

Saeed further confirmed that there was a current shortage, stating: “As doctors, we worry about this. If something happens, it is we who must take responsibility. Our question is, when this country runs out of medicine, who is to be held accountable? Who will take responsibility for this?”

Dr Fathimath Nadhiya stated that the issue of shortages of even the most essential drugs has been a longstanding concern for a long period of time, further saying that if shortages were such an issue in the capital island Male’, then the loss must be felt even more harshly at remote island health facilities.

“Hospitals and health centres store the minimum required amounts of critical medicines at any given time. But we are not aware who carries the oversight responsibility to check whether this minimum is always maintained,” Nadhiya said.

She further spoke of her worry that with the lack of monitoring, island health facilities may have an even harder time to obtain many of the critical medicines. She said that in many islands, there were only one or more pharmacies run by private businessmen, who would prioritse medicine supplies not based on their medical importance, but rather on their sales statistics.

Ahmed Afaal, Managing Director of ADK, has also expressed concern on the matter on social media network, Twitter. He sent a message to President Dr Mohamed Waheed Hassan, urging him to look into the matter, stating that “tomorrow we may have to stop surgeries [because of an] injection neostigmine shortage. The only supplier is out of stock. Please help.”

Not yet a “doomsday scenario”: government

While many practicing clinicians have expressed concerns on the matter, the government denies the issue is as serious as claimed by the doctors.

“Checked with Health Minister and STO MD. There is no reason to worry about medicines,” President Waheed said,  in a short statement on Twitter.

Minister of Health, Dr Ahmed Jamsheed, backed the statement, saying at a press conference on Sunday that “although some social media messages on Twitter by practicing doctors may make the public dread a doomsday scenario, things aren’t all that bad yet”.

Jamsheed however did confirm that medicine shortages were a recurring problem in the health sector, stating that the Ministry of Health was planning to start a programme with the assistance of UNOPS and WHO to create a procurement/supply chain management system. Jamsheed said he believed that all the current concerns would be addressed and found a solution to through this programme.

“There is a common misconception that I would like to clarify. Although people usually assume otherwise, the health sector has never been involved in importing and supplying medicines. This is left to the private sector and the government-owned company STO,” Jamsheed explained.

“What we are seeing is that those responsible are not able to sufficiently supply medicines. I think we need to change this system if we are to find a solution. If we are to get a permanent solution, then we must make supplying medicines to patients the responsibility of the service provider, regardless of who imports it.”

Although some local practitioners say that the complaint is that the first choice medicines are unavailable, Jamsheed alleged that some of the complaints were because brands of medicine preferred by an individual doctor were not widely for sale.

“If there is an emergency, then the routine is that hospitals or the government flies in the medicine from neighbouring countries at the earliest,” Jamsheed said.

“If those staff in medical facilities who are responsible for these tasks are able to perform their jobs correctly, then it wouldn’t come to such a critical stage where provision of services are interrupted,” he stated.

Meanwhile, some doctors who spoke to Minivan News rejected the idea that emergency stocks were a solution, insisting that stock records ought to better kept and that patients in critical conditions do not have the option of waiting for medicine stocks to be flown in.

Legislative intervention

Maldives Democratic Party (MDP) MP Ibrahim Rasheed ‘Bonda’ submitted an emergency motion to the parliament on Monday, calling on the legislature to take action to “immediately resolve” the problem of medicine shortages.

Rasheed claimed that this failure to provide critical “life-saving medicines” to patients in crucial need of them was causing loss of lives.

“When practising doctors take the initiative to raise concerns, we realised the gravity of this problem. We then researched the issue in depth,” Rasheed told Minivan News.

“Millions of rufiya worth medicines need to be disposed of due to the failure to manage stocks. The stock is still managed manually. There is also a lot of corruption involved in the procurement and supply of medicines,” he said.

“There are permanent parliament committees within whose mandate this issue will fall. The problem is there are already a large number of pending bills that need to be worked on by these committees. We are now discussing within our party to determine what the most effective course of action will be,” Rasheed said.

During the one hour debate that ensued after the submission of the motion, Dhivehi Rayyithunge Party MP Ahmed Mohamed claimed that health services in his constituency had deteriorated, calling the condition of health care provision “regrettable”.

Progressive Party of Maldives (PPM) MP Adam Ahmed Shareef stated that health centres in the constituency he represented did not have the capacity for “the most basic tests”, adding that the pharmacy was managed by the women’s committee.

STO Spokesperson Ismail Sadiq was unavailable to speak to Minivan News this afternoon, and was not responding to calls.

Minivan News was not able to contact the Director General of Maldives Food and Drug Authority, Shareefa Adam, as her phone was switched off up to the time of press.


Government bans smoking in public places

The government has published new regulations to control tobacco, banning smoking inside all government buildings, private restaurants, cafes, teashops and social spaces.

The regulation prohibits smoking at Rehabilitation Centres, children’s parks and places frequently visited by children, aboard ferries and ferry terminals and at any place where people have to wait in a queue to obtain services.

According to the new regulation places such as cafes and restaurants that want to have smoking allowed will have to apply for permission from the Ministry of Health. The permission will be granted to places determined by the Ministry.

Any person who smokes in an area determined to be non-smoking can be fined to MVR 500 (US$32) and the owner of a place that allows smoking in such places without authority can be fined MVR 1000 (US$64) according to the regulation.

The regulation states that if the owner of the premises has not put up the sign board to inform that smoking inside the place is disallowed, the ministry has the authority to fine the venue MVR 500 first time and MVR 5000 (US$3200) on further occasions.

The Centre 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.

Customs data shows that in 2010 alone 346 million cigarettes were imported into the Maldives at a cost of MVR 124 million (US$8 million) – a disproportionate figure considering the 350,000 populace. In 2009, MVR 110 million was spent to import 348 million cigarettes – mostly included well-known brands such as Marlborough, Camel, and Mild Seven.

The first President of the Maldives Ameen Didi, who assumed office in 1953, banned tobacco in the Maldives. However, people were outraged over this decision and a group of rebellious citizens overthrew his government and lynched Didi in the street.


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

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 such as Aasandha’s management.

“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.


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.


President establishes two new ministries in healthcare shake-up

President Mohamed Waheed Hassan has  abolished the Ministry of Health and Family in favour of two new separate ministerial bodies.

The Ministry of Health and the Ministry of Gender, Family and Human Rights have both now been established following the abolition of the previous healthcare body.

Under these two new bodies, Dr Ahmed Jamsheed Mohamed will retain his post as Minister of Health, while Dhiyana Saeed will head the Ministry of Gender, Family and Human Rights.

Saeed, former SAARC Secretary General and wife of recently-elected Jumhoree Party (JP) MP for Kaashidhoo, Abdulla Jabir, resigned from her SAARC position after criticising former President Mohamed Nasheed for the arrest of Chief Criminal Court judge, Abdulla Mohamed. Saeed was youngest SAARC Secretary General ever appointed and the first female.

Both new ministers conducted their respective oath of office today in-front of Supreme Court Judge Abdulla Areef, according to the President’s Office.

The ministerial changes were made a week after the government announced the abolition of the country’s Health Service Corporations. President Waheed said the service facilities provided by the corporations would be brought under control of the Ministry of Health.

The decision was taken by the cabinet based on the experiences of previous government health policy over the last three years, the government stated. The government claimed that a number of “challenges” needed to be faced in providing healthcare across the country’s atolls.

Just last month, the government announced that 30 state companies providing provincial health and utility services would be abolished to try and streamline various public services.

Seven health corporations charged with overseeing regional medical services were also dissolved in favour of returning their functions to the Ministry of Health and Family.

The now opposition Maldivan Democratic Party (MDP) criticised the decision as reversing the decentralisation policy that had been undertaken in recent years.

“Maldives’ geographical fragmentation means one central board or company will find it impossible to effectively monitor and deliver services in an equitable manner,” former President Nasheed’s former Policy Undersecretary Aminath Shauna told Minivan News at the time.

Regional hospitals

Mohammed Abdul Samad, temporary manager for Gan Regional Hospital in Addu Atoll, told Minivan News Thursday that he personally welcomed the decision to abolish the Health Service Corperations.

Samad claimed that despite the relative success in recent years of Maldives health policy in areas such as cutting infant mortality rates, the quality of health services had been generally declining.

“We are desperately in need for urgent supplies like certain injections. We have so many pending bills and the government has had to arrange money for us,” he said.

Samad, who said he was temporarily overseeing operations at Gan Regional Hospital, added that he therefore welcomed the decision to have the Ministry of Health oversee the former Health Service Corporations’ work.

He also claimed that the government would be better able to provide more technically-experienced health staff rather businessmen to oversee hospital operations.

Samad added that Gan Regional Hospital presently faced significant problems in paying off debts relating to much needed drug supplies.

He claimed that the Health Ministry faced major challenges in relation to hiring trained medical staff at hospitals around the country. Taking the example of Gan Regional Hospital alone, Samad said the site presently had the need to employ additional specialist staff like a second gynaecologist to meet local patient demand, though added that management were unable to find suitable candidates.


Market to decide cost of private clinics, cabinet rules

The Maldivian government has dropped price controls of private health clinics months after clinics raised them illegally, according to President Mohamed Nasheed’s Press Secretary, Mohamed Zuhair.

The decision, recommended by the Cabinet, was a reaction to the rising costs of medical materials and consumables.

Earlier, the Health Ministry had approved a general consultation fee of Rf 75-100 (US$5-6), with Rf 300 (US$20) as the highest fee chargeable for a specialist consultation. So-called ‘super-specialists’  could charge more than Rf 300.

On May 12, 2011, Minivan News reported that private health clinics had raised consultation charges without government permission. The cost change was allegedly an effort to balance the devaluation of the dollar exchange rate following the government’s decision in May to implement a managed float of the rufiya.

“The private sector complained that the government had too much control over their services, and after the costs rose they weren’t able to fully operate,” Zuhair told Minivan News.

Zuhair said the government expects private clinic rates to remain moderate, and said most services will be eligible under the government’s Madhana health insurance program. The government also requires changes in medical service charges to be presented to the Ministry of Health one month before taking effect.

“The Minister of Health already has a wonderful system of monitoring in place, and whenever necessary the Ministry will propose a policy change,” said Zuhair. He added that the situation was not expected to be problematic. “The quality of treatment is equal at private clinics and public hospitals,” he claimed. “Now, people don’t have much to complain about.”

A senior informed source in the Maldives health sector told Minivan News that on average, private clinics were a Maldivian’s first choice for treatment. Although the medical treatment might be the same, the atmosphere and degree of personal supervision was often better at a clinic than at a hospital, the source said.

“Cost recovery is not the objective at most hospitals, which are subsidised,” the source explained, revealing that many patient bills at state-run hospitals only cover 25-35 percent of the total service.

“When people go to a hospital to get treated, they are not usually aware of what the hospital is able to provide,” said the source. “The treatment is fine, but hospitals need to increase the quality of care because people expect it, in spite of the low fees.”

The source said he believed that the competition between private clinics would keep costs affordable: “I think it’s good for the markets to determine the rate,” he said.

The source added that large clinics were likely to keep costs within the scope of the Madhana program, in order to maintain their clientele.


Doctor WHO: Celebrating World Health Day in Malé this weekend

The World Health Organisation (WHO) is celebrating World Health Day today with activities around the world, and the theme “urbanisation and health” which aims to improve urban equity gaps, the leading cause for many health problem’s in the world’s poor according to the WHO.

Past themes have been “working together for health” in 2006 which focused on the health workforce crisis; “international health society” in 2007, aiming to improve the first line of defence against public health emergencies; “protecting health from climate change” in 2008, which looked at the effects of climate change on vulnerable populations; and “save lives, make hospitals safer in emergencies” in 2009.

This year’s campaign 1000 cities, 1000 lives is bringing attention to the issues of urban health. The WHO believes “urbanization is one of the major threats to health in the twenty-first century.”

Urban health

Although the WHO recognises urban environments can provide “great opportunities for individuals and families to prosper,” they can also harm our health in many ways, if the infrastructure and lifestyle in these urban sectors aren’t improved.

Some of the challenges the WHO cites as being problematic in urban areas are “overcrowding; air pollution; rising levels of risk factors like tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol; road traffic injuries; inadequate infrastructure, transport facilities, solid waste management systems; and insufficient access to health facilities in slum areas.”

According to the WHO, more than half of the world’s population now lives in urban areas, something that has never before happened in our history. They note that about 34% of the total population of the WHO’s South-East Asia Region is urban.

This year’s World Health Day aims to promote finding solutions to the roots of urban health issues and to “build partnerships with multiple sectors of society to make cities healthier.”

But improving urban sectors does not just benefit health, but is an economically sound proposal. The WHO estimates that “every $1 spent on sanitation gives a return of US$ 9.10 in terms of prevention and treatment of illnesses. Improved transportation, infrastructure and greener technologies enhance urban quality of life, including fewer respiratory ailments and accidents and better health for all.”

WHO Representative to the Maldives Dr Jorge Mario Luna says the solution to many of the health issues exacerbated by overcrowding, pollution, inactivity and unhealthy diets, violence and injury is proper urban planning.

“Proper urban planning can promote healthy behaviours and safety through investment in active transport, designing areas to promote physical activity and passing regulatory controls on tobacco and food safety. Improving urban living conditions in the areas of housing, water and sanitation will go a long way to mitigating health risks. Building inclusive cities that are accessible and age-friendly will benefit all urban residents.”

He added that “such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.”

Malé Health Fair

With this in mind, this year’s campaign is promoting ‘greener’ and healthier lifestyle options, which will be  showcased in Malé’s Health Fair, to be held on Saturday 10 April from 4:00-6:30 pm, and then from 8:00-10:30 pm in different locations around the city.

There will be activities held in Ameenee Park, Children’s Park, the Social Center, and other locations around Malé, Hulhumalé and Vilingili.

Some of the activities include free sporting events like dodge-ball and gymnastics; public awareness demonstrations on first aid and sanitation; food preparation counselling for kids; quizzes and puzzles; medical check-ups at ADK hospital; and distribution of information on living a healthier life.

On Friday 9 April there will be a ‘bicycle round’ where senior government officials and other volunteers will join in bicycle round of Malé.

The ‘round’ will start at the Artificial Beach at 4:00 pm and will follow a westerly route, for about half an hour, along Boduthakurufaan Magu, ending at Licence Sarahahdhu near IGMH.

A full schedule of events will be available at the WHO website and the Ministry of Health and Family website from tomorrow.


Apollo Hospital Group to run IGMH in privatisation deal

The ministry of health and family has announced a 15 year agreement with Apollo Hospital Group to manage Indira Gandhi Memorial Hospital (IGMH) in Male’.

The deal was signed on behalf of the government by Health Minister Dr Aminath Jameel and Dr Preetha Reddy, who represented Apollo Hospital Group.

Apollo estimates it will need to spend US$25 million to bring the hospital up to global standards, according to the  Economic Times, an Indian newspaper.

A statement released by the ministry claimed the objective of the deal is to improve health services while keeping prices stable.

Apollo Hospital Group was first established in 1983, and is now considered the third largest private healthcare provider in the world. The company currently administrates 8,000 beds and has plans to reach 15,000 beds, reports the Economic Times.

Apollo is expected to make an assessment of the hospital’s needs in the first three months, and plans to offer orthopedics, cardiology, gastro, neurology and acute care and trauma specialities in the first phase of the privatisation deal. The hospital will set up and operate a cardiology unit within the year, the health ministry added.

Chairman of the privatisation committee Mahmood Razee said one of the first changes to be made by Apollo would be to management.

“The major issue was that the management structure [at IGMH] was not working properly, this led to high costs and some services and medicines not being available. The overall qaulity of service went down,” he said.

“Over the next three months there will be structural changes to management changes at IGMH, and an evaluation plan will be submitted as well. Apollo group gives IGMH the advantage of economies of scale, which will lower the overall running costs.”

The hospital’s new management group has also revealed its intentions to make 80% of its employees Maldivian over a 15 year period, although it was unclear as to how this would be achieved given the lack of medical higher education facilities in the country.

Another objective the ministry noted was to ensure that all employees are treated within the correct employment regulations set by the government.

Razee noted that the deal was not part of the government’s public-private partnership scheme.

A doctor working at IGMH said staff were unable to comment on the deal “because we haven’t been officially informed yet. All the information we have received has come through the media.”


Swine flu threat decreases as alert level rises to six

The ministry of health has announced it has raised the H1N1 swine flu alert level from four to six.

Despite the counterintuitive increase, alert level six is when the danger of the disease goes down and the risk of it spreading also decreases.

Dr Ibrahim Yasir, director general of health services, said “The disease has not spread in the way we predicted it might. We expected the disease to spread [more] with the start of the academic year and people returning from abroad.”

He said the spread of the disease had been controlled by the hard work of people in the health sector, “the priority given to the pandemic by the government and the awareness of the public.

“Since we didn’t see an increase in the spread of the disease we decided it didn’t warrant a level five alert status,” he said.

The ministry announced that with the level six status many, of the H1N1 precautions would be lifted.

Dr Ahmed Jamsheed Mohamed from the Centre of Disease Control said “Our warnings about not to gather in public places have been lifted, and places like KudaKudhinge Bageecha (children’s park) can now be opened.

“Our swine flu clinic is closing as hardly anyone who goes there any more, and the 24-hour hotline is also being closed.”

Jamsheed said lifting the precautions “does not mean we have to stop being vigilant. There is still a possibility that the disease could spread.”

Next step

The ministry announced that it would now divert its resources towards preparing for the next outbreak.

“We have 120,000 people who have been classified as a prioirty group to receive swine flu vaccines,” Dr Yasir said.

According to the ministry, vaccine doses promised to the Maldives so far include 20,000 from Saudi Arabia, 30,000 from the World Health Organisation (WHO), 15,000 from China, 1500 from Singapore and 50,000 from the government’s own budget.

“The Chinese doses have not been approved by the WHO yet so we are keeping that on hold for the moment,” Jamsheed noted.