Comment: One of Maldives’ biggest killers entirely preventable

It is indeed sad that one of the biggest killers of people in Maldives is an addiction that is entirely preventable, but requires a good will to act from everyone.

In 2010, the Government of Maldives, in a commendable move, passed a Tobacco Control Law and in January 2013 introduced its first regulation to reduce the amount of public real estate on which smokers can indulge in their harmful habit – it banned smoking cigarettes inside all government buildings, private restaurants, cafes and other public places.

It further bans smoking tobacco at rehabilitation centres, children’s parks and spaces often visited by children, aboard transport vehicles and at any area where residents have to wait in a line to receive services. Individual violators can be fined MRF500 and proprietors MRF1000 for not enforcing the law on their premises.

Of course, with any law, enforcement is key and we know that the government is aware of the need to encourage law enforcement to not only uphold the law but to become better educated on the details. WHO has suggested incentivising law enforcement so that they will take a more active role in upholding this crucial piece of legislation. There is work to be done to gazette certain provisions, and provide support for more training and awareness-raising activities.

The statistics themselves are alarming enough:

  • According to the 2009 Maldives Demographic and Health Survey (DHS), 42 percent of people in the between the ages of 20-24 are smokers in the country, one of the highest in the region.
  • Although importation figures are showing some decline, in 2011 about 454 million cigarette sticks were imported. This represents a retail value of about MVR 910 million.
  • Globally – tobacco kills nearly 5.4 million people each year; and by 2030 it will kill more than 8 million people each year.
  • If no serious action is taken, up to 1 billion people could die from tobacco use in the 21st century.

There is well-established evidence: tobacco kills and its use carries many negative effects on health and quality of life.

However, despite efforts globally by governments, NGOs and individuals to curb tobacco smoking, it is no secret that the opposition backing the tobacco industry is well-organised and well-funded. Some of the firms will stop at nothing to silence the anti-tobacco lobby. Even for small nations such as Maldives, introducing anti-tobacco legislation and measures can face fierce resistance from those who promote their commercial interests.

The theme of World No Tobacco Day 2013 is “Tobacco advertising, promotion and sponsorship.” The WHO position is clear: all forms of tobacco advertising, promotion and sponsorship should be banned – full stop. We believe that banning tobacco advertising, promotion and sponsorship is one of the most effective ways to reduce tobacco use. In fact, this is a requirement under Article 13 of the WHO Framework Convention for Tobacco Control (FCTC), the international treaty that was developed in response to the globalisation of the tobacco epidemic.

Why is this measure so important? Nearly three in four children between the ages of 13 and 15 are exposed to pro-cigarette ads on billboards and to pro-tobacco messages at sports and other events.

The link between such messages and the uptake of the habit are indisputable. Our figures show that a comprehensive ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by an average of about 7 percent, with some countries experiencing a decline in consumption of up to 16 percent.

I commend the Government of Maldives for introducing a total ban on tobacco advertising, promotion and sponsorship. The Tobacco Control Law (Law15/2010), with the first regulation introduced in January 2013 and more underway, provides a base for reinforcing such a ban.

I know that the Government of Maldives is taking this matter very seriously and continues to place an importance on introducing a full set of regulations, coordination of efforts in multiple sectors and educating small traders and communities on the provisions of the law.

The evidence is clear: such bans work and help us to protect our youth from this deadly addiction.
The time to act is now.

Dr Magtymova is the World Health Organisation (WHO) Representative to the Republic of Maldives.

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]


New drug-resistant strain of TB found in Maldives “quite serious”: HPA

The Health Protection Agency (HPA) has warned that a new drug-resistant strain of tuberculosis (TB) that has appeared in the Maldives poses “quite a serious threat” to people’s health.

The agency’s comments follow a report released by the Ministry of Health on Sunday (March 24), revealing that it faces new challenges in order to control the disease in the Maldives.

According to the World Health Organisation (WHO), TB is an infectious bacterial disease that can be transmitted via droplets in the throat and lungs of the infected.

WHO states that drug-resistant strains of TB have become a major public health problem that has resulted from patients not fully completing the recommended six-month course of treatment.

HPA Public Health Program Officer Shina Ahmed told Minivan News today (March 25) that although the new strain of TB is “quite serious”, the particular strain found in the Maldives is not resistant to every drug available to patients.

“We have had a few cases come in now with the new strain. The most important thing we have to do is to continue and complete the course of treatment.

“Most of these drug-resistant strains are caused by patients stopping the treatment. We have enough drug supplies to give to them, but because the course goes on for six months, patients tend to go off taking the treatment towards the end,” Shina said.

Local media reported that the Health Ministry had revealed that 10,563 people had been registered to receive treatment for TB since 1963, out of which 5,256 people were said to have infected lungs.

Shina claimed that the majority of cases within the Maldives have been reported on the islands as opposed to Male’, and that in order to prevent the spread of the disease the HPA will be undertaking awareness programs.

An official from Indira Gandhi Memorial Hospital (IGMH) in Male’ stated that there was no need for the public to be concerned in regard to the spread of the disease, adding that there may have been only “one or two” cases found to have contracted the new strain.

“When we find a patient who is not responding to the prescribed course of treatment, there is always a second course they can take instead,” the official told Minivan News.

According to WHO, healthy individuals infected with TB are not often affected by any symptoms as the person’s immune system acts to “wall off” the bacteria.

The organisation states that symptoms of active TB are coughing, sometimes with blood, chest pains, weakness, weight loss, fever and night sweats.

The WHO Representative to the Maldives, Dr Akjemal Magtymova, Health Minister Dr Ahmed Jamsheed Mohamed and the Health Ministry were not responding to calls at time of press.


Reported increase in practice of female circumcision raises alarm

Claims that female circumcision is rising in practice in the Maldives have triggered alarm across the government and NGO sector.

“We are beginning to hear reports of this occurring, and I have heard on radio and television people justifying the practice. It is quite disheartening,” said Vice President Dr Mohamed Waheed Hassan, speaking at a UN event last week.

Then-Attorney General Husnu Suood raised concern in December 2009 that female circumcision in the name of Islam had been revived in Addu Atoll, claiming that religious scholars “are going around to midwives giving fatwas that girls have to be circumcised. They’re giving fatwas saying it is religiously compulsory. According to my information, the circumcising of girls has started and is going on with a new spirit.”

Minivan News subsequently traveled to Addu to investigate the matter and meet with sources, but was unable to determine if the practice was indeed occurring.

Speaking last week, Dr Waheed did not pinpoint a specific area where female circumcision was taking place, but attributed the “general trend” to “rising conservatism and traditional values imported from other parts of the world.”

“Mostly this is a failure of education – there are not enough opportunities for higher education and many students receive free offers to go to madrassas in places like Pakistan, where they learn very traditional values,” Dr Waheed said.

A source from the Health Ministry’s Department of Gender and Family Protection told Minivan News that while female circumcision was widely known to have occurred in the Maldives, it stopped in the 80s and 90s but “now we are hearing media reports that it is happening again.”

The Ministry was not aware where the practice was occurring, but said it intended to investigate.

“There is no formal reporting happening in the islands,” she said. “We have been trying to get reports but health facilities are not aware of the situation.”

Deputy Health Minister Fathimath Afiya meanwhile confirmed that the Ministry was sufficiently concerned to launch a study seeking to identify where female circumcision was occuring.

“There are no reports but NGOs have been talking about it,” she said, stating the Ministry had held a series of meetings on the subject after it received a letter voicing concern from NGO ‘Hope for Women’.

Interim President of that NGO, former Gender Minister Aneesa Ahmed, confirmed to Minivan News today that “some Islamic organisations are advocating this and people are having girls circumcised. I don’t know where and when, but I have heard people say on various programs including Raajje radio.

“I heard two Islamic scholars speaking, and this woman called the radio station and asked two Islamic scholars on the program what Islam said about [female circumcision], and the scholar said yes, that the Prophet Mohamed advocated that girls be circumcised. My concern is that scholars are advocating this has to be done according to Islam, people will not question it and start circumcising girls.”

Aneesa said a representative from the NGO had met with State Minister for Islamic Affairs, Sheikh Hussein Rasheed, who said there was “no question about it: that girls had to be circumcised.”

When Minivan News spoke to Sheikh Rasheed today, he said he did not wish to comment on the matter as he had a meeting scheduled with the Health Ministry regarding the issue.

”If I say anything people might assume it was said on behalf of the Islamic Ministry, or that it was the ruling of the Ministry, so I will not say anything for the time being,” he said.

According to Aneesa, the concern was not whether female circumcision was indeed Islamic.
“I am not a scholar, I am not arguing whether it is right under Islam. If that is the case, we should not stop talking about it. We must undo conventions to which the Maldives is party.
“I don’t want girls to go through the negative complications such as infections and bleeding. I am not questioning whether it is Islamic, but if it is, then people need to be properly trained to do it. Some people are asking if boys are circumcised, why not girls? I am not questioning Islam, my concern is the negative [health] impact.”

According to information from the World Health Organisation (WHO), female genital mutilation is divided into four types: “clitoridectomy, the partial or total removal of the clitoris; excision, partial or total removal of the clitoris and the labia minora; infibulation, the narrowing of the vaginal opening through the creation of a covering seal by cutting and repositioning the inner or outer labia, with or without removal of the clitoris; and all other harmful procedures to the female genitalia for non-medical purposes.”

Dr Akjemal Magtymova of the WHO’s Maldives country office told Minivan News that from her limited research into the practice in the Maldives, “it looks like this is not a very intrusive form practiced here. It is more just a following of tradition, a show to a higher power that something has been done about it and the responsibility has been fulfilled.”

Unlike male circumcision there was, she said, “no health benefit to female circumcision.”

“There are risks including infection, infertility, and complications during pregnancy and birth when the wounds are not healed or where there is scar tissue,” she explained.

According to the WHO, girls undergoing the procedure also risk cysts and recurrent bladder and urinary tract infections, as well as more immediate complications including severe pain, shock, haemorrhage, tetanus or sepsis, urine retention, open sores in the genital region and injury to nearby genital tissue.
It was, observed Dr Akjemal, an ethical dilemma around whether to train doctors to perform the operation safely.

“I am not sure about it – if you train doctors to perform the operation, you open it up to business and supply-induced demand. Rather than a practice isolated to traditional healers, it becomes a lucrative business,” she suggested.

Female genital mutilation is widely practiced in Africa with an estimated three million girls undergoing the proceedure each year, the WHO reports. Across Asia only Indonesia reports the practice although it is also believed to be performed in Malaysia.

In 1997, the World Health Organisation (WHO) issued a joint statement with the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) against the practice, and in February 2008 received wider UN support to increase advocacy against it.

“Female genital mutilation is recognised internationally as a violation of the human rights of girls and women,” the WHO advises. “It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.”

Former State Islamic Minister Sheikh Mohamed Shaheem Ali Saeed, now the Dean of Villa College’s Faculty of Islamic Sharia, said he had studied the issue and determined that there was no valid hadith demanding females be circumcised.

”All scholars who say it is something that Muslim females should do are citing invalid hadiths,” Sheikh Shaheem said, calling for the practice to be stopped.

”Currently it is uncommon in the Maldives. When I was young I used to hear that it was something done, but now it is very uncommon and I think it was carried to this generation more as a cultural thing,” he said.


Maldives holds regional record as malaria-free zone

The Maldives holds South-East Asia’s record for being malaria-free. Meanwhile, the region is falling behind as one-third of affected countries show signs of eliminating the vector-borne disease over the next ten years.

Dr Robert Newman, director of the Global Malaria Program of World Health Organisation (WHO) said malaria control has improved significantly. “The world has made remarkable progress with malaria control. Better diagnostic testing and surveillance has shown that there are countries eliminating malaria in all endemic regions of the world.”

Malaria affects 40 percent of the world population. While the Maldives had a volatile track record in the 1970s, peaking at 1100 cases in 1976, virtually no cases of local origins have been reported since 1984.

Director General of Health Services Dr. Ibrahim Yasir said the only malaria cases have involved foreigners or Maldivians who have traveled to regions where the disease is endemic.

“A few times a year a foreigner might come who has been infected elsewhere, or in a recent case a Maldivian boat capsized near Africa and those on board contracted malaria and were treated here,” he said.

Yasir noted that the interiors of transport vehicles coming from malaria-infected locations are sprayed with a disinfectant to prevent accidental importing of the bug.

Certain countries that share regular traffic with the Maldives are showing worrisome resistance to malaria elimination.

According to an article published by Times of India today, Roll Back Malaria Partnership (RBM)’s latest report says that high rates in India, Indonesia and Myanmar have kept South East Asia’s malaria report rate stable while other regions see a declining report rate.

RBM’s report compares 5,200,000 probable and confirmed cases of malaria in 2000 in India against 5,000,000 in 2010. A WHO fact sheet, however, notes that 2 million fewer cases of death due to malaria were reported for the same time period.

Sri Lanka and Korea are in the pre-elimination phase.

Malaria elimination – the deliberate prevention of mosquito-borne malaria transmission resulting in zero incidence of infection in a defined geographical area – was first attempted at large scale during the Global Malaria Eradication Program from 1955 to 1972.

WHO certified 20 countries as malaria-free during this time, however in the 30 years that followed efforts to control the disease deteriorated and only four countries were certified.

During the 1970s, the Maldives successfully eliminated the malaria-carrying mosquito. It continues to combat the dengue-carrying mosquito, however, and several outbreaks have claimed 11 lives this year, making 2011 the worst year on record for dengue fatalities.

Among the factors that prevent the elimination of malaria, dengue and other viral diseases is the over-use of antibiotics. At the 64th meeting of the Regional Committee for South-East Asia in September, members suggested that overuse of antibiotics was making diseases harder to treat.

In 2010, WHO introduced a program combatting the reflexive practice of prescribing anti-malarials to any child with a fever. “Anti-malarial treatment without diagnostic confirmation means poor care for patients. It masks other deadly childhood illnesses, wastes precious medicines, hastens the inevitable emergence of drug-resistant parasites and makes it impossible to know the actual burden of malaria.”

In a previous interview with Minivan News, ADK Chief Operating Officer Ahmed Jamsheed called antibiotics “the most misused drug in the Maldives,” and warned that the trend could put Maldivians more at risk for dengue fever and chikungunya, as well as viral diseases.


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>


Residential Properties Bill accepted by Parliament

The Residential Properties Bill intended to regulate the housing rental industry has been accepted by Parliament.

Independent MP for Kulhudhuffushi-South, Mohamed Nasheed originally presented the bill to the Parliament in November 2009, which aims to protect the rights of both tenants and landlords. It has been in the queue system since.

The bill was widely based upon the Residential Tenancies Act (1987) of New South Wales, Australia, and proposes the creation of a tenancy deposit scheme, with deposits made at the start of a tenancy to be held by the government rather than individual landlords.

There would be a limit on how much the deposit could be and tenants would have the right to appeal if they believe they are not getting a fair rental price.

When he first presented the bill in 2009, Nasheed told Minivan News stricter housing regulations are necessary in a city as overcrowded as Malé, where demand for accommodation dramatically outstrips supply, leaving tenants vulnerable to unscrupulous landlords.

Even then, Nasheed admitted the bill was controversial and said he was unsure it would be passed as it was, but now that it has been accepted by the Majlis, Nasheed said he has “greater hope that a compromise will be reached between those who agree with it and those who don’t.”

“I basically looked at it from a consumer protection point of view,” he said. “So far [housing] has been regulated by ordinary terms of contract.”

Nasheed said he wanted to protect the rights of both the tenant and the landlord, and hopes the bill will help the market by leaving “less room for undue influence.”

The bill was accepted by 45 votes, “seven votes above majority,” Nasheed noted. It will now be sent to a committee before being sent back to Parliament for approval.

“I hope it will all be over in six months,” Nasheed added.

knocking down house
Demolishing a house in Malé

A holistic approach to the housing crisis

Minister for Housing, Transport and Environment, Mohamed Alsam, said the bill “has got rather ridiculous things in it. It’s very foolish to control the market.”

Aslam said the government was trying a more “holistic approach” to the housing crisis in Malé by “diverting demand elsewhere.”

He said the best thing to do was to improve services in other islands and provinces, so people would want to move out of Malé and back to their homes.

“It’s a national development issue,” he said. “Other parts of the country aren’t attractive enough.”

Aslam said that is where the government’s decentralisation plan comes into play. “We have always seen the issue of housing as a broad development issue, not an isolated thing. If we leave Malé as it is, no law will regulate it.”

Although the minister did admit “certain elements of [the bill] are good,” he said “I don’t think I would go with it.”

Housing in Malé

With a growing population of over 100,000, Malé is among the most densely populated cities on the planet, and the housing crisis is only getting worse as more people migrate from other islands and demands grow, allowing rental prices to spike.

Due to the high demand and low supply for housing in Malé, many people who own land choose to rent it out for extra income, either by renting a part of their house or giving the land for the construction of apartment buildings.

A 2008 report by the Human Rights Commission of the Maldives (HRCM) found that 68 percent of families in Malé were living in accommodation that “qualifies as slums by UN definitions.”

Additionally, they found survey participants spent 85 percent of their income on rent and utilities in Malé and Vilingili. They also found some landlords were increasing rent “at will” and forcibly evicting tenants if they were unable to meet their ever-increasing demands.

Effects of overcrowded areas

There are many other issues with overpopulation besides money and rental control; health problems, psychological welfare and even sexual abuse have all been directly connected to living in overcrowded areas.

Dr Jorge Mario Luna, World Health Organization (WHO) representative to the Maldives, wrote: “Several social problems are also faced within the household including child abuse, psychological impact in growing up in areas of overcrowding, breakdown of many families due to the hardship faced by them stimulating a ripple effect of social disorder for the families, particularly the children caught in the situation.”

Buildings in Malé
Buildings in Malé

Dr Luna added: “It is important to note that the major drivers, or social determinants, of health in urban settings are beyond the health sector, including physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities.”


Comment: Urbanisation is a challenge for public health

Historically, Malé city has been an engine of economic growth, a centre of culture, and a generator of ideas. But while human potential is infinite, resources are finite.

Urbanisation creates problems, but healthy cities can solve them. A billion people now live in the world’s urban slums. The urban population of Asia is expected to double between 2000 and 2030. The health sector needs to take the lead in calling attention to the enormous implications of this growth in cities for the health of the people who live and work in them.

On 7 April 2010, World Health Day, WHO will focus on the themes of Urbanisation and Health.

With the possibility that over the next 30 years all population growth will be in urban areas, urbanisation becomes a real challenge for public health.

Urbanisation is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (NCDs) and their risk factors like tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks.

In poorly planned cities, the urban poor are the ones who will suffer the burden of these and other health problems, including an increased risk for violence and for some communicable diseases such as tuberculosis and HIV/AIDS.

In 2008, the Human Rights Commission of Maldives (HRCM) carried on a “Rapid Assessment of the Housing Situation in the Maldives”.

In interviews in Malé, the study described issues such as exorbitant rent levels, housing space, size, overcrowding, unaffordable access to clean drinking water, and many other problems like unhealthy living conditions, social problems as a result of overcrowding.

Many of the respondents indicated that these problems were the key causes of rising social issues such as gang warfare and drug abuse.

Furthermore, several social problems are also faced within the household including child abuse, psychological impact in growing up in areas of overcrowding, breakdown of many families due to the hardship faced by them stimulating a ripple effect of social disorder for the families, particularly the children caught in the situation.

The assessment highlighted that the sources of such housing stress are many, but it is mainly attributed by the raising demand for housing as a result of increased migration of Maldivians and foreigners to the capital. There are over 30,000 international migrant laborers now living in Malé under more crowded situations.

In the rapid assessment, local residents reported as many as 30 men sharing 3m x 3m flats without running water or sanitation facilities. These workers have to queue at public water taps to access clean water and often have to sleep in shifts as not all of them are able to fit into the space they occupy at the same time.

Among nationals, they felt that public services in Malé and to a lesser extent in Hithadhoo, Thulusdhoo and Kulhudhufushi were significantly better than the services they could receive at home or urban centers closer to them, being hospitals, secondary schools and higher education the most commonly mentioned services.

Other important factors for individual and family migration included the availability of employment opportunities and higher wages in Malé and better prospects for developing one’s own business from the capital.

As we can see, it is important to note that the major drivers, or social determinants, of health in urban settings are beyond the health sector, including physical infrastructure, access to social and health services, local governance, and the distribution of income and educational opportunities.

The solution? 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.

Such actions do not necessarily require additional funding, but commitment to redirect resources to priority interventions, thereby achieving greater efficiency.

The Rapid Assessment of the Housing Situation in Maldives conducted by the HRCM, concluded providing a series of recommendations, which together are designed to kick-start a broader process leading to continuously improving housing conditions in the Maldives.

Dr Jorge Mario Luna is the WHO Representative to the Maldives.