Family Planning in Asia and the Pacific - International Council on ...

practised <strong>the</strong> community would be targeted for be<strong>in</strong>gmoved to ano<strong>the</strong>r isl<strong>and</strong> for consolidation, <strong>and</strong> would haveto face more difficulties than it had <strong>in</strong> <strong>the</strong> past.The United Nations Country Team, <strong>in</strong> its countrysituation analysis drafted <strong>in</strong> preparation for <strong>the</strong> next cycleof support, recognized that <strong>the</strong>re had been an <strong>in</strong>crease <strong>in</strong>Islamic fundamentalism <strong>and</strong> this critical factor would havean important bear<strong>in</strong>g on Maldives’ future development(UNCT, 2010). Such fundamentalists were us<strong>in</strong>g FP <strong>in</strong><strong>the</strong>ir propag<strong>and</strong>a <strong>and</strong> were claim<strong>in</strong>g that <strong>the</strong> use of FP wasaga<strong>in</strong>st Islamic pr<strong>in</strong>cipals, so <strong>the</strong>y discouraged people frompractis<strong>in</strong>g FP. Their l<strong>in</strong>e of propag<strong>and</strong>a also <strong>in</strong>fluenced <strong>the</strong>attitudes <strong>and</strong> behaviour of service providers who wereencouraged to not promote FP.Despite Maldives’ relatively good socio-economic<strong>in</strong>dicators, violence aga<strong>in</strong>st women is widespread: one <strong>in</strong>every three women has experienced violence <strong>in</strong> her lifetime(M<strong>in</strong>istry of Gender <strong>and</strong> <strong>Family</strong>, 2007). Maldives also hasone of <strong>the</strong> highest percentages of women who are headsof household. This situation puts an added burden onwomen who have to take on <strong>the</strong> role of head of <strong>the</strong> family<strong>in</strong> addition to <strong>the</strong>ir o<strong>the</strong>r responsibilities.Of critical importance are <strong>the</strong> new government policies<strong>and</strong> programmes. The Strategic Action Plan 2009-2013,<strong>the</strong> National Framework for Development, will serve as<strong>the</strong> pr<strong>in</strong>cipal plann<strong>in</strong>g document of <strong>the</strong> government <strong>in</strong> <strong>the</strong>delivery of <strong>the</strong> pledges <strong>and</strong> programmes outl<strong>in</strong>ed <strong>in</strong> <strong>the</strong>alliance manifesto of <strong>the</strong> Maldives Democratic Party. Thefive pledges <strong>in</strong>volve: (a) develop<strong>in</strong>g a nationwide transportnetwork that would allow people <strong>and</strong> commerce to movewithout h<strong>in</strong>drance throughout <strong>the</strong> whole country; (b)provid<strong>in</strong>g all citizens with affordable hous<strong>in</strong>g; (c) ensur<strong>in</strong>greasonable <strong>and</strong> affordable health care for all citizens;(d) br<strong>in</strong>g<strong>in</strong>g down <strong>the</strong> cost of <strong>the</strong> most basic goods <strong>and</strong>services; <strong>and</strong> (e) elim<strong>in</strong>at<strong>in</strong>g <strong>the</strong> rampant traffick<strong>in</strong>g <strong>in</strong> <strong>and</strong>abuse of narcotic drugs currently prevalent <strong>in</strong> <strong>the</strong> country.The Strategic Action Plan is to date <strong>the</strong> government’s mostcomprehensive plann<strong>in</strong>g document. A number of policyframeworks are proposed under each sector. Under <strong>the</strong>health sector, <strong>the</strong> follow<strong>in</strong>g policy statements have beenarticulated:Streng<strong>the</strong>n health promotion, protection <strong>and</strong> advocacyfor healthy public policiesProvide access to affordable, equitable <strong>and</strong> good-qualityhealth services for all Maldivians, <strong>in</strong>clud<strong>in</strong>g provision ofuniversal health <strong>in</strong>suranceBuild a competent, professional health-serviceworkforceBuild a culture of evidence-based decision-mak<strong>in</strong>gwith<strong>in</strong> <strong>the</strong> health systemEstablish <strong>and</strong> enforce appropriate quality assurance <strong>and</strong>regulatory framework for patientsEnhance <strong>the</strong> response of health systems <strong>in</strong> emergenciesIn its mission statement <strong>the</strong> M<strong>in</strong>istry of Health <strong>and</strong> <strong>Family</strong>mentioned that it <strong>in</strong>tends to establish systems for <strong>the</strong> health,well-be<strong>in</strong>g <strong>and</strong> social protection of <strong>the</strong> people; provideaffordable, accessible <strong>and</strong> good-quality health-care services<strong>and</strong> drug rehabilitation services; streng<strong>the</strong>n mechanismsfor protect<strong>in</strong>g <strong>the</strong> rights of its children, women, personswith disabilities <strong>and</strong> <strong>the</strong> elderly; <strong>and</strong> susta<strong>in</strong> <strong>the</strong> qualityof health care <strong>and</strong> social protection services. One of <strong>the</strong>pillars of <strong>the</strong> Plan is “affordable <strong>and</strong> (good-)quality healthcare for all”. Among o<strong>the</strong>r th<strong>in</strong>gs, its strategies <strong>in</strong>cludestreng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> mo<strong>the</strong>rhood <strong>and</strong> RH programmes that<strong>in</strong>clude age-appropriate adolescent sexual <strong>and</strong> reproductivehealth care, treatment of cancers, address<strong>in</strong>g genderbasedviolence, provid<strong>in</strong>g RH commodities <strong>and</strong> assur<strong>in</strong>guniversal health <strong>in</strong>surance for all.The government has formulated a new health masterplan (MOH, 2006b); it has also put <strong>in</strong>to operation anew RH strategy for <strong>the</strong> period 2008-2010. Accord<strong>in</strong>gto <strong>the</strong> Strategic Action Plan, <strong>the</strong> government <strong>in</strong>tendsto streng<strong>the</strong>n public-private partnerships <strong>and</strong> entrust<strong>the</strong> operation of health facilities to corporations. Thegovernment also <strong>in</strong>tends to promote decentralization <strong>and</strong>give greater control to <strong>the</strong> people. Accord<strong>in</strong>gly, it has alreadyformed two corporations for <strong>the</strong> Indira G<strong>and</strong>hi MemorialHospital <strong>and</strong> Addu City Regional Hospital. However,<strong>the</strong>re is no clear policy on how <strong>the</strong> corporatization of healthfacilities will help to achieve <strong>the</strong> pledges made under <strong>the</strong>Strategic Action Plan. Likewise, <strong>the</strong> government has alsodeveloped an ambitious health <strong>in</strong>surance plan known as <strong>the</strong>Madhana Scheme to cover all Maldivians. Except for <strong>the</strong>voluntary health <strong>in</strong>surance scheme, which is patronized bysemi-government entities, Madhana is <strong>the</strong> only <strong>in</strong>surancescheme that promises to cover all Maldivians. In 2011,“Madhana Plus” is likely to be <strong>in</strong>troduced to providesubsidies for treatment <strong>in</strong>ternationally. The governmentalso plans to subsidize <strong>in</strong>surance premiums for thosewho earn less than Rufiyaa (rf ) 21 per day (US$ 1 = 15.3Rufiyaa); about 100,000 persons are estimated to earn lessthan 21 rf per day. This would entail a recurr<strong>in</strong>g f<strong>in</strong>ancialburden of US$ 200 million at a time when <strong>the</strong> world isundergo<strong>in</strong>g <strong>the</strong> effects of a serious f<strong>in</strong>ancial crisis (M<strong>in</strong>istryof Health <strong>and</strong> WHO, 2009). Ano<strong>the</strong>r study (Chamaraet al., 2009) on <strong>in</strong>equality <strong>in</strong> health services <strong>in</strong> Maldivesrecognized <strong>the</strong> ga<strong>in</strong>s made by <strong>the</strong> country <strong>and</strong> noted that,even though health services outside Malé are pro-poor,<strong>in</strong>equality prevails <strong>in</strong> <strong>the</strong> provision of special services <strong>and</strong>care. The cost of travel to seek a higher level of healthservices is very high, <strong>and</strong> significant <strong>in</strong>equality is <strong>in</strong>volved<strong>in</strong> obta<strong>in</strong><strong>in</strong>g medic<strong>in</strong>e when needed. Government policies,such as <strong>the</strong> ones mentioned above, have wider implicationsfor <strong>the</strong> delivery of health services. Maldives’ current success165