Our Resident Representative of the WHO Dr Luna; the Vice President; Minister of Health Dr Aminath Jameel; and everyone present here today.
Dr Luna has suggested to me that it might be best if I spoke in Dhivehi. So I think I will listen to him and speak in Dhivehi.
But I have a feeling that because this whole thing was done thinking in English, so even though I will make my views very clear in Dhivehi, I believe there is enough reason for me to say a few words in English.
I have had a look at the report. I have also heard, and I have been listening. We came into government determined to correct a number of inequalities. A number of wrongs that we felt were within our society.
We went to the people. We spoke to them. We asked them what was wrong with it – what is the problem with our health service? Certainly not money – per capita amount of funds that the budget provides on health services are far higher, sometimes, than development.
So we started wondering why we are unable to actually meet the expectations and demands of the people. We felt that we were moving away – we were moving away from a country, a population that is infected by primary health issues to tertiary health issues. But meanwhile, all our programmes, all our policies were very much focused and directed in trying to cure primary health issues – malaria, malnutrition and all sorts of transmittable diseases – which was all very good and we should continue to do that.
I think Rasheeda very rightly asked Dr Sheena, why is she not saying this and is she not finding it. Is it not apparent in the data or in the analysis. I wasn’t very clear of what Dr Sheena said. But I did ask Dr Aminath Jameel, “Exactly what was the relationship here, why is Rasheeda having this question, on Dr Sheena?”
In my mind, Rasheeda, I think my feeling is that we have moved away. It is no longer such a serious issue. It is an issue, it is a central issue, but it is no longer the issue. We are fed and we eat fairly well. A fair amount of us do.
We do need to go into all the statistical collections and everything. But going door to door, from house to house, gives you a very good impression of what others are eating. You are able to have a look at their issues. You are able to actually see and understand how they are living. It was with that idea. It was with that information that we started. I went into almost every single house with Dr Aminath Jameel in this country. Almost every single house- and Aminath Jameel accompanied me to almost all throughout these visits. I might be exaggerating when I say all 74,000 of them, but we have done a fair amount.
We came to realize that we have to do exactly all these things that you mentioned that we should do. One of the most important things that we have to do was to go for programmes instead of having budget lines. We did build a programme that cut across many streets, stakeholders and departments. We have come up with the Strategic Action Plan. I hope and I do wish that people look at it. That is what we are supposed to do. In my mind, if we do that, what is written in it, we will succeed. But if we continue to deviate from the programmes that we have outlined and the focus that we are trying to maintain, of course, we will be all over the place.
I would like to go ahead with your recommendations, and in my mind we are doing exactly that.
The whole concept or the whole policy that we are trying to implement revolves around three main pillars.
One is health insurance for all. It is very sustainable – far more sustainable than trying to sustain inefficient public health delivery systems. Health insurance for all will cost us Rf 600 million. Subsidizing and trying to prop up inefficient public service are costing us Rf 1.5 billion. Again I would like to stress that per capita expenditure on health is high – it has always been high.
We have no doubt that we have to move towards private sector health delivery programmes and measures through which we will be able to do that. Public-private partnerships are crucial in bringing the right efficiency to the health system. So one of the things we did was, we wanted to corporatize health delivery system. We are glad that the corporatization programme is moving. I hope and I believe that when that is done and when everyone is properly insured then we should go into our third pillar, or rather, we are doing it – our social protection programme.
I believe that it is now succeeding and I am surprised that the indicators are not indicating that. The number of people who have died over sixty five in the last two years must have remarkably fallen, even though, the immediate indication from the policy, I believe would have been very substantial.
I went to Hulhudhuffaaru yesterday. I met an over sixty five year old gentleman who came to me and said he and his sister both are over sixty five and both their children are dead and they have some eight grand children. He says that he is now wearing a pair of tennis shoes- as we have asked- and he was looking extremely rosy and very healthy and he was himself feeling extremely healthy. He was himself telling us how the pension programme is helping him. I believe this is making a difference.
In my mind, one of the many reasons why we are able to have a better grip on the government is because deliveries are happening and people are aware of them.
I would, as a last point, always like to consider why the people’s demands are not met. Their demands are to cure their symptoms or what is right now in front of them. However much we try to cure the fundamental reasoning, the first principles of why they are in that situation have a parallel track. We should have policies that address their immediate needs. We can’t just stand on a high horse and say that “you are wrong, you are in this situation because you have not listened to me – because you have done that, you have done this. What needs to be done is for you not to do all that. Now that you are ill, there is no reason why you should come”. No, we can’t do that. We cannot have that attitude and we should be able to have both the tracks moving.
I don’t want to take too much time. I was just wondering if I should speak in Dhivehi. But now looking at the people, I feel that I am fairly clear and I should finish. And I also have made it very clear to you, Dr Luna.
Thank you very much for the very good work WHO is doing here. WHO has been in the Maldives well before we joined the UN system – WHO has been established here since the 1940s. I am sure we are able to achieve a number of our Millennium Development Goals and our own development goals because of WHO and very good assistance the organization has been giving to the country.
As a last point, just before we finish, because the whole workshop revolves around the idea that you are ill not because of health but other things has to be properly focused. You are ill because you are unable to travel. Because you can’t move from your home to the next door island. You are ill because of many other things other than your health. The whole thing is about prgrammes, how cross cutting agencies, how interrelated stakeholders should be involved in trying to solve the issue.
So my request to the health sector workers is to please move away from what you have been doing all along and come to our thinking. We are not trying to invent the wheel, we are not talking about rocket science. We are actually talking about very simple health delivery needs.
Thank you very much.
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