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Country Setting

International Symposium on Volunteering 18-21 November 2001, Geneva Role of Volunteering in Health in Maldives Presented by Mohamed Zuhair. Country Setting. Island Nation with about 1200 small islands, and 200 dispersed communities

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Country Setting

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  1. International Symposium on Volunteering18-21 November 2001, GenevaRole of Volunteering inHealth in MaldivesPresented by Mohamed Zuhair

  2. Country Setting • Island Nation with about 1200 small islands, and 200 dispersed communities • Unique geographical features inhibiting transportation and mobility • Small land mass (less than 1 % of geographical area) • Total population of around 300,000 people • Fragile environment

  3. Country Setting • Wide dispersion of population, and the small size of the communities: on average a community has a population of around 800 people; only two communities have a population exceeding 10,000 people • Excessive congestion in some communities, and over stretching carrying capacity in terms of housing and water; the capital Male’ has a population of 70,000 with an area of about 2 sq.km

  4. Country Setting • Economy characterized by two dominant sectors of tourism and fisheries, and almost full dependence on import • Difficulty in attaining sustainability in service delivery due to dis-economies of scale • Excessive dependence on expatriate labour (at present more than one fourth of the labour force comprises expatriates)

  5. Country Setting • Traditionally, communities had very limited support from the public sector in providing basic services, including health and education • Close to universal literacy with high school enrolment at primary level, and strong commitment for education

  6. Country Setting • Dynamic population growth experienced from early 1960s to early 1990s • Sudden decline in mortality experienced during mid 1980s • Current Life Expectancy at birth is around 70 years for both sexes • Difficulty in further reduction in MMR; though the number of cases remains low

  7. Country Setting • Success in maintaining socio-economic progress for about three decades • Five-fold increase in GDP per capita in two decades • High cost of living • Lead in HDI among the South Asian countries • Absence of absolute (visible) poverty

  8. Country Setting • A culture demanding establishment of all services on each individual community irrespective of physical and population size - some communities have a population of s less than 200 people • Modern health facilities introduced only in late 1950s • Facilities established in the rural areas (or the Atoll region) became effectively functional only in the 1980s

  9. Issues Related to the Health Sector • Excessive unit costs for establishing most services, due to geographical dispersion of communities and import dependency • Difficulty in ensuring accessibility due to wide dispersion of communities and transportation constraints • Limited local health personnel, and the need to recruit expatriates even for unskilled work

  10. Issues Related to the Health Sector • Government policy supports in establishing a service network that is accessible to every community within two hours by using normal sea transport • Service network comprises national-level facilities in the capital Male’, five regional hospitals, and Atoll-level hospitals and health posts

  11. Issues Related to the Health Sector • Under utilization of most facilities established in the Atoll region • Limited motivation to join the health profession by locals • Services not effectively accessible to most communities • Significant proportion travelling abroad for medical treatment

  12. Issues Related to the Health Sector • High divorce rate and consequential pressure to have more children • High fertility • Malnutrition and poor food habits; inadequate food security • Limited variety of locally available food items • Limited knowledge and awareness on health matters

  13. Issues Related to the Health Sector • High proportion of adolescent and youth • Lack of family life education within the family and in schools • Dependence on extended family norms

  14. Issues Related to the Health Sector • High prevalence of some genetic disorders; especially thalassaemia - at present Maldives has the highest carrier prevalence rate (18%) • Increasing risk of HIV/AIDS problem due to worsening situation in the South Asia Region • Uncontrolled expansion in substance abuse

  15. Issues Related to the Health Sector • Shift of morbidity towards life style related problems; high blood pressure, diabetes, cancer • High incidence of kidney failures • High incidence of ARI related problems • Possible increase in mental health problems

  16. Issues Related to the Health Sector • Some preferring unreliable traditional treatment options • Popular demand for medication, • Complacency in following and completing dosage

  17. Issues Related to the Health Sector • Tourism related risks (HIV/AIDS) • Increasing dependence on expatriates health personnel • Need to travel abroad for medical treatment

  18. Scopes and Responses of the Voluntary Sector • Geo-physical environment demands strong community participation in development • In times of crisis (famine or natural disasters), difficult to seek outside support due to constraints in accessibility • Strong tradition of voluntary support at the grassroots level • Formal recognition of voluntary service by the Government; annually since 1979

  19. Scopes and Responses of the Voluntary Sector Voluntary support has traditionally remained prominent in following areas: • Basic literacy • Health treatment (traditional medicine) • Religious and cultural functions • Welfare / security • Transportation (sea travel)

  20. Scopes and Responses of the Voluntary Sector At present, volunteers and NGOs remain active in the following fields: • Sports, recreation and entertainment • Education (pre- and primary school) • Utilities, especially in providing electricity to small communities • Environment • Welfare and security

  21. Scopes and Responses ..... NGOs remain active in ... • Global development agendas - eg. gender and environment • Promotion of environmental issues • Community development • Awareness raising on HIV/AIDS • Health improvement

  22. Volunteers Contributions to the Health Sector • Advocacy • Health Promotion and Awareness Raising • Infrastructure and Service Delivery • Prevention and Treatment • Consultation • Counseling

  23. Contributions....- Advocacy • Role of gender in health • Importance of establishing island level facilities • Government policy now supports expansion of infrastructure • Posting of doctors in the field along with paramedics

  24. Contributions....- Advocacy • Implication of the high prevalence of thalassaemia • Reservation in addressing the problem till 1990s • NGO efforts led to the launching of a national programme and establishment of the National Thalassaemia Centre • Acceptance for PND/MTP

  25. Contributions....- Advocacy • Reproductive Health • De-sensitization of child spacing methods • First Family Planning Clinic • Popularization of condom use

  26. Contributions....- Promotion • Dissemination of print materials on crucial topics - HIV/AIDS, Substance abuse, nutrition • TV and Radio spots and programmes • Training of peer educators to raise awareness among adolescent and youth

  27. Contributions....- Promotion • School visits and group discussion • Public meetings • Help-lines (reproductive health, HIV/AIDS, diabetes) • Organization of Health Festivals • Fielding of mobile teams for health education and facilitating access to medical consultation

  28. Contributions....- Infrastructure • Construction of Island Health Posts that are managed by the community or Community Based Organisations • Island Health Posts directly managed by NGOs (one at present) • Facilities for disabled people

  29. Contributions....- Prevention and Treatment... • Nation wide thalassaemia screening programme - targeting 10,000 per year at a cost of US $ 13.5 per test • Securing funds for costly treatment abroad (bone marrow and kidney transplantation, and cancer) - costs of a bone marrow transplantation for a thalassaemia major exceeds US $ 30,000

  30. Contributions....- Prevention and Treatment... • Donation of pumps and injections required for iron chelation - thalassaemia major requires daily treatment • Donation of filters required for blood transfusion for thalassaemia majors

  31. Contributions....- Prevention and Treatment... • Blood donation, especially for thalassaemia majors who require transfusion on a monthly basis to stay alive • Regular financial support for medical treatment • Provision of free drugs to attract people for awareness raising programmes conducted in rural areas

  32. Contributions....- Prevention and Treatment... • Free treatment by those practicing traditional medicine • Physiotherapy for disabled people • Teaching the sign language • Teaching children who are deaf or having other disabilities • Supporting the parents of disabled children in taking care of their children

  33. Contributions....- Consultation • Doctors participating in field trips, without any remuneration • Routine free consultation by those practicing traditional medicine • Accompanying those go abroad for medical treatment • Guiding the patients who visits the hospital for consultation and treatment

  34. Contributions....- Counseling • General counseling support through telephone • Face to face counseling (family problems, drugs, HIV/AIDS) • Genetic counseling for thalassaemia carriers • Providing guidance and counseling for parents of thalassaemia majors • Providing counseling for those opting PND/MTP

  35. Thank you for your voluntary time!

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