Country Capacity and Accomplishments and Application of the Policy Options Framework(cont...)

Maldives

Key Policy Options and Strategic Actions

Assess

* Create a national NCD surveillance system. A national system is needed to inform strategic

planning and policy development. Limited efforts for subnational behavior risk factor

surveillance for tobacco and youth have been undertaken. However, the system should also

include NCD mortality, morbidity, health services utilization, and economic burden data

(available from national health accounts). This information will be critical as decentralization

evolves. Core public health institutions are needed to provide technical support along with

international institutions (such as WHO).

Develop and Implement

* Coordinate national efforts. It would be necessary to build the sections capacity and provide

sufficient resources and authority to meet its objectives It is also important to address social,

economic and environmental determinants that underlie NCDs. Cross-sector and

collaborative mechanisms need to be expanded and strengthened to address the latter.

* Strengthen tobacco control policies. Control efforts have made a good start. However, full

implementation and enforcement are lagging.

* Develop a competent workforce to tackle NCDs. Assets include the national guidelines and

standard practices that need full implementation, and they will need periodic updating.

Human resources require assessment for current and near-future needs, and that

assessment must account for the large use of expatriate providers. Human resource for key

areas such as mental health need to be addressed urgently.

* Strengthen financing for NCD care. Much progress has been made with social health

insurance, but equity and access need to be addressed. The restructuring of the health

system should not compromise on the public expenditure for health, especially preventive

health. New avenues for health financing such as earmarking of taxes from tobacco and other

unhealthy goods towards preventive health should be explored.

Evaluate

* Create capacity to evaluate programs and policy. As policies are developed and more resources committed to NCD efforts, evaluation will help fine tune or redirect activities.

* Electronic medical record system needs institutionalization. The recently developed system for chronic NCDs needs to be developed and incorporated broadly into service delivery.