Country presentation: Maldives Dr Ali Latheef Focal Point, NCD unit IGM Hospital

Situation analysis Geographical distribution 1200 island spread over 900 km; 198 islands are inhabited Population – 350,000 ; more than 1/3rd lives in capital, Male (2 square kilometers) NCD burden % of disease burden % of NCD deaths All NCDs 52.8 79 Cancer 13.4 7 CVD 11.4 39.4 COPD 4.5 8.4 Diabetes 2.9 2

Overall structure of prevention services and resources CCHDC – Center for Community Health and Disease Control Non communicable disease unit Tobacco control unit Limited staff at central and Atoll (regional) level Same staffs look after both NCD program & CD programs Lack of trained staffs leading preventive work NGOs – Diabetic society

Achievements in tackling NCDs and their risk factors Maldives have acknowledged NCD as a top priority. CVD, DM, COPD and selected cancers were identified Developed the NCD strategic Plan The biggest achievement – Law on Tobacco (2010) Took a long time Tobacco lobby is very strong Able to increase the tax on tobacco products, restrict advertising etc STEPS survey in 2004 Tobacco free islands

Challenges encountered in Maldives At present biggest challenge is political and financial crisis Privatization of health services Preventive work significantly affected Geographical distribution of islands Transport difficulties Small population in most of the islands Most of the fruits and vegetables are imported Expensive Unavailable in islands

Challenges encountered in Maldives Difficult to bring changes in to existing regulation Public involvement is less Many prominent public figure appear to be on the “other side” High incidence of drug abuse Implementing rules and regulations is difficult Implementation and enforcement of policies Proliferation of fast food joints Energy drinks very popular No regulation on advertising except tobacco

Main lessons learnt over the last 5 years NCD and their risk factors are on the increase’ Adequate preventive measures are lacking all over the country Strong media advertisement has caused significant increase in sales of soft drinks/energy drinks leading to obesity Fast food industry is rapidly growing An adequate budget and a stronger commitment needed from all stake holders

Main steps for the next five years Strengthen the NCD units Developing capacity for implementing the policies and evaluating the program Establish NCD units at Atoll level for preventive work Allocation of sufficient budget for preventive activities and ensure that it remains a priority for all sectors Establish a close relationship with media Laws and regulation on advertising on products related to nutrition etc Strengthen the school health program to reduce childhood obesity

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