Because every child deserves a shot at a healthy life
Context and challenges
Maldives has made significant progression reducing maternal and child mortality rates. The health care delivery system of Maldives is organized into a four-tier referral system with the island level health facilities referring patients to higher level health facilities in the atolls, regions and to central level depending upon the need and service availability. Hence, basic health care services are available on all 187 inhabited islands. The universal health insurance scheme covers the cost of health expenditure through the national health insurance scheme (Aasandha). A high percentage of the health care professionals (around 80%) are expatriates, leading to high turnover.
Nearly all mothers give birth at an established health facility, and all deliveries are assisted by skilled providers (Maldives Demographic Health Survey, 2016-2017). Infant and child mortality rates fell steeply during the 1980s and 1990s. In recent years, mortality rate has remained below 10 per 1000 live births and infant mortality rate has stayed below 8 per 1000 live births (Maldives Health Profile, 2016). A greater challenge for further reduction in child mortality now lies with reducing neonatal death rate.
Among the children who die, majority (over 65%) are newborns – or babies who die before they reach their first month of life.
The majority of newborn deaths are linked to birth defects such as congenital abnormalities and neural tube defects. In addition, rising levels of obesity are triggering high blood pressure and diabetes in pregnant women, placing both mothers and children at risk. Prevention efforts need to be further strengthened to reduce preventable deaths.
Child morbidity, or illnesses has also seen significant improvements, mainly owing to expansion of the immunization programme to every populated island of the dispersed country. Currently dengue, viral fever, diarrhoeal diseases and acute respiratory infections (ARI) continue to be major causes for illness. A strong focus and investment in the childhood immunization programme in the last 40 years has enabled very high vaccination coverage, reaching 93% for all EPI vaccines in 2012.
However, the recent DHS indicates that vaccine coverage is sliding back, with 77% prevalence rate of all essential vaccines.
The immunization programme is facing challenges, including capacity gaps, pockets of vaccine hesitancy and cold chain issues.
While HIV/AIDS rates are low in the Maldives, several risk factors exist that makes young people vulnerable to HIV/AIDs. Research shows young people are engaging in high risk activities such as early initiation of sex and unsafe sexual behaviour. Further, comprehensive knowledge of HIV is low among young people, according to Maldives Demographic Health Survey (2016 -2017), with just 29 percent of women and 26 percent of males of 15 -24 years knowing how to prevent HIV transmission. Studies also show that unsafe sexual practices are happening among youth. National data and studies such as the National Drug Use Survey (2013) reveals that higher proportion of drug users are young. Prevalence of unsafe sex, multiple partners and other harmful behaviour among drug users are relatively high (National Drug Use Survey, 2013; National Strategic Plan on HIV/AIDS, 2015).
UNICEF’s work with the health sector is supporting the Government and partners to achieve results in maternal, child and adolescent health, through advocacy, systems strengthening, capacity development as well as strengthening prevention efforts. We are supporting systems strengthening efforts by
developing capacity of health professionals in specialised areas of Child Health. UNICEF takes a life-cycle based approach, recognizing the importance of early childhood development and adolescence.
Capacity Development of health workforce in child health specialised areas
UNICEF is working with the Government of the Maldives and partners to enhance capacity of doctors and nurses in specialised areas of child health. UNICEF continues to promote a continuum of care for babies and their mothers, during the critical period of first 1000 days of life, ensuring services begin before conception, through pregnancy and after birth and beyond. Further, to lower risks for new-borns, we support the development and implementation of policies, protocols and resources for doctors and nurses. UNICEF, with partners, is building capacity of doctors’ and nurses’ in the delivery room by conducting trainings on stimulating breathing, preventing hypothermia, and delayed code clamping, along with the early initiation of breastfeeding.
We are advocating for Baby Friendly Hospitals that ensure that every baby is breast fed within the first hour of life, giving the child the best chance of life. With our partners, we are supporting to build skills of health care staff on Breastfeeding Counselling and Kangaroo Mother Care, a method of care that promotes skin-to-skin contact for preterm babies. We are supporting to establish Kangaroo Mother Care facilities in hospitals across the country. We promote safe spaces in hospitals where mothers can breastfeed and equip hospital staff with the knowledge and materials they need to help mothers begin breastfeeding immediately.
Educating adolescents about HIV/AIDS
To minimise the risk of HIV, UNICEF is helping young people protect themselves by increasing their knowledge of healthy, preventive behaviours. We are working with the Government to strengthen youth-friendly Health and HIV prevention services and integrate more of these practices into the existing HIV and health programming.
Protecting children through immunizations
UNICEF procures all child vaccines for the Government of the Maldives. This key investment by the Government is providing all essential vaccines free of charge to all children in the country. UNICEF supports the institutional capacity building of the Immunization programme (EPI), and helps to introduce on new vaccines. More recently, UNICEF is also supporting to strengthen vaccine communication and ensure quality of the vaccine supply chain.
The Maldives Demographic & Health Survey | Ministry of Health, ICF, UNFPA, WHO and UNICEF, 2017
The Maldives Health Profile 2016 | Ministry of Health, 2016
National Drug Use Survey | United Nations Office on Drugs and Crime, 2012