Why are we protesting?

It looks as if someone told them to enjoy a day out without work! Everyone’s, smiling, jolly and shouting. Yes! I am talking about the recent “protest” held by the administrative staff of the Maldivian National University.

Photo - courtesy Haveeru Daily

As a member of the University Council, I believe that the employees were misled into having this protest. From the faces, it is seen that some of them are lost, some are enjoying and some were there just because someone asked them to do so. So what actually did happen?

Well, I started sitting in the University Council this year when a new Council was elected, appointed and or selected as per the provisions of the University Law. Since the very inception, staff salary was high on the agenda. Apparently, this was a process that started since 2004 and the previous College Council was also not able to do anything about. Then came the Civil Service Commission. The argument apparently by that Commission at the time was that the University will become independent by Law and then they can amend the salaries as they please.

Alas! The University was formed. It is “independent”. All earnings from the University go into the national treasury and the Government allocates a budget. In terms of spending the money, there is a contradiction between the legal provisions of the University Law, which give the University Council the discretion and authority to spend its earnings, but the National Treasury Laws put the Finance Minister responsible for all government earnings, a complex legal problem that need to be addressed.

At first, when the University Staff salary structure was brought to the present Council, it was thrown out! The justification was that it required more information and a methodology on how these salaries were arrived at. Being the National University, an expectation for proper research on the subject was required. The Council appointed a smaller sub committee to do the work and present their proposal. Extensive research led to a scientific methodology of relating the academic staff salaries to be related to the GDP Per Capita income of the country. A gold standard used by many established universities around the world.

Although the Council approved this, the members were also insisting on a structure for the administrative staff. Again, a similar process was followed and the Council agreed to set the administrative staff salaries not at an ideal increase but a reasonable increase, given the justification of the economic and financial situation of the country. Now one may ask why there was a compromise for administrative staff while the academic staff got an ideal thumbs up. Simple! There is a need to retain and attract the best academia to the National University given the emerging competition.

Rightly as been quoted on the reports after the administrative staff protest, the University Council endorsed a 20% increase as an allowance. From the moment, the Council formed sub committees to meet the Minister of Finance and eventually even the President, to get this increment to the staff. However, despite the efforts of the Council, the Council also had to settle for a compromise. A compromise where the academic staff got a pay rise but the administrative staff did not.

So the protest! I believe that the staff has not been provided adequate information on what actually happened. The slogans and headlines were that Council did not endorse a pay rise to the administrative staff! It is actually quite the contrary. The Council’s decision on the compromise was also to work additionally with more efforts to try and get an increment to the administrative staff as well and this is where the staff is misled.

The next day’s headline was that the staff assumed work with conditions. Ironically, the conditions quoted were exactly the same decision that the Council made on their meeting the day before the protest. Again reason to believe that the staff were not given proper information on the matter or perhaps deliberately misled? May be this is just part of the conditions and the full picture is not shown to the media? Perhaps the next Council meeting will be very interesting! Heated? Emotional?

There is a further issue too! The academic staff who got a pay rise after seven years! Or did they really get it? What next? A protest by the academic staff? That would be damaging!

I believe that the Maldives National University should undergo a major change. A Change in thinking! Looking at it in a critical manner within. I strongly believe there is great potential in the University for it to be an Institute of Excellence nationally and even perhaps internationally.

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Universal Healthcare …

Everyone has the right to a standard of living adequate
for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Article 25(a) of the United Nations Universal Declaration on Human Rights (UN, 1948)

Appendicectomies are currently covered under MADHANA

Recently President Nasheed announced that starting January 2012, all Maldivians will be covered under the National Health Scheme, MADHANA. An ambition and policy that all Maldivians would like to have happen. This probably is the first step the Maldives have taken towards universal healthcare. The notion of universal healthcare refers to an organized healthcare system built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision (WHO).

Just like most countries, the Maldives’ health system has been evolving continuously. In the past we had had a very regressive system where all expenses were out of pocket and hence costly. Many people had to beg, borrow or steel to make healthcare affordable. I know instances where families went bankrupt when a member fell sick with a major non-communicable disease. However, in the latter part of the provisos government, health insurance or health cover become a priority. In a previous article of mine, I wrote about the initial stages of this scheme.

Even at present, we have some fundamental issues that needed to be addressed. Six years back, I wrote a concept paper for the government in which I proposed the following.

  1. A solid legal framework – especially one that looks at consumer protection and simultaneously protecting the providers from heavy financial losses.
  2. A vigorous campaign to educate the public on health insurance. I believe that we are really not aware of the benefits, exclusions and possible consequences and of course the fine print.
  3. There should be a national scheme administered by a government authority but shall not attempt to cover every citizen of the country. The national scheme should cover the civil service, the poor (we do not have a proper poverty line and a mechanism to identify the real poor) and the unemployed (again a grey area) and the retired. Employers should also have a responsibility for health care of their employees. The current Employment Act failed badly on this provision (one of the failures of the Act amongst many).
  4. The scheme should invest generated capital and continuously enhance the system from the profits. Should have 100% transparency and independent audit reports published nationally.
When we look at the current situation, we still do not have a proper legal framework for social protection, let alone health cover. Perhaps the implementation needs are too fast driven for political reasons, the basics are eft behind. Awareness is still low, but I feel that more efforts are now being made to make people aware of the schemes. A lot more can be done. The retired and elderly are now covered irrespective of their affordability, this has pros and cons too. The investment component of the scheme is still nil.
I believe that we can achieve universal health coverage in the Maldives. To do that, we will have to revisit the MADHANA package and reassess it. The current package, although some may not lie me saying this, is very generous and perhaps may not be sustainable for the longer term. Like all countries who have successfully implemented universal cover, we need to have a basic basket of cover. This needs to be determined. Some of the local experts argue that we can achieve this even with the generosity of MADHANA. Well and good then!
Just like all Maldivians, I too look forward to see a universal cover implemented. I have and always contribute my little expertise on this area. Having been participating in some of the current discussions on achieving universal cover next year, I have contributed in every way I can where of course in some matters of principle my view may be the complete opposite of what is proposed.
Ideally, a publicly administered scheme should cover the basic needs and other private or quasi-private schemes should compliment the public scheme. All employees should cover their employees through mandatory legal provision (current Employment Act badly fails on achieving this). Government and employers should not bear the full premium or contribution, but shall be shared hence increased ownership of the user. Also, funding can be geared to the scheme through earmarked taxes from harmful products such as tobacco and alcohol etc …
In an optimistic, perhaps innovative view, the public scheme may consider investing in a wellness resort for the elderly. Slots can be sold to the Japanese, Hong Kong and Korea with very long life expectancies while compensating to take care of the local elderly through the same vehicle.
Challenges lie ahead, but lets face them and overcome them to make healthcare universal and affordable to all Maldivians.

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E-suggestions! A mechanism for customer feedback …

Long before I joined ADK Hospital, I used to wonder about a certain “Suggestion Box” that was kept in the lobby. Since this box is no longer there, the current clients will not see it. Some who may have been regular at the Hospital may note this difference.

During those days, when I come to the hospital for a service I sometimes ask myself whether people really use it? What would they write about? Will they get any feedback? And even whether anyone in the hospital would read it and or take an action on what people suggest?

There was a form that was designed for people to comment on and drop into the box. I read this form more than once but never filled it to drop into the box.

When I took up my employment at ADK Hospital, one of the first things that I did was to take the pile of suggestions that people had put into the box. Out of curiosity perhaps, but more than that I thought that there could be some suggestions that are really constructive and if some changes can be brought based on those suggestions, customers would really see a difference. I believe that our customers would know quite a lot of things that could be improved.

I personally read the suggestions for three months. However, I wasn’t too impressed with what I read. There were hardly any suggestions that are constructive. Most of the comments were made on the reception girls. For example, many people answered the question, why did you choose ADK Hospital? The answers were something like “because of the girls in the reception” and so forth.

A couple of good suggestions struck me though.

One was to make it easy to get appointments for gynecological patients for their regular ANC visits. I thought a lot about this comment and studied that pattern of appointments of these patients and their waiting queue. Over 96% of these patients visit the hospital regularly for the whole nine months and after that too. For a start, then we decided to give all follow up appointments to these patients. Hence we started a process of making an appointment when a pregnant lady sees her doctor for the first time and continue it for the whole nine months and also for the post natal appointment. A reminder also was given by phone and sometimes appointments rescheduled for their convenience. Eventually all the departments of the Hospital now follow this as a standard procedure. Thanks to the person who send in the suggestion.

The second significant comment was about privacy in the private rooms. A patient suggested that a curtain be put up near the beds in private rooms. Although the room is private, the patient’s view was that for ladies, and for gents that matter, a curtain will provide even better privacy for doctors’ examinations, breast feeding and so forth. It was implemented immediately and now is the standard for all private rooms.

The regular collection of suggestions lead to an empty suggestion box for a few months and I decided that we will look for alternative mechanisms to get patient feedback. I did have some brainstorming among the staff. One staff member suggested having an electronic suggestion system. It seemed a good idea for many of us and we implemented the e-suggestions mechanism where users can send in suggestions through an email. It has been implemented now for over an year and I have to say that some very good suggestions have come to us. Apart from comments, grievances and complaints have also been sent via this mechanism.

We have made it a point to reply all the e-suggestions that come in and in some instances we have had made dialogue with patients to relive their problems. Some of the good suggestions that we have received are being worked on and will be implemented. We keep an open mind and accept customer feedback positively. This is one culture that I wish to develop further in the Hospital in order to make our customers happier. Customers obviously are our biggest assets. Send in your suggestions to suggestions@adkenterprises.com.

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The CHAMPIONS of tobacco control …

It is obvious that many steps need to be taken to control the tobacco menace. In past articles I have written about many aspects of tobacco control and the challenges faced by the advocates for tobacco control.

Well in this article, I will present to you real champions. People of the community who have taken drastic actions to ensure that they play a role in controlling tobacco. They made these decisions on their free will and for good reason.

One of the very famous shops in Male’ is Luxury Shopping Centre situated at a prime location on Majeedhee Magu. This shop is known as

Violet Shop on Rhadhebaimagu do not sell cigarettes

a place where people can get a variety of goods and a place of foreign exchange. In the not too distant past, they also were a mayo seller of tobacco. Cartons of tobacco were displayed and a particular window to the road is where these packs and cartons traded hands and on a regular manner. About two years back, Luxury stopped selling cigarettes. Why? Well they declared that they were selling a product harmful to the people. Rewards and awards should be given to such champions, but Luxury humbly declined any awards saying that they did it for the public good. What a luxury to have the thought! Luxury has not dropped its sales and the shop still operates at full swing day and night and it is hard to get in.

Apart from Luxury and Violet Shop shown in the picture, the following shops have also stopped selling tobacco.

Evening Mart, Anees Shop, Thanbee Shop, Approach, Huan Mart, Puree and Daily Link 1 in Male’. Kaaky mart and Check Mate in Vilimale’. I would call them real champions. Monetary gain foregone for the public good.

Well those are the shops. Can we ban smoking in hotels (kada). The notion of this makes some people raise eyebrows and open their eyes wide. For many this would be an impossible task. An action if taken will cause public outcry. Or will it really?

There is one kada, namely Naasthaa Hotel who has declared themselves tobacco free. They do not sell tobacco nor do the allow people to smoke. This also used to be like a normal kada with lots of noise and lots of smoke. A brave decision. And the kada is not deserted at all. Just like before there still is a lot of noise but without the smoke. Sounds really cool! More kada’s should follow suit.

Now comes the modern coffee culture. For many people, entertainment is a coffee with a smoke. It is a common sight in most of the middle to higher range coffee shops around. It is more of a norm. Unfortunately, the smoke is causing a problem for the shop owner. Why? Sales are down! Really? Yes. Many coffee shops are now opting not to sell loose sticks available, the coffee goers are spending more time at the table fuming hence reducing turn over of clients. Also, a number of customers who do not smoke turn away. Unfortunately these coffee shops are designed to smoke.

Coffee without smoke

Now look at this! Would there be someone bold enough for a challenge? Change the coffee culture smokeless? Yes a new champion has emerged. Recently an exclusive coffee shop has been designed and opened smoke free. Cafe’ Ier, Home of the Italian Coffee is full of customers and a new coffee culture emerged. Well one that is smoke free. Three cheers to Cafe’ Ier.

The notion that smoking bans in cafe’s and restaurants will cause a down turn business is a false. Research elsewhere in the world shows that there has been no impact on the sales with smoking bans. The pubs, cafes and restaurants in Ireland, Australia and New Zealand has gone smoke free and even in countries like Sri Lanka, roads are becoming smoke free and all of these with legislation. If we have a will, here in the Maldives we can do better.

 

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Economics of tobacco control – the Maldives

In the year 2003, myself and Dr. Ibrahim Riaz Shareef did a study on the economics of tobacco control in the Maldives. This paper was done for the World Health Organization and presented at a meeting on the Economics of Tobacco Control in the South East Asia Region held in Jakarta from December 3 – 4, 2003. This study was later published by the WHO-SEARO and World Bank and is also available at the e-scholarship database as well.

Economics of Tobacco Control - The Maldives full report

When I look back at that study and the recommendations that we made in 2003, nothing much has changed. In fact things look much worse that at that time.

For example, there has been n o gradual increase in the taxation of tobacco products up until this year when the rate of taxation per stick has been raised to 90 Laari. However, the incidence of tax on tobacco is still the lowest in the South East Asia Region and needs to be implemented. The current proposed draft regulations under the Law has many provisions for such incidences of taxation.

The prevalence of smoking has gone up and the female smoking rate has increased rapidly. The prevalence of non-communicable diseases have gone up and the leading cause of death in the country is now cardiac diseases. There is no proper cancer registry still and the direct impact of tobacco on health in the Maldives remain to be assessed.

The Law although an achievement is weak and the regulations are pending with a claim that gold standards in tobacco control regulation does not suit the Maldivian way of life and social structure. Something needs to be done to save Maldivians from the tobacco menace.

Following is the summary of the report. Click the image to read the full report.

Country Situation

The Maldives, an archipelago of about 1190 islands, lies in the middle of the Indian Ocean. The population was 269 010 in 2000. Per capita GDP was estimated at US$ 1279 in 1998, twice as high as the regional average, and has a growth at an average of 9% for the past 25 years.

The Maldives’ social welfare indicators are good compared to most countries with comparable income levels. Adult literacy rate is close to 1005. Infant mortality hd fallen to 35 per 1000 by 1995, and the crude death rate to 0.5%. Life expectancy at birth was 72 years in 1998. Cardiovascular and respiratory diseases and cancers are the 3 leading cause of death; they are all linked to tobacco use.

Curative and preventive health services are organized into a four-tier system comprising of central, regional, atoll and island levels. Services are provided through both public and private sectors.

Tobacco imports and tobacco control

Most tobacco products are imported, imported volumes are increasing. Cigarettes account for 97% of all tobacco products by quantity. There will be little local tobacco productions – just a small amount of bidi and tobacco for hukkah – in the Maldives. Tobacco smuggling is believed to be negligible. There are no specialist tobacco importers or retail outlets in the country. Thus no jobs would be lost if tobacco sales were to fall.

Maldivian tobacco control goes back to a 1942 law which banned tobacco product imports for some years. A 1947 bill that was enforced for a period of time banned smoking by all students and Maldivians under the age of 17, and prohibited smoking in public. In 1984, advertising was banned in government media, and in 1994 a total ban on all forms of advertisement and promotion was imposed. Smoking was banned in all health care facilities in 1993, and in all government buildings and educational institutions in 1994. Islands declaring themselves tobacco-free may qualify for trophies and cash prizes. In 2000, a large-scale school anti-tobacco programme was initiated by education sector for the whole country. One tobacco-free island, Madifushi, runs a quit smoking programme that provides accommodation and food for people who come to the island to quit smoking. This island received a WHO tobacco-free award in 2000.

Prevalence and consumption

A survey conducted in 1997 showed that 57% of males and 29% females consumed some form of tobacco, and the smoking prevalence stood at 41%. Prevalence is higher in the outlying islands. Per capita consumption is highest in the 15 – 49 age groups, and averages 14 cigarettes a day for men and 10 a day for women.

Prices, taxes and government revenue

Prices of cigarettes were relatively stable (in nominal and real terms) from 1997 to 2000. In 2000, prices rose steeply but then fell to 40% above the earlier price. Until May 2000, duty on all imported tobacco products was 50% of CHF value. In 2000 the levy for cigarettes only was changed to 30 laari per cigarette (100 laari = 1 rufiyaa) to reduce cigarette price differentials and eliminate trade in cheap cigarettes. The overall effect was positive for revenue and public health: imports dropped and import duty revenue rose by over 50%. Tobacco duty revenues have fallen as a share of all import revenues from around 4% to below 2%.

Policy recommendations

There should be an annual increase in tobacco prices. The World Health Organization recommends an annual 5% increase in the real price of tobacco products. Tax increases should apply to all tobacco products. The Maldives should consider introducing an ad valorem excise tax to sustain increase tobacco prices.

Tobacco control measures should be consolidated and a comprehensive tobacco control law formulated as a foundation for ratification of the Framework Convention on Tobacco Control. The National Tobacco Control Committee needs to be revamped to play a more active role in tobacco control. Surveillance and enforcement need to be enhanced. An assessment of smoking prevalence in the Maldives should be done every five years, as part of the existing regular household surveys.

The government should implement a smoking cessation programme.

Information, education and communication programmes need further innovation and strengthening.

The government should also improve routinely gathered data such as the cancer registry and lifestyle-related disease statistics so that the smoking-attributed burden of disease can be better understood. The government should also consider revising death certificates to include smoking status in order to enhance future research.

 

 

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Cigarette imports, an alarming statistic …

I wonder just how much tobacco is consumed in the Maldives!

One of the best indicators of this would be import figures. Lets for argument sake take just two brands and see the magnitude of the issue from a different angle. Take for example Marlboro and Camel import figures for 2010 (Customs).

In 2010 alone the following numbers of cigarette sticks were imported

Marlboro sticks: 26,485,000 corresponding to 1,324,250 packs.

Camel sticks: 205,350,000 corresponding to 10,267,500 packs.

Note that these are the import figures for only two brands. There are many other brands, but in less amounts imported.

Now who consumes this? When I quote the import figures, most people argue on the counter saying that its not for locals. The tourists consume them. Lets look at it more closely.

Ironically, the majority of tourists come from developed european countries where the consumption is much lower comparatively and keeps going down. Perhaps the increased Chinese and Russian market may have a higher consumption.

For the purposes of this argument, I take the following population.

Locals: 310,000

Expats: 85,000

Tourists: 700,000

That totals to 1,095,000

That would be a reasonable estimate of the total population of the country in a given year. Probably less.

Now if we correspond that to the import figures, about 24 sticks for Marlboro are imported per person (slightly more than 1 pack)

And for Camel, it comes to about 188 sticks per person (more than 9 packs)

On average this means over 10 packs are imported per person per year for these two brands alone to the country.

This means that the tobacco importers are earning huge profits at the expense of the health and well being of the people of this country. The motive of these companies would be perhaps to increase and sustain the addiction!!

What about the implications of this on the public expenditure on health. With the government implementing a universal health care financing scheme for the Maldivians, the big picture is that, tobacco will be the main menace to the sustenance of the costs governments will have to spend on healthcare. Wonder who thinks of this picture?

 

 

 

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You are trapped! Tobacco companies cheat you …

According to Article 11, 1(a), the WHO Framework Convention on Tobacco Control (FCTC),

tobacco product packaging and labelling do not promote a tobacco product by any means that are false, misleading, deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions, including any term, descriptor, trademark, figurative or any other sign that directly or indirectly creates the false impression that a particular tobacco product is less harmful than other tobacco products. These may include terms such as “low tar”, “light”, “ultra-light”, or “mild”;

Why would this be such an issue that needed attention in a global convention?

Smokers choose “low-tar,” “mild,” or “light” cigarettes because they think that light cigarettes may be less harmful to their health than “regular” or “hard” cigarettes. Smoke from light cigarettes feels smoother and lighter on the throat and chest – so lights must be healthier than regulars, right? WRONG!

The truth is that such misleading words do not reduce the health risk of smoking. These words are used simply to cheat you on the tactics used by the tobacco giants to kill you …

So you may ask. What about the lower tar and nicotine numbers on the light cigarette packs? Yes they are misleading too. The truth is

A very simple message ...

These numbers come from smoking machines that “smoke” every brand of cigarettes exactly the same way. it does not really tell how much tar and nicotine a particular smoker may get because people do not smoke cigarettes in the same way the machines do. In fact the design of the cigarette tricks the machine. How? Simple and you can test it yourself too …

Have look at the filter of these cigarettes! Some have hard filter paper with no holes (regular) others have softer paper with small holes or vents on the filter paper (so called mild ones).

Light cigarettes are designed with tiny pinholes on the filters. These “filter vents” dilute cigarette smoke with air when light cigarettes are “puffed” on by smoking machines, causing the machines to measure artificially low tar and nicotine levels because these vents are uncovered when used in the machine. They also make the paper wrapped around the tobacco of light cigarettes burn faster so that the smoking machines get in few puffs before the cigarettes burn down. The result is that the machine measures less tar and nicotine in the smoke of the cigarette.

A smoker though cannot avoid blocking these tiny vent holes with their fingers and lips, which basically turns the light cigarette to a regular one. Also people, unlike machines, crave nicotine, they inhale more deeply; take larger, more rapid, or more frequent puffs; or smoke a few extra cigarettes each day to get enough nicotine to satisfy their craving. This is called “compensating,” and it means that smokers end up inhaling more tar, nicotine, and other harmful chemicals than the machine-based numbers suggest.

Convinced? Lets read a bit more …

The National Cancer Institute in the US published a report on the cancer risks of “light” cigarettes that indicate that there is basically no difference at all and the irony is that the tobacco industry determined this fact in their own documents.

Tobacco industry documents show that companies were aware that smokers of light cigarettes compensated by taking bigger puffs. Industry documents also show that the companies were aware of the difference between machine-measured yields of tar and nicotine and what the smoker actually inhaled (reference)

If you are not convinced by now, you are trapped in addiction!

Don’t be trapped, free yourself from tobacco …

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Tobacco legislation in the Maldives – a brief history!

Here I present translations of the very first Laws on tobacco control in the Maldives. There were three Laws passed during the 40s and 50s. The first Bill was passed in 1942.

___________________________________________________________

Bill no: 1/61

Date: 12 May 1942

Bill on Bidi, Cigars, Cigarettes and other forms of tobacco

  1. Bidi, Cigars, Cigarettes and other forms of tobacco should not be imported into the Maldives at present
  2. Bidi, Cigars, Cigarettes and other forms of tobacco should not be smoked in public (on the streets)

The above Laws passed by the Citizen’s majlis on the 2nd day of Rabeeul Awwal 1361, is herewith ratified and we give permission to the Home Ministry to put this Law in effect.

Signed

Hassan Noordeen, Sultan of the Maldives

Mohamed Fareed Didi, Prime Minister of Maldives

___________________________________________________________

Gazetted Tobacco Control Law of 1942

Note that in addition to tobacco, the above Law restricted the imports of sports materials and products as well as jewelry and other ornaments

A second Law was passed 6 June 1948 as written below

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Bill no: 2/67

Tobacco Control Bill

  1. No student or any Maldivian below the age of seventeen years should smoke or consume tobacco in any form.
  2. Cigars, cigarettes, bidi or tobacco in any other form should not be smoked in the streets of Male’.
  3. Import of tobacco to the Maldives in a year will be permitted according to the following.
    1. Chewing tobacco – A third more than the average of the past three years (i.e. 1 1/3 of the average).
    2. Gudaaku tobacco – A third less than the average of the past three years (i.e. 2/3 of the average).
    3. Cigarettes, cigars, bidi – A quarter less than the average of the past three years (i.e. ¾ of the average).
    4. The price of tobacco should be controlled.
    5. Import license for tobacco will be given to people who imported food in the past three years, according to the average quantity of food they imported. But, while giving this permission, special attention will be paid to the quantity of rice imported.
    6. It is a Policy of the Government of the Maldives to protect the people of Maldives from tobacco use.

Tobacco Control Bill passed by the Citizen’s Majlis on the 21st day of Rajab 1367 is here with ratified and the Home Minister is hereby given permission to put this Bill to effect

28 Rajab 1367

Signed

Mohamed Fareed

Abdulla Fahumee Didi

___________________________________________________________

In the above Bill the date is given in Hijri calendar and corresponds to 6 June 1948.

It is interesting to note that in this Bill the import quotas are based on the previous imports for three years. However, in the first Bill, tobacco importation was completely banned. There is no evidence of alternative direction and hence this is not clear as to why the imports are used as a guide for quota.

Also interesting to note is that this Bill specifically states that it is the Policy of the Government to “protect” the people of Maldives form tobacco use. It is not clear what, and ironically the health impacts of tobacco were first determined in the 1960s. Perhaps this is to protect from the financial burden.

The last of the series of these Bills were passed on 23 September 1951.

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Bill no: 2/70

Law on prohibiting the import of tobacco and tobacco products in to the Maldives

  1. Due to the current situation in the Maldives, it is prohibited to import tobacco and tobacco products in to the Maldives.
  2. Such products stocked by businesspersons and such products, for which an order has been placed before today, will be bought by the “Qawmee Kunfuni” at control rate, if the placement of order can be proved by Customs, and sold at a price fixed by the Ministry of Trade.

The above Bill No. 2/70 passed by the Citizen’s Majlis on the 19th day of Zul Hijjaa 1370, is herewith ratified, and the Prime Minister is hereby given permission to put this Bill into effect.

___________________________________________________________

Despite the destruction tobacco causes, the lead taken by our forefathers to control tobacco by legal processes has today become the gold standard for the whole world. The Framework Convention on Tobacco Control is the only Convention passed to protect the public health of the Global Population.

It has taken 59 years before a new Law to be passed by the Majlis and ratified by the President. The current Law though much longer is much weaker that any of the above Laws. Those past Laws are short, sweet and to the point.

The current Law passed by the Majlis is a much-watered down version of the initial drafts. The assassination of the first President, mythically related to his strong tobacco control measures, may still be influencing the minds of current lawmakers and politicians.

To protect the majority of the smoking Maldivians from death before they reach their potential life expectancy, strong laws are needed to reduce the supply and demand for tobacco. We are way behind!

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Tobacco advertisement is against the Law … or is it?

The Maldivian Tobacco Control Law 15/2010 (Ratified on 18 August 2010) Article 16 states that:

“The name of any tobacco product, or a pictogram, picture, slogan, or anything or part of it that may denote the product should not be displayed to the public, for the purpose of advertising. Names of tobacco products, pictograms, pictures, slogans, or anything denoting a tobacco product or part of it must not be printed on anything that does not relate to tobacco, including buildings and such places, and displayed to the public for sale or for the purpose of advertising”.

When we look at the history, Maldives first took steps to control tobacco advertisement in 1994 when all forms of tobacco advertising were banned in the country through a regulation brought out on 31 May 1994 and came into effect on 1 January 1995, which of course, although not ideal, served more or less like a Law back then.

So did the tobacco distributors and importers really adhere to this regulation? One may see that since direct advertising was banned, there were limitations and hence the impact of advertising may not be that big in Maldives. I see it otherwise. In the many years I have been advocating for tobacco control, I have come across a number of instances where the regulations were breached.

American Legend. Sound any bells? Well, American Legend is a low quality cigarette that was imported to Maldives in large scale by one of the three main tobacco importers. The way they approached advertising was different. The idea, in my opinion was to make it a household name. Being a cheaper brand, the main target probably was islands and hence mainly this brand was sold wholesale in the shop around the northern side harbor area of Male. Cheap washing machines and water pumps were made and imported and promoted through the radio. Why radio? Most people in the islands listened to it that time. So, people had the analogy, I have an American Legend pump, washing machine and also I smoke American Legend. Appealing perhaps!!! A tactic, multinationals have used elsewhere in the world.

Marlboro van 2004

Around the same time, came the Marlboro era too! Umbrellas, lighters, t-shirts and many more paraphernalia were distributed. The more significant though was the Marlboro Van! Did you see it? Wit a lot of struggle and with a lot of meetings and correspondence, eventually the party gave up and repainted the van.

As you can see the effect created here is indirect but has a direct impact on what is actually being advertised. The pack design and the fonts! Amazing the extent that tobacco companies go to mislead the public.

In the modern day, tobacco advertising would be even more cunning. A form of tobacco advertising has crept in to our daily lives with out us even knowing that it is happening! We may not have a clue whether it is a tobacco advert, but yes, it is making and impact and it is deliberate.

First there were the ashtrays with a certain half circle covered with a head and a hump. Then came the small bill folders in brown leather. Yes and there was a certain word that came along with it …

Discover!

This, the advertisers may see as a loophole in the law and get away with it. But no, it is well covered for exactly the same reason.

Open - closed boards where the O is always the hump

Point of sale advertising at the corner shop next to my house

The discover ashtrays, bill folders and even the open close boards at many shops all started to be common. Also when you walk into many shops, cigarettes are displayed in a discover box! (Point of sale advertising). So the discover logo became something that people see on a daily basis everywhere. Eventually, the big slogans of discover arrived. Just like before, vans have been painted and send to some atolls and the production is continuing.

So any clues where this is leading? Mass scale indirect tobacco advertising in here! But in this case I wouldn’t call it indirect either, because when you see the real picture, it is really direct. The discover display begins at the root of tobacco distribution in the country.

Discover what? “Discover Death”

 

Discover vans about to be dispatched

 

 

 

 

 

 

 

My research lead me to the root of the issue! Familiar?

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An Achievement …

logo_isoIt’s been over an year since we started to work on getting the Hospital Laboratory internationally accredited. It is important that as many of our services are certified to internationally accepted standards in order to gain and maintain confidence of the public.

One of the major endeavours for me in managing ADK Hospital is to get such standards in place and get international recognition. So I decided that we should start slow and improve our services to achieve such recognition.

Last year we established a new laboratory and acquired some more machinery and expert staff. With this development I thought that it would only be fitting that we get this lab accredited. On proposing this, my staff was very enthusiastic and they gave me a commitment to make this happen.

Laboratories get two types of accreditation from the International Standards Organization. The ISO 9001:2000 is the Quality Management System Standard and the ISO 15189 is specific to medical laboratories and is a unique standard that takes into consideration the specific requirements of the medical environment and the importance of the medical laboratory to patient care. We decided to initially go to the Quality Management Standard and later go for the more detailed one. In reality, the initial Management Accreditation sets the standard for the other one and hence it will be much easier to get it with this in hand.

In fact, it was a lot of hard work to get all the major core conformities in place. We had to get all protocols, goals, targets, outputs and much more first on paper to ISO requirements. But that is not enough. We had to implement the standards and get the staff trained to apply the standards. This took us a lot of effort and a lot of support from the laboratory staff specially. I do acknowledge and congratulate them for their achievement. We achieved this working as team together. After all this work, on July 20, 2009, the Laboratory was audited for conformities of ISO 9001:2000 with the certification scope of Diagnostic Laboratory Testing and Reporting.

It was a bit of a tense day since the laboratory staff and the management were eagerly and anxiously looking forward to the outcome of the audit. When the final verdict came it was a time of relief and a time for celebration. Yes! Laboratory has successfully completed the requirements and passed the audit for ISO certification. It is indeed a milestone in the endeavour to provide reliable and quality health services to the Maldivian public. The Laboratory is now accredited for the period 30 July 2009 to 29th July 2012. By the end of this period the lab will have to undergo another audit for renewal of its accredited standard.

With this certification, the Laboratory will now operated all its procedures strictly adhering to ISO approved standard operating procedures. These procedures will be continuously reviewed and assessed so that the standards are maintained and the conformities are met in future audit processes.

The partners of ADK Hospital in the certification process were Assistance Maldives Pvt. Ltd, Maldives, affiliated with Nexus Business Solutions Pvt. Ltd, of Sri Lanka. Auditors of the SGS GROUP, Switzerland, conducted the certification audit. SGS is the world’s leading Inspection, Verification, Testing and Certification Company established in 1878.

Achievement of this certification is only a beginning for improvement and maintenance of quality in the laboratory. We will start to further enhance the processes and also put efforts towards certification for the ISO 15189 standards as well. This achievement also paves avenue for the motivation and initiation of certification processes for other departments of the Hospital as well.

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