Aasandha to Maldivians abroad as medicine shortage at home persists: Does it make sense?

The Maldives is currently facing a shortage of medicines, with many essential drugs unavailable. Citizens also face serious challenges in accessing doctors. The widespread public complaints about healthcare quality reflect real, structural problems, and even basic treatments are often difficult to obtain. Yet, instead of addressing these issues, the government has taken steps that may place additional strain on the healthcare system.

On the last day of the year, the government announced that Maldivians living in the Philippines would now be able to access healthcare services through Aasandha. Many Maldivians live in the Philippines for pilot training or medical studies, with around 700 residing there. While larger Maldivian communities exist in other countries, it is unclear why the Philippines was added to the program.

Raajjeygai beyheh neiy, beyrugai dhiriulhey meehunnah aasandha: Dhekolhu jeheytha?
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The Aasandha program for Maldivians abroad was first introduced under former President Ibrahim Mohamed Solih through a scheme called “Meranaa,” which allowed citizens in Sri Lanka, India, and Malaysia to receive treatment under Aasandha. Each participant under the Meranaa scheme is allocated total coverage of 150,000 rufiyaa per annum. For outpatient services not requiring hospitalisation, the annual limit is 10,000 rufiyaa. For inpatient services, including outpatient care, total annual coverage remains 150,000 rufiyaa. In the Philippines, 65 percent of medical treatment costs are proposed to be covered.

A key problem with the original program was that the state covered expenses for all participants, regardless of wealth. Instead of reforming this system, the current government has now expanded it to include the Philippines, increasing the burden on an already overstretched Aasandha system.

Most Maldivians living abroad are relatively well-off, residing in developed countries, paying taxes, and able to afford private healthcare. Universities abroad also require proof of medical insurance prior to admission. Given these circumstances, questions arise as to whether Aasandha should be provided universally to all Maldivians living overseas.

Seasoned professionals in the healthcare sector have indicated that this policy is likely to impose additional financial pressure on the state. They contend that the provision of Aasandha services to all Maldivians living abroad, without distinction, is not a suitable approach.

However, experts point out that in countries such as India and Sri Lanka, some Maldivians relocate specifically to access treatments unavailable in the Maldives. Many of these individuals are not wealthy. In such instances, it is reasonable for the state to cover medical expenses. Nevertheless, they stress that services should not be extended universally.

“If Aasandha is demanded in other countries where Maldivians live, such as Bangladesh or elsewhere, this already overburdened system will become even more strained if the policy continues in this manner,” one expert said.

Officials who have worked closely on Aasandha for many years also echoed this concern, stating that while the policy itself is not objectionable, its expansion without limits will further burden the state.

They also highlighted inequities within the current Meranaa scheme.

“Maldivians living in India and Sri Lanka can receive treatment on a cashless basis, meaning they do not pay out of pocket. However, in countries like Malaysia and the Philippines, patients must first pay for treatment and then seek reimbursement. This creates inequality within the same scheme,” said a long-serving official.

The official added that introducing the scheme to everyone without any criteria is a serious policy failure. Instead, the government should assess a person’s financial situation and the reason they are living abroad, and provide assistance only to those who genuinely qualify.

“It is wrong to provide it indiscriminately. Treatment in countries like Malaysia is very expensive. The state should only bear these costs for people who cannot afford them,” the official said.

“They keep expanding it, but how will this be sustained? This is not a viable approach.”

Aasandha’s budget is already under pressure. Although 1.8 billion rufiyaa was allocated this year, spending had reached 2.1 billion rufiyaa by mid-December. This recurring pattern places severe pressure on an already debt-laden nation. Experts stress that Aasandha cannot continue as an unlimited system. Reforms, such as an insurance-based model with co-payments and clear limits on services, are essential.

Efforts to obtain comment from Aasandha for this report were unsuccessful.

International financial institutions have long advised the Maldives on implementing reforms to ensure the program’s financial sustainability. Despite discussions by the government regarding reform, meaningful action has not been undertaken. Instead, recent policy decisions risk exacerbating the challenges facing the system.

Investing the funds used for overseas treatment in domestic healthcare would yield greater long-term benefits. Patients could access care locally, families would face less hardship, and overall state expenditure would decrease.

At a time when medicines are scarce and adequate local care is not guaranteed, the government’s decision to expand Aasandha abroad without reform is controversial. State support should focus on those who genuinely cannot afford treatment, rather than being provided universally to all Maldivians living overseas.