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Mauritius counts health successes
World Report
Mauritius counts health successes Mauritius has much to celebrate as it marks its 40th year of independence. Life expectancy has increased and infant mortality has fallen since the late 1960s. But drug addiction and chronic disease continue to challenge the island’s health system. Sharmila Devi reports from Port Louis.
www.thelancet.com Vol 371 May 10, 2008
has risen to around US$7000 this year from $200 at independence. Whereas unemployment was about 40% in the 1960s and 1970s and young Mauritians would seek work abroad—often to train as nurses in Britain—most now remain at home. Work is much more easily found and
“Mauritius’ geographical location makes it vulnerable to illicit drug syndicates...” unemployment is about 8·8% since the government has embarked on diversification, firstly tourism and textiles, then financial services such as offshore banking and outsourcing. Health care is considered a basic human right and treated as a spending priority in the national budget. But the system is challenged by constantly evolving threats—from a growing drug addiction problem, to HIV/AIDS and avian influenza, as well as a shortage of certain experts and specialists. The health budget has increased by over 12 000% over the last 39 years, to
4·4 billion rupees (86 million pounds) in 2007–08 from 35·9 million rupees in 1968. “There is a free health system, free service from primary to tertiary care”, says Satya Veyash Faugoo, Mauritian health minister, in an interview at his office in the capital, Port Louis. “I think we have a gone a long way in 40 years and today I must say that we are proud of our system and also proud we are able to sustain it despite a lot of economic problems.” Although there is a private health sector, compulsory private health insurance is not on the agenda and universal care for everybody remains the goal. Faugoo said government efforts had concentrated on improving infrastructure and basic primary care, taking health services to the people so that nobody had to travel more than a few kilometres to access a clinic or doctor. In 1978, Mauritius endorsed the Alma-Ata Declaration on primary health care, considered a major milestone in 20th century public-
Oxford Cartographers
When Mauritius emerged independent of British rule 40 years ago, the island in the Indian Ocean appeared to have few prospects, dependent as it was on sugar cane and workers’ remittances. Two Nobel-prize winners gave the country little chance of pulling out of poverty. James Meade, a Cambridge economics don, said in the 1960s that it would be a “great achievement” if Mauritius ever found employment for its increased population. Author V S Naipaul, meanwhile, labelled Mauritius the “overcrowded barracoon”, saying the island’s “problems defy solution”. But Mauritius has defied the naysayers, regularly topping regional African groupings in terms of growth, progress, and competitiveness, as well as human factors such as education, media freedom, and health. Neerunjun Gopee, the island’s chief medical officer, commented on Naipaul’s book in one of his regular columns in the Mauritius Times. “[Naipaul] labels Mauritius the ‘island of disaster’. Is getting rid of malaria a disaster? For Naipaul it is—because as a result the population soared to make us overpopulated at more than a thousand inhabitants per square mile.” But Mauritians see things differently. They are understandably proud of their small country’s achievements. Not only is malaria a disease of the past, but so are schistosomiasis, measles, whooping cough, diphtheria, smallpox, and polio. However, the country’s people are aware of the many challenges that remain as they celebrate the 40th anniversary of independence this year. While the foreign tourists who visit Mauritius see an idyllic, sunsoaked paradise, poverty still exists here although income per person
1567
World Report
Reuters
The printed journal includes an image merely for illustration An HIV-prevention worker displays clean syringes for injecting drug users
health care. Only 43 dispensaries provided primary health care in 1968. Now hundreds of centres and clinics cater for 3·5 million attendances each year. “We face a very challenging situation, such as a rise in cancer or trauma, and the present health system that was designed in the 1970s is being transformed to cope”, says Gopee, the chief medical officer. “Along with the curative approach, the accent is on prevention and promoting a healthy lifestyle.” Life expectancy has risen to 68·7 years for men and 75·6 years for women from an average of 59 years in 1968. Infant mortality has fallen to 14 per thousand livebirths in 2006 from 70 per thousand livebirths in 1968. The mostly Creole and Frenchspeaking population of just over 1 million is made up of Mauritians descended from India, Africa, China, and Europe. The main public-health challenge is non-communicable disease. “Nearly 20% of the population above 30 years is diabetic and nearly another 20% is pre-diabetic, who can at any time become diabetic”, says Faugoo. “The curative services are there but we want to lay more emphasis on prevention. We have a national plan of action called the National Service Framework for Diabetes because I believe it is a problem not only of the Ministry of Health but the whole government.” 1568
As many western countries grapple with the problems of obesity and diabetes, Mauritius has banned the sale of aerated soft drinks in educational institutions since the start of this year. Screening for diabetes has been underway since 2006 and a national nutrition plan will be finalised soon. A major health challenge is a shortage of certain human resources, especially in the fields of vascular surgery, renal transplantation, plastic surgery, certain aspects of spinal surgery, paediatric, and general surgery. Around 10 patients a week are sent abroad for treatment, often to India or Geneva, including cardiology and neurology cases, and the government pays partial or full costs. Foreign teams also come to Mauritius from the University of Bordeaux, University Hospital of Geneva, and the New Jersey School of Medicine and Dentistry in the USA. Surgeons from Mumbai, Chennai, Poland, and Turkey are also regular visitors. Given the pace of development in Mauritius, non-governmental organisations operate few assistance programmes in the country but rising HIV/AIDS rates have led to more concern. 3137 cases of HIV/AIDS were reported between 1987 and the end of August last year, with 92% of new infections in injecting drug users. Antiretroviral treatment is freely available. Although the rate is still low in comparison to Africa, public-health officials worry about an HIV epidemic if drug addicts continue to share contaminated needles. The island also faces increased abuse of the drug buprenorphine, which is smuggled into and not prescribed in the island. Measures such as a needleexchange programme, methadone substitution therapy, and greater distribution of condoms have met with some resistance in the culturally conservative island, but the need for them has been recognised given the presence of more than 20 000 drug addicts in the small country.
Mauritius’ geographical location makes it vulnerable to illicit drug syndicates, which have expanded their transit network to include the island as well as Tanzania, Uganda, and Ethiopia. The drugs are then distributed on to Kenya, southern and western Africa, and then Europe and North America, says the United Nations Office on Drugs and Crime. “Mauritius is an open society and access is very easy”, says Faugoo. Another threat to public health came in 2005 with the first cases of chikungunya virus, a mosquitotransmitted disease similar to dengue fever that was imported to the island. It reached its peak in 2006 with 14 000 cases and none have been reported since, but the country is on the alert to prevent any further outbreaks. Despite these challenges, the government has bold plans for the future. It wants to make Mauritius a medical hub. Some medical tourist niches such as in-vitro fertilisation and hair replacement are available but the government is looking for expansion, such as becoming a host for clinical trials and pharmaceutical companies. A $70 million, 200-bed hospital will open next year and offer treatments from cardiology and hip replacements to cosmetic surgery. India’s Apollo Hospitals and the Mauritius-based British American Investment Company are building the centre and will employ about 500 staff. “We have beautiful hotels, beautiful beaches, first-class services. Why not make Mauritius a hub, a place where people can combine a holiday and medical treatment”, says Faugoo. “Today, Mauritius can export fully fledged doctors and this hasn’t happened in any of the African countries. There are 250 doctors doing pre-registration training in our system and there are no vacancies for doctors. This is a big step forward.”
Sharmila Devi www.thelancet.com Vol 371 May 10, 2008
Mauritius counts health successes Mauritius has much to celebrate as it marks its 40th year of independence. Life expectancy has increased and infant mortality has fallen since the late 1960s. But drug addiction and chronic disease continue to challenge the island’s health system. Sharmila Devi reports from Port Louis.
www.thelancet.com Vol 371 May 10, 2008
has risen to around US$7000 this year from $200 at independence. Whereas unemployment was about 40% in the 1960s and 1970s and young Mauritians would seek work abroad—often to train as nurses in Britain—most now remain at home. Work is much more easily found and
“Mauritius’ geographical location makes it vulnerable to illicit drug syndicates...” unemployment is about 8·8% since the government has embarked on diversification, firstly tourism and textiles, then financial services such as offshore banking and outsourcing. Health care is considered a basic human right and treated as a spending priority in the national budget. But the system is challenged by constantly evolving threats—from a growing drug addiction problem, to HIV/AIDS and avian influenza, as well as a shortage of certain experts and specialists. The health budget has increased by over 12 000% over the last 39 years, to
4·4 billion rupees (86 million pounds) in 2007–08 from 35·9 million rupees in 1968. “There is a free health system, free service from primary to tertiary care”, says Satya Veyash Faugoo, Mauritian health minister, in an interview at his office in the capital, Port Louis. “I think we have a gone a long way in 40 years and today I must say that we are proud of our system and also proud we are able to sustain it despite a lot of economic problems.” Although there is a private health sector, compulsory private health insurance is not on the agenda and universal care for everybody remains the goal. Faugoo said government efforts had concentrated on improving infrastructure and basic primary care, taking health services to the people so that nobody had to travel more than a few kilometres to access a clinic or doctor. In 1978, Mauritius endorsed the Alma-Ata Declaration on primary health care, considered a major milestone in 20th century public-
Oxford Cartographers
When Mauritius emerged independent of British rule 40 years ago, the island in the Indian Ocean appeared to have few prospects, dependent as it was on sugar cane and workers’ remittances. Two Nobel-prize winners gave the country little chance of pulling out of poverty. James Meade, a Cambridge economics don, said in the 1960s that it would be a “great achievement” if Mauritius ever found employment for its increased population. Author V S Naipaul, meanwhile, labelled Mauritius the “overcrowded barracoon”, saying the island’s “problems defy solution”. But Mauritius has defied the naysayers, regularly topping regional African groupings in terms of growth, progress, and competitiveness, as well as human factors such as education, media freedom, and health. Neerunjun Gopee, the island’s chief medical officer, commented on Naipaul’s book in one of his regular columns in the Mauritius Times. “[Naipaul] labels Mauritius the ‘island of disaster’. Is getting rid of malaria a disaster? For Naipaul it is—because as a result the population soared to make us overpopulated at more than a thousand inhabitants per square mile.” But Mauritians see things differently. They are understandably proud of their small country’s achievements. Not only is malaria a disease of the past, but so are schistosomiasis, measles, whooping cough, diphtheria, smallpox, and polio. However, the country’s people are aware of the many challenges that remain as they celebrate the 40th anniversary of independence this year. While the foreign tourists who visit Mauritius see an idyllic, sunsoaked paradise, poverty still exists here although income per person
1567
World Report
Reuters
The printed journal includes an image merely for illustration An HIV-prevention worker displays clean syringes for injecting drug users
health care. Only 43 dispensaries provided primary health care in 1968. Now hundreds of centres and clinics cater for 3·5 million attendances each year. “We face a very challenging situation, such as a rise in cancer or trauma, and the present health system that was designed in the 1970s is being transformed to cope”, says Gopee, the chief medical officer. “Along with the curative approach, the accent is on prevention and promoting a healthy lifestyle.” Life expectancy has risen to 68·7 years for men and 75·6 years for women from an average of 59 years in 1968. Infant mortality has fallen to 14 per thousand livebirths in 2006 from 70 per thousand livebirths in 1968. The mostly Creole and Frenchspeaking population of just over 1 million is made up of Mauritians descended from India, Africa, China, and Europe. The main public-health challenge is non-communicable disease. “Nearly 20% of the population above 30 years is diabetic and nearly another 20% is pre-diabetic, who can at any time become diabetic”, says Faugoo. “The curative services are there but we want to lay more emphasis on prevention. We have a national plan of action called the National Service Framework for Diabetes because I believe it is a problem not only of the Ministry of Health but the whole government.” 1568
As many western countries grapple with the problems of obesity and diabetes, Mauritius has banned the sale of aerated soft drinks in educational institutions since the start of this year. Screening for diabetes has been underway since 2006 and a national nutrition plan will be finalised soon. A major health challenge is a shortage of certain human resources, especially in the fields of vascular surgery, renal transplantation, plastic surgery, certain aspects of spinal surgery, paediatric, and general surgery. Around 10 patients a week are sent abroad for treatment, often to India or Geneva, including cardiology and neurology cases, and the government pays partial or full costs. Foreign teams also come to Mauritius from the University of Bordeaux, University Hospital of Geneva, and the New Jersey School of Medicine and Dentistry in the USA. Surgeons from Mumbai, Chennai, Poland, and Turkey are also regular visitors. Given the pace of development in Mauritius, non-governmental organisations operate few assistance programmes in the country but rising HIV/AIDS rates have led to more concern. 3137 cases of HIV/AIDS were reported between 1987 and the end of August last year, with 92% of new infections in injecting drug users. Antiretroviral treatment is freely available. Although the rate is still low in comparison to Africa, public-health officials worry about an HIV epidemic if drug addicts continue to share contaminated needles. The island also faces increased abuse of the drug buprenorphine, which is smuggled into and not prescribed in the island. Measures such as a needleexchange programme, methadone substitution therapy, and greater distribution of condoms have met with some resistance in the culturally conservative island, but the need for them has been recognised given the presence of more than 20 000 drug addicts in the small country.
Mauritius’ geographical location makes it vulnerable to illicit drug syndicates, which have expanded their transit network to include the island as well as Tanzania, Uganda, and Ethiopia. The drugs are then distributed on to Kenya, southern and western Africa, and then Europe and North America, says the United Nations Office on Drugs and Crime. “Mauritius is an open society and access is very easy”, says Faugoo. Another threat to public health came in 2005 with the first cases of chikungunya virus, a mosquitotransmitted disease similar to dengue fever that was imported to the island. It reached its peak in 2006 with 14 000 cases and none have been reported since, but the country is on the alert to prevent any further outbreaks. Despite these challenges, the government has bold plans for the future. It wants to make Mauritius a medical hub. Some medical tourist niches such as in-vitro fertilisation and hair replacement are available but the government is looking for expansion, such as becoming a host for clinical trials and pharmaceutical companies. A $70 million, 200-bed hospital will open next year and offer treatments from cardiology and hip replacements to cosmetic surgery. India’s Apollo Hospitals and the Mauritius-based British American Investment Company are building the centre and will employ about 500 staff. “We have beautiful hotels, beautiful beaches, first-class services. Why not make Mauritius a hub, a place where people can combine a holiday and medical treatment”, says Faugoo. “Today, Mauritius can export fully fledged doctors and this hasn’t happened in any of the African countries. There are 250 doctors doing pre-registration training in our system and there are no vacancies for doctors. This is a big step forward.”
Sharmila Devi www.thelancet.com Vol 371 May 10, 2008