Maldives Health Financing Progress Matrix Assessment Report
Overview
This report summarizes the findings of the Health Financing Progress Matrix (HFPM) assessment for the Maldives, using WHO’s standardized qualitative assessment of a country’s health financing policies. Conducted by the Ministry of Health, Republic of Maldives, in collaboration with the World Health Organization, the assessment examines key health financing functions (revenue raising, fund pooling, strategic purchasing, benefit package design, and financial protection) and benchmarks them against desirable attributes of health financing systems in support of universal health coverage (UHC). The assessment complements Maldives’ quantitative monitoring through National Health Accounts (NHA), SDG monitoring, and the UHC Service Coverage Index.
The report highlights notable progress in Maldives’ journey toward UHC, particularly through the establishment and expansion of the Aasandha national health insurance scheme which covers services from both public and private providers, significantly increasing government health expenditure and reducing out-of-pocket spending. Strengths include high revenue-raising performance, strong public health functions, and good progress in pooling and benefits design. However, the system has reached a turning point, with persistent challenges arising from fragmentation in fund pooling, limited strategic purchasing, over-reliance on fee-for-service payments, high spending on curative care, and insufficient integration of funding flows.
Priorities for attention include strengthening health financing policy development and coordination under the joint stewardship of the Ministry of Health and Ministry of Finance and Planning, improving efficiency through better resource allocation and spending policies, and implementing strategic purchasing for the Aasandha scheme — particularly clearer governance and accountability mechanisms, more appropriate provider payment systems (shifting from fee-for-service toward bundled or capitation payments), and stronger cost-control measures. The report recommends a set of measures to take forward realistic and gradual reforms.
The Health Financing Progress Matrix assessment provides guidance to policy makers, building on international experience and evidence, while reflecting the unique features and context of the Maldivian health system including its small, geographically dispersed population, heavy reliance on tourism revenue, and the presence of a large expatriate population.
