Healthy Gaaf Alif Atoll

Introduction – General information on the Atoll

Gaaf Alilf Atoll, the fourth-most Southern atoll in Maldives comprises about 10,000 population aggregated over 11 islands. It is about 200 miles from Male, the capital of Maldives. The administration of the atoll is governed through the coordinating action of an Atoll Chief who is appointed by the Central Ministry of Atolls Administration. There is no local government system as such in the way it exists in other regional countries where devolution of decision-making authority is vested in an elected local authority. The atoll chief is assisted in his functions by an Atoll Development Committee and Island Development Committees, whose roles are more consultative and advisory than actual rule making and regulating vis-à-vis staffing and financing -- a centralized function provided by the Ministry of Atolls Administration located in Male, the Capital of Maldives. Addressing the well-being of each island is the responsibility of the island office and that of the Atoll is vested in the duty of the Atoll Chief based on instructions from Male. The total atoll development budget for Gaaf Alif for 2002 is MRF 5.7 million. 

The capital of Gaaf Alif is Villingili island with a population of 2843 in 2002, (age-wise breakdown to be requested) and about 360 households. Perhaps about 80 percent of the workforce engages in fishing, and the rest in small-scale agriculture and general trade. This atoll is considered a very strong fishing atoll as good fishing grounds are within easy access to the island of this atoll. This is why the government has set up a 1500-ton capacity freezing facility in an island of this atoll so that the fish catch can be kept good for the collector vessels to take away as export to regional countries. The average annual income of a Villingili island family is estimated at about US $ 3000 (MRF 3000 per month per household – this was estimated from general discussions with island development committee members).  About 50-60 percent of the island appears to be under green cover. 

As for agriculture, the island is fertile for growing bananas, and allocasia yam both of which can grown in conditions of high water table. Willingili’s woes relate very much to this high water table that renders flooding and muddying of the surface soil layers very easy. There are two mangrove type of marshes at both ends of the island which according to hydrological experts from the Ministry of Environment act as a drainage system for the island in case of heavy rainfall – without which this excess accumulations from high precipitation will be washed into the sea, thus affecting the recharge potential of the aquifer in this coral island.  The high water table also contributes to easy contamination of the ground water from leachate of waste dumps and septic tanks. Villingili has two primary schools and one secondary school. All children go to school. Illiteracy is less than one percent. 


Health scenario.

Diarrheal disease episodes is still prevalent to the level that it affects nutritional and growth of children to their full potential. ARI is also another disease concern that is of high priority in the child-care as evidenced by the frequent visits to the health centre. Access to safe water supply, due to the contamination and thus the un-usability of the ground water, is a difficult one. Like all of Maldives, the populations have got acclimated to using rain-water for drinking and cooking. The issue is access in the needed quantities rather than availability. Maldives has an average rainfall of about 200 centimetres per annum While many are already using High Density Polyester (HDP) tanks for such catchments, the volumes are still inadequate to save for the longer periods that go without rainfall.  

Infant mortality rate for the atoll is 14 per1000, and Villingili has not had an infant death so far this year. Neither has there been a maternal death this year. Crude death rate is 2.9 for the Atoll and 3.9 for Villingili. Low Birth weight is also insignificant according to the health worker (this needs to be verified from the records at the health centre). Growth monitoring of infants and up to 3 year of age is done very regularly. Again the health worker says that very few are below minus 2 standard deviations from the mean (needs to verify from the growth monitoring charts in Villingili at least for now). Birth rate is 12.5 for the atoll and 8.8 for Villingili (there were 25 births and 11 deaths in absolute numbers in the Atoll this year). The atoll has one Atoll Health Centre and 11 Family Health Centres (one for each island)  with an aggregate of 22 health workers and one medical doctor. 

Environmentally, the settings are very clean and tidy. The coral sand streets are swept every morning, and household compounds are also kept as neatly. This is still the prevailing cultural practice over the years without a necessary urging by the island authorities. School compounds are neat and tidy and so were the class-rooms and the children in them. However, the school toilet had something to be desired. The sinks were broken and some toilets not well flushed and cleaned. Also there was no soap available for hand-washing.

The island garbage and trash is dumped in a nearby sea fill and some dumped at open spaces at the end of the island and burned periodically. They are aware of the low water table and the effect the leachate may have on the quality of the aquifer. The mangrove marshes also pose a particularly intractable problem. While the natural ecosystem needs to be maintained by preserving the biodiversity of these wetland water-bodies, there is also the mosquito problems generated by it. Villingili is an island with a heavy mosquito problem that needs immediate attention. 

Access to drinking water is 100 percent based on the fact that every one is able to reach is easily. However, there is issue of inadequacy particularly for dry periods. About 75 percent of the households have at least one water sealed latrine. 

No ambient air pollution issues as there is no motor vehicle traffic to be concerned about. However, indoor air pollution is mentioned as a concern with respect to kitchens that use wood fire for cooking. Many households in Villingili island use kerosene or compressed natural gas for cooking. 

With respect to disability, Villingili has 46 cases for a population of 2800 (8 deaf, 4 blind, 1 lame, and 33 in the others category – need some disaggregation here for these 33!!).   There appears also not been any incidence of suicide or household violence. Alcohol is not consumed as it is a forbidden item in the practice of Islam. Tobacco consumption is also decreasing as the cigarettes price has been raised. Non-smoking is practiced in the school arena and government buildings. 


Priority health issues as identified by the Healthy Atoll Planning workshop

Personal hygiene:  This is a composite issue that people see as contributing to may health issues such as ARI in children, diarrheal diseases, skin diseases etc. The causes mentioned are the lack of awareness on how to take care of children for better protection from getting colds and coughs, lack of hand-washing, and general body cleanliness. Some environmental hygiene especially at the household level was considered here too. 

Access to safe water:  The access to rainwater is prevalent but the quantities needed have to be stored by the community and the households. Only can this reflect truly on the availability of safe water for tiding over the dry periods too. 

Nutritional concerns: The community concern here is the lack of adequate food and nutritious foods. The prevalent issue was observed as low caloric intake and also low use offruits and vegetables in the diet. The causes, related to the cost of food items, lack of availability of fruits and vegetables in the island, and also the lack of awareness of the goodness these can give for growth of children and opportunities to do well in studies and in later employment. Nutritional disorders (clinical aspects would need to be looked at subsequently).

Solid waste disposal: In a coral island with high water table the issue of leachate and also in islands with limited space, this is an issue particularly with respect to throw away batteries,  non-biodegradable materials and clinical wastes from the health centre

Flies nuisance:  While this was seen as more of a nuisance issue, the health implications are also evident. The fly breeding occurs most primarily because of the inadequate disposal of fish waste (fish offals etc) on the beach. This is often done by fisherman when they bring back unsold fish to the storage facility island nearby. The fish that is brought is cleaned on the beach and the offals left on the at the shoreline from where they are beached further by the waves and left exposed to fly breeding. The swarms that rise from these are found everywhere and is considered an utter nuisance by the community but strangely, nothing has been done about it. 

Mosquito nuisance: The source of mosquitoes in the Villingili island setting is the mangrove wetland body. The wind then carries these swarms into the inhabited areas of the island. This source and others from the wooded areas and garbage dumps that hold anything that can harbour a pooling of water for breedingmay be added to the sources to be eliminated.

ARI:  This aggregates the coughs and colds of infants and adults that move through the community periodically. For mothers, this is particularly of concern because infants and children lose appetite, lose time from school, and take away precious income for medicines. 

Mother’s health:  This is mostly with respect to safe motherhood services (quality) that is not available to mothers in Villingili. Late stage pregnancy concerns such as eclampsia and slow referrals were pointed out here. Also lack of quality antenatal care and family planning practice advice. 

Tobacco use:  There has been a decline in tobacco use, but was flagged as one to be in on with national policy. And also express need to deter the teenager from taking up the habit. There was the effort to promote no smoking by all teachers. 

Lack of access to health care: There was a need for quality health workers and nurses and higher-level expertise. There was little concern given to the recurrent and community related expenses the community would have to assume ownership/responsible for. 


Managerial process

The group undertook to carryout the work of implementation as three task forces for given issues in the Plan of Action. These three groups would be coordinated by a higher level Consultative/Advisory Committee that is also to have two members from each of the working groups that discussed issues at the workshop. As these discussion groups at the workshop constituted senior and responsible community leaders in each of the major group areas of the community, the Consultative groups would thus constitute a subset of senior community leaders – well accepted by the others to be advisors. In this particular case this is a very welcome situation in that, hopefully, the enthusiasm they themselves generated in the planning process would flow into the work they would do during implementation.  Hopefully ensuring a great measure of ownership.  

The Vision they expressed for Villingili was:

“That Villingili be an island that is completely free from the nuisance of mosquitoes, flies, other environmental concerns, and be a community that is working together in cooperative harmony in the pursuit of island development actions”. 



To establish a well functioning healthy atoll process in the Gaaf Alif Atoll, starting the action from Villingili island. (in Villingil by 2003 end, and begin replicating by 2005 to other islands of the Atoll. 

Plan of Action:

This action plan was developed by the participants to the Healthy Atoll Planning workshop held in Gaaf Alif Villingilli island on 17 October, 2002 with participation of major community groups of the Villingili island, the representatives of the atoll and island development committees and the assistant Atoll Chief. Also participated in the workshop by representatives of the Ministries of Atolls Administration, Planning, Environment and Health. WHO also participated as technical facilitator. All actions were to be completed by the end of 2003 when a review mission will visit Villingili island for assessment of progress and replanning.