Audit urges expansion of local treatment to curb overseas referrals

The Auditor General’s Office has recommended that systems be strengthened to treat patients within the Maldives, as the number of people referred abroad for medical treatment continues to increase each year.

The recommendation was made in a performance audit report on the Aasandha scheme, released on Tuesday.

The report noted that while the number of patients sent overseas for treatment has risen steadily, measures to reduce reliance on foreign treatment facilities within the Maldives have not kept pace.

According to the audit, MVR 1.64 billion was spent on overseas treatment under Aasandha between 2019 and 2023. This represents an average annual expenditure of MVR 328 million. The majority of patients were referred to Amrita Hospital in India.

The audit found that referrals abroad for certain specialties have declined following the establishment of domestic services. For example, referrals for cardiac treatment decreased after the opening of the National Cardiac Centre at Indira Gandhi Memorial Hospital.

However, the report noted that patients continue to be sent abroad in several specialties despite the existence of treatment facilities in the Maldives. This was attributed to unimplemented agreements with foreign hospitals, gaps in supporting treatment systems, and limited public confidence in some locally available services.

The audit highlighted cancer treatment as a key area of concern. A cancer treatment centre has been established at Hulhumalé Hospital, but the agreement governing its operation has not been fully implemented. Between 2015 and 2024, 14,311 cancer cases were referred abroad for treatment, marking a 126 per cent increase over the period, with an average annual increase of nine per cent.

Despite the scale of expenditure on overseas cancer treatment, the audit found that sufficient progress has not been made to expand domestic cancer care. Under an agreement signed on 15 April 2017 between Aasandha and Amrita Hospital, cancer services were to be provided locally during standard working hours by visiting doctors. The report noted that 10 to 15 new cancer patients are registered each month.

The audit stated that while the number of patients seeking cancer treatment continues to rise, identifying contributing factors and strengthening prevention measures is necessary to manage long-term expenditure under Aasandha.

The report also examined the Euro-Fertility Centre, established under an agreement signed between IGMH and NU Hospital on 2 May 2016 to treat kidney, urinary and fertility-related conditions. The IGMH budget spent MVR 466 million on equipment, staff salaries, service fees and benefits for the centre.

Despite this investment, the audit found that overseas referrals for kidney and urinary tract conditions increased after the centre became operational. From 2015 to 2024, 10,463 such cases were referred abroad, representing a 58 per cent increase. During this period, MVR 254 million was spent on treatment at NU Hospital.

The audit recommended preventing misuse of the overseas referral process and strengthening referral assessments for treatments available within the Maldives. It advised Aasandha to work with the National Social Protection Agency to ensure that cases referred abroad genuinely require services unavailable domestically.

The report also called for measures to manage Aasandha expenditure in a sustainable manner and ensure equitable access to services. It recommended maintaining proper records and ensuring that service providers verify bills with recipients to confirm that services charged to Aasandha were received.