A performance audit of the national Social Health Insurance Scheme has recommended shifting Aasandha benefits from universal coverage to a targeted model that prioritises those who genuinely need state assistance.
The audit, released Tuesday by the Auditor General’s Office, reviewed the performance of Aasandha and NSPA between 2019 and 2024. It found that MVR 35.8 billion was spent on medical treatment during the period, an average of MVR 5.9 billion a year. Of this, MVR 16 billion was spent under the Aasandha scheme alone.
According to the report, expenditure under the scheme rose 32 percent, while the number of people seeking services increased by only seven percent. The audit notes that both Aasandha and NSPA continue to incur heavy annual costs, with spending last year exceeding the budgeted MVR 1.8 billion. By December 18, MVR 2 billion had already been spent on Aasandha, alongside more than MVR 300 million on medical welfare and MVR 3.4 billion on subsidies.
International financial institutions have long advised the Maldives to target subsidies and medical assistance only at low‑income groups. However, successive governments have not implemented these recommendations.
Photo shows the entrance of the Dharumavantha complex of IGMH. (Sun Photo/Fayaz Moosa)
The audit proposes several corrective measures, including:
Introducing a targeted subsidy system for those who require state support to access healthcare  
Setting maximum retail prices for medicines  
Implementing a co‑payment system for patients seeking treatment abroad  
Strengthening preventive healthcare to reduce long‑term costs  
The report comes at a time when the Maldives faces significant fiscal pressure. The country is due to repay USD 1 billion in debt this year, including a single USD 500 million payment. Credit rating agencies have downgraded the Maldives to “junk” status, making it harder to secure foreign financing at affordable rates.
Despite this, the government has maintained that all debt obligations will be met on time.