In the Maldives, noncommunicable diseases (NCDs) are the leading causes of morbidity and mortality, contributing to approximately 84 percent of all deaths.[1] In response, the World Health Organization (WHO) Maldives collaborated with the Ministry of Health to launch the Faafu Atoll Primary Health Care Demonstration Site (FADS) in December 2022, targeting the integration of NCD care into the existing healthcare infrastructure. Remarkably, by November 2023, just nine months following its commencement in March 2023, the program had successfully enrolled over 93 percent of its targeted population. Within this group, 14.2 percent had hypertension, 8.7 percent diabetes, and 22.8 percent high cholesterol, with a majority now under treatment. Notable progress in treatment rates were observed between March and November 2023: hypertension treatment rates climbed from 92 percent to 95.5 percent, diabetes from 86 percent to 95.1 percent, and high cholesterol from 57 percent to 71.6 percent, indicating substantial progress in the management of NCDs in the demonstration site.[2][3] The FADS project is strategically aligned with WHO priorities, bolstering policy implementation related to Sustainable Development Goals (SDGs) 3.4 (reducing non-communicable diseases and promoting mental health) and 3.8 (achieving universal health coverage), as well as building local capacity as outlined in United Nations Sustainable Development Cooperation Framework Objective 2.1 and WHO Country Cooperation Strategy Priority 1. This initiative underscores the importance of non-communicable disease (NCD) prevention and overall well-being, presenting a scalable and effective solution for meeting both national and international health objectives.

- H.E Ahmed Naseem, Minister of Health Maldives

In response to these findings, WHO developed a concept note for a pilot project, which was then presented to a high-level delegation from the Maldives' Ministry of Health (MoH), including the Minister of Health. Upon receiving approval, the MoH selected Faafu Atoll as the location for its Primary Health Care (PHC) demonstration initiative. Subsequently, the MoH formally extended an invitation to the WHO to lead the project, initiating a collaborative effort. The WHO Regional Office for South-East Asia contributed its technical expertise to devise a detailed strategy and action plan for the Faafu Atoll Primary Health Care Demonstration Site (FADS). An integral part of this cooperative effort was a WHO-conducted workshop, instrumental in shaping the action plan through the identification and prioritization of critical areas and activities in partnership with various MoH departments. The strategy aimed to seamlessly integrate NCD care into the existing healthcare framework, thus broadening access to essential services, including targeted NCD screenings, lifestyle counselling, and the identification and referral for common cancers and selected mental health conditions.

To advance the project, detailed assessments were jointly conducted by the WHO and the Maldives' Ministry of Health (MoH) at health facilities across Faafu Atoll, aiming to assess the readiness and availability of healthcare services, including the provision of medicines, equipment, and human resource capacity.

The project was inaugurated in December 2022, under the supervision of Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia, and the Honourable Ahmed Naseem, the Maldives’ Minister of Health. The demonstration site quickly evolved into a dynamic environment serving dual purposes: a practical field laboratory and an immersive training hub. WHO played a crucial role in shaping service delivery models aligned with WHO global guidelines for service integration and packaging. This entailed assessing training needs with WHO-developed tools and organizing a capacity-building training program incorporating the WHO Package of Essential Noncommunicable Disease Interventions (PEN), the Mental Health Gap Action Programme (mhGAP), and country-specific training modules for the digital health information system and modified care pathways.[5][6] WHO used its guidelines and tools to customize the training programs to meet local needs and involved local training facilitators for effective implementation. 

Remarkable advancements were made in health information technology through the efforts of the WHO Maldives team who played a pivotal role in the development of a Primary Health Care Register using the District Health Information System (DHIS2). This register aims to enroll all eligible individuals, facilitate early patient screening, enable ongoing monitoring at the demonstration site, and create an Island Health Profile database. The integration of this digital system has not only improved healthcare services but also allowed for the empirical evaluation of the project's success through concrete data. 

- Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia

In May 2023, a significant milestone was reached with the ceremonial transfer of the ownership and management of the Faafu Atoll site to the local community. This event presided over by His Excellency Faisal Naseem, Vice President of the Maldives, marked a step towards ensuring the project's longevity and the continued provision of services by the Faafu Atoll community.

The FADS project has set a precedent as a scalable and replicable model that leverages the current healthcare workforce and integrates digital health technologies to enhance service delivery. There are plans to extend this model across the nation, with a targeted expansion to 10 additional atolls out of the country's 20 atolls scheduled for 2024.This strategic enlargement positions the FADS project as a potential template for other Small Island Developing States (SIDS) grappling with similar healthcare challenges.