Executive Summary

Mauritius has one of the highest prevalence of type II diabetes in the world and is additionally impacted by the consequences of other associated chronic non-communicable diseases (CNCD are defined to also include cardiovascular disease and stroke). The central thesis of the 5-2035 vision we propose to remedy the situation is that healthcare is an inalienable right as well a collective responsibility (Fig. 1).  In ambition, the 5-2035 vision aims to curb type II diabetes in the country to 5% by the year 2035.  Although 5-2035 has the stated goal of decreasing prevalence of type II diabetes as a tangible outcome measure, we have a larger ambition of improving the entire Mauritian healthcare system and quality of life within the next generation.   

Operationally, through the Directorate of Health Care Reform (DHCR), supported by an external advisory board (Fig. 1), 5-2035 will be guided by five principles:

1) National Unity and Social Justice:

Bettering the health and quality of life of the nation by the 5-2035 vision will be presented as a matter of national security, an endeavor that must involve all sectors of our society towards national unity and for the cause of social justice.  Central to our strategy will be an effective 5-2035 branding campaign. We propose to present political, social and religious figures as committed proponents of improving our CNCD burden, overall health and quality of life for current and future generations, all working together to improve our health. 

2) Grassroots Integrated Community Health:

In 5-2035, we learn both from successes and failures of the past in Mauritius and internationally to develop an innovative grassroots integrated community health.  We will tap the internal energy of communities using the SEED-SCALE (Self-Evaluation for Effective Decision-making + System for Communities to Adapt Learning and Expand) model of sustainable community-based human development.  The overarching goal of 5-2035 will be to empower and incentivize citizens living in communities to have control over their health in a supportive and positive manner to promote behavioral changes towards better health and quality of life for all;

3) Organic Native Institutional and Human Resources Development:

To the Mauritian challenge of CNCD and poor health, 5-2035 will enable development of homegrown Mauritian solutions.  We envision nurturing existing institutions and creation of new institutions (Fig. 1) under the direction of the DHCR as agents of change in 5-2035.  We will heavily invest in human resources development. 5-2035 calls for training and/or retraining of 1,500 innovatively-conceived community health nurse practitioners (CHNPs) and 150 community health doctors (CHDrs), supported by a secretariat at the community health development initiative (CHDI; Fig. 1).  A cadre of professionals will also be trained and nurtured within the other new institutions we propose, namely the Mauritius Health Policy Institute (MHPI) and the Mauritius Agency for Medical Informatics (MAMI) (Fig. 1).  These institutions and individuals will assure sustainability of 5-2035, and in essence will become international ambassadors of inclusive and fiscally responsible health care reform centered around an innovative and integrated community health;

4) Public-Private Partnerships:

An often-overlooked aspect of policy in governmental programs is the benefit of engaging entrepreneurship and working with existing business infrastructure that already may be catering for the services targeted.  In Mauritius, we have a thriving fee-for-service health care system as well as enterprising individuals and small businesses that can be recruited to accelerate and expand the 5-2035 vision.  We have designed elements of 5-2035 such that motivated individuals and businesses can promote economic growth in the local healthcare industry by improving efficiency and choices for the healthcare consumer.  Importantly, 5-2035 has a grand ambition to be a model for successful national implementation of an integrated community health for other nations.  The public-private partnerships that will develop within the 5-2035 framework can become exportable services for further economic growth for the country, and

5) Pragmatism and Frugal Innovation:

For any ambitious endeavor to succeed over the long-term, it needs to have sound philosophical foundations, the glue that binds everything together.  For 5-2035, we have identified two such philosophical principles: American pragmatism and frugal innovation.  Pragmatism, as expounded by Josiah Royce, calls for self-reliant decision-making that is socially oriented and hence aimed toward the maximum good for the whole community.  This means that the more people who are brought into the decision-making process, the better it is for both society and individual.  In 5-2035, we will rely heavily on the internal energy of communities and individuals living on those communities through the SEED-SCALE system as exemplified by pragmatism.  In this context, frugal innovation, as a method of seeking opportunity in adversity, doing more with less, thinking and acting flexibly, keeping it simple, including all sectors of society and investing in passion, is an extension of pragmatic philosophy in our vision of 5-2035.

By enabling the creation of a grassroots integrated health care system through 5-2035, we will address manifold issues simultaneously at the local community level by empowering and shepherding citizens towards behavioral changes and sensible action to improve their health and quality of life.  A specific CNCD (type II diabetes in our case) reflects the interaction of complex systems, including nutritional status, spiritual state, stress levels, access to services, educational status, environmental influences, genetics, just to name a few [1]. In other words, while our marketing focus on the nation will be 5-2035 by messaging simple and tangible goals (of decreasing the prevalence of type II diabetes from 22% currently to 5% by 2035) that all can rally around, the proposed health care reform will redefine Mauritian health by having far-reaching improvements in all sectors included under its vast umbrella.  Additionally, by empowering communities and community service in productive ways, we will strengthen the dynamism and unity of our nation.

Chapter Synopsis

In the introduction (Chapter B), we will provide an overview of the socioeconomic and political contexts that are assembled to make 5-2035 a success.  We touch upon the international sources of inspiration for 5-2035.  In Chapter C, we provide an overview of the political and governmental landscape that is conducive to 5-2035 realization. We then elaborate our 5 guiding principles for 5-2035 mentioned above.  In Chapter D, we focus on how 5-2035 will produce an integrated health care system based on community health and empowerment and how we will utilize the SEED-SCALE model of sustainable community-based human development to our ends.  Chapter E details new institutions and human resource development program for 5-2035 and how we will use frugal innovation and local expertise to achieve our health policy goals.  In Chapter F, we will present an overview of the curriculum development and continuing medical education for 5-2035 healthcare professionals.  Finally, Chapter G we will overview the 5-2035 5-year operational plan and in Chapter H, we will provide concluding thoughts. 

Chapter I constitutes of a series of appendices:

1) personal motivation;

2) health economics for 5-2035;

3) fixed infrastructure cost analysis for 5-2035;

4) information system cost analysis;

5) medical decision support system (MDSS) case study;

6) branding 5-2035;

7) possible examples of 5-2035 community projects, and

8) vision of an inter-ministerial working group to accelerate implementation and sustainability of 5-2035.

In summary, 5-2035 will bring an overall revolution in health care and quality of life in Mauritius, and make the country an exportable model for success in curbing CNCD for the rest of the world in less than a generation.

Reference: [1] Bloom, D.E., et al. The global economic burden of non-communicable diseases. Geneva World Economic Forum. 2011.