Mauritius has the unique historical, economic and political attributes to succeed in controlling CNCD* by the vision of 5-2035
* CNCD; chronic non-communicable diseases are the related preventable conditions of type II diabetes, stroke and cardiovascular diseases
Mauritius, an Eden 1,200 miles due east as the crow flies out of Southern Africa and half the size of Rhode Island, is an improbable experiment because of the rainbow people who live in it. In what must have been a loud bang, scientists now think that the land erupted 9 million years ago through a submerged continent that geological forces had forgotten for 75 million years [1]. This natural oddity of shining in an unlikely spot at an unlikely time, is an apt metaphor for the tides that have brought the country’s fortunes.
So the story goes, in 1968, the country was viewed as an overcrowded barracoon, a depot for slaves, “set adrift” in good riddance by independence from Great Britain [2]; at that time, the path towards a failed state for Mauritius was all but certain. History though, has a different account: buoyed by the hard work of the French, Chinese, Africans and South Asians who settled the place, Mauritius has come a long way to become a upper middle income country and strong inclusive political institutions that gives it perennially an undisputed number one spot in the Ibrahim Index of African Governance [3]. Prevailing health and other indicators make Mauritius an ideal spot to try the great experiment that is 5-2035 (Fig. 1) [4-8]. Currently, government health services are free to citizens. Because our contention is that the wish to decrease CNCD in a country is a political endeavor above a health policy task, inclusive political institutions [9] are key for success, which the country can boast about.Mauritius already has the physical infrastructure and human potential to make the 5-2035 vision a reality
Political will and economic indicators will be for naught if we do not have an appropriate physical infrastructure and potential for human development to develop the ideas we present in 5-2035. In terms of physical infrastructure, 5-2035 envisions a decentralized, community-based point of care system as bedrock, thus alleviating the chokehold of routine care services that overwhelm hospitals and regional medical centers. Mauritius is lucky to have established a sophisticated network of community health centers in its territory (Fig. 1 & 2). The system constitutes of 6 regions (5 on the mainland and 1 region for the island of Rodrigues). Most of the regions have a regional medical center with associated specialty hospitals. Regions may also have district or community hospitals depending on the size of the population served. The community health infrastructure constitutes of nodes of area health centers and medi-clinics with satellite family health clinics and community health centers (Fig. 2). In this way, all populated areas of the country have community point of care already established, thus leveraging this set-up for the vision of 5-2035.
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). Our internal very rough estimate shows that if we make the 5-2035 vision a reality in Mauritius, we could stand to save Rs 158 billion (~$5B) by the year 2035.
There are two critical aspects of human resources that make 5-2035 a seamless entry within the Mauritian health ecosystem:
1) The current personnel within the community health, can easily be retrained and reassigned as CHNPs, CHDrs and secretariat personnel with minimal effort, and
2) Mauritius has a highly trainable and literate population and so recruiting the extra personnel over the medium range will not be challenging
Understandably, any change from the status quo is bound to produce anxieties in the current personnel. However, if we engage unions and other stakeholders in a respectful and open manner, and especially when stakeholders realize the benefit that 5-2035 can bring to their interests as well as the country, we think that we will get buy-in from all sectors for success of the endeavor.
Please see the 5-2035 Executive Summary to have an overview of our plan or request the full 76-page 5-2035 White Paper for further details. If you have any specific questions, please do not hesitate contact us. Our response time may be slow as all of us at the GFCH are volunteers for the 5-2035 mission and have full time commitments. Thank you for your understanding and patience.References
1. Torsvik, T.H., et al., A Precambrian microcontinent in the Indian Ocean. Nature Geoscience, 2013. 6: p. 223-227.
2. Naipaul, V.S., The overcrowded barracoon, and other articles. 1972, London: Deutsch.
3. Foundation, M.I., Ibrahim Index of African Governance. 2014.
4. Central Intelligence Agency, U.S., World Factbook. 2014.
5. Life, M.M.o.H.a.Q.o., Health Statistics Report 2012. 2012.
Mauritius already has the physical infrastructure and human potential to make the 5-2035 vision a reality
Political will and economic indicators will be for naught if we do not have an appropriate physical infrastructure and potential for human development to develop the ideas we present in 5-2035. In terms of physical infrastructure, 5-2035 envisions a decentralized, community-based point of care system as bedrock, thus alleviating the chokehold of routine care services that overwhelm hospitals and regional medical centers. Mauritius is lucky to have established a sophisticated network of community health centers in its territory (Fig. 1 & 2). The system constitutes of 6 regions (5 on the mainland and 1 region for the island of Rodrigues). Most of the regions have a regional medical center with associated specialty hospitals. Regions may also have district or community hospitals depending on the size of the population served. The community health infrastructure constitutes of nodes of area health centers and medi-clinics with satellite family health clinics and community health centers (Fig. 2). In this way, all populated areas of the country have community point of care already established, thus leveraging this set-up for the vision of 5-2035. 
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). Our internal very rough estimate shows that if we make the 5-2035 vision a reality in Mauritius, we could stand to save Rs 158 billion (~$5B) by the year 2035.
There are two critical aspects of human resources that make 5-2035 a seamless entry within the Mauritian health ecosystem: