includes lack of budget, proper transportation facilities, properly trained staff, a mechanism for witness protection, cooperation between institutions and awareness on relevant legislations, particularly among law enforcement officials and judges. 214,215 Additionally, the complaints lodging and referral mechanism in place are complicated and there are inconsistencies in interpretation and codifying DVPA among institutions.216 Victims of DV are still hesitant to come forward due to lack of trust in law enforcement and the justice system.217, 218 Furthermore, financial dependency on perpetrators, considerations given to children’s wellbeing and lack of support from families are also reasons for this hesitancy. 219,220 VAW cases are sometimes treated as private family matters by LEAs.221,222 Mechanisms for the protection of victims are poor: the existing safe houses are not fully functional; confidentiality is not always maintained; and victims are subject to further victimization.223, 224 As DV is not criminalized as a separate offence, prosecutors have to fall back on other legislations to prosecute perpetrators of VAW and hence such cases are not documented as DV.225 Health care professionals in the atolls are not adequately trained on the mechanism in place to report VAW and are hesitant to report.226,227 32. Available data suggests that the prevalence of FGM among girls aged 0-14 is at 1%.228 Additionally, there is limited research on FGM and VAW. Recommendations: Establish legislative quotas as an affirmative action to achieve gender equality. Review, amend and enforce Domestic Violence Prevention Act. Criminalize DV as separate criminal offence. Enforce legislative provisions on protection of victims. Strengthen existing mechanism for reporting DV cases identified through the health systems. Establish a system for rehabilitation and reintegration of victims and offenders. Enact Witness Protection Act. Create an enabling environment – including workspaces – and allocate sufficient budget for WDCs. Strengthen the role of women and WDCs in the manner that as envisaged by decentralisation and good governance principles. Amend Decentralization Act to mandate the EC to administer WDC elections. Enforce implementation of Gender Equality Law to ensure gender equity. Health 33. Though healthcare facilities and pharmacies are established in all inhabited islands, access to healthcare is limited outside of Male’ and most health facilities lack specialized healthcare professionals. 229 The health sector rely heavily on expatriate health professionals.230 About 70% of the total expenditure on health sector go to curative health programs and only 5.5 % is spent on preventive health care making the country vulnerable to health issues.231 HRCM investigated 8 deaths related to medical negligence in the past four years. Most Maldivian youth do not have access to appropriate information about SRH and the general public lack awareness on available SRH services.232 Mental health care is distressingly poor overall and extremely limited outside of Male’.233 The misconception that mental health issues are a result of weak religious faith cause stigma and discrimination. 234 235 NGOs and private practitioners that provide mental health services lack resources.236 237 Private mental health care is costly and available only in Malé.238 No significant actions are taken to achieve the objectives set out in the Mental Health Policy 2015-2025.239 34. NCDs account for 75% and 69% of all deaths in year 2015 and 2016. Furthermore, in 2016, 54% of all deaths due to NCD were related to cardiovascular diseases and around 18% were related to respiratory diseases.240 However, CDs including dengue remain a prevalent issue.241 Health facilities throughout the country are not equipped to fully implement the national NCD Action Plan. 242 While Maldives has one of the highest known incidences of Thalassemia in the world,243 MTS stated that management and treatment of patients in the country is substandard.244, 245 In 2019, 8 Thalassemia patients died within two consecutive months raising concern over the management and treatment of patients.246 MoH raised concerns that compliance from thalassemia patients to necessary treatment is poor.247 35. Though all citizens are covered under a national health insurance program, nearly 20% of people spent more than 10% of their household's total expenditure on health care.248 The cost of travelling to Male’ or abroad to access necessary medical care adds up to the expenditure spent on health.249 In South East Asian region, Maldives spends the highest amount of its GDP on health.250, 251 Despite this, out-of-pocket health spending pushes 1.5% of people into poverty.252 36. Vaccine hesitancy has become a growing concern and poses as a challenge for the national immunization program. 253 Further, a social media campaign against vaccination was observed recently.254 Proportion of children who received all basic vaccinations decreased by 16% since 2009 and 8% of children had not received any vaccinations. 255 37. An air transport service dedicated to health emergencies is essential to overcome the geographical challenges. 256 The existing emergency response and rescue system is disintegrated.257 38. Medical facilities are not equipped with adequately trained staff on forensics and this poses as a challenge in criminal investigations. 258, 259 39. Legislative gaps exist in addressing various issues related to health provision. 260 Recommendations: Establish a national emergency medical service throughout the country for the full utilization of health care delivery system. Increase budget allocation for preventive health care. Ensure availability of quality mental health care throughout the country. Strengthen healthcare system across the nation. Enact Mental Health Bill, Medical Negligence Bill, Patient Rights Bill, Occupational Health and Safety Bill and relevant Regulations. Strengthen policies and platforms to ensure access to SRH information and services for youth. Take actions to mitigate the issue of rising trend in anti-vaccination. Equip health facilities with forensic medical experts. Housing 40. Development efforts has been significantly centralized and as a result, 38% of the total population live in the capital city Male’ making it extremely overcrowded.261 As a result, there is a housing crisis exists in Male’ and people who have internally migrated are forced to depend on expensive private housing: 63% of the households in Male’ live on rent;262,263 31% of monthly household 5