Maldives was a caste society well into the 1920s. Modernization efforts however, have helped to make Maldives more homogeneous in the early 1990s. Traditionally, a significant gap has existed between the elite living on Male and the remainder of the population inhabiting the outer islands--those atolls distant from Male. President Gayoom's development philosophy has centered on decreasing this gap by raising the standard of living among the 75 percent of Maldivians who live in the outer atolls as well as making Maldives more self-sufficient.

Fortunately, social tensions that might have affected these two distinct societies were lessened by the isolation of the outer islands. The geographical advantage of having many islands, for example, has enabled Maldives to limit the impact of tourism to special resorts.

Male, the traditional seat of the sultans and of the nobility, remains an elite society wielding political and economic power. Members of the several traditionally privileged ruling families; government, business, religious leaders; professionals; and scholars are found there. Male differs from other island communities also because as many as 40 percent of its residents are migrants.

The island communities outside Male are in most cases selfcontained economic units, drawing meager sustenance from the sea around them. Islanders are in many instances interrelated by marriage and form a small, tightly knit group whose main economic pursuit is fishing. Apart from the heads of individual households, local influence is exerted by the government appointed island khatib, or chief. Regional control over each atoll is administered by the atolu verin, or atoll chief, and by the gazi, or community religious leader.

Boat owners, as employers, also dominate the local economy and, in many cases, provide an informal, but effective, link to Male's power structure. The family is the basic unit of society. Roughly 80 percent of Maldivian households consist of a single nuclear family composed of a married couple and their children rather than an extended family. Typically, unmarried adults remain with relatives instead of living alone or with strangers. The man is usually the head of the family household, and descent is patrilineal. Women do not accept their husbands' names after marriage but maintain their maiden names. Inheritance of property is through both males and females.

As Muslims, men may have as many as four wives, but there is little evidence to suggest that many have more than one. Islamic law, as practiced in Maldives, makes divorce easy for men and women. Divorce rates are among the highest in the world. According to the 1977 census, nearly half the women over the age of thirty had been married four times or more. Half of all women marry by the age of fifteen. About 60 percent of men marry at age twenty or later. The status of women has traditionally been fairly high, as attested to in part by the existence of four sultanas. Women do not veil, nor are they strictly secluded, but special sections are reserved for women in public places, such as stadiums and mosques.

Health Care

In Maldives the Ministry of Health is responsible for the delivery of health services. Despite government efforts, a major constraint facing the health sector in the early 1990s is a shortage of skilled personnel and health facilities. The WHO reported in 1989 that the population per physician was 7,723. However, when the ratio for Male was separated from that for the atolls, the acute shortage of physicians for the majority of Maldivians became even more obvious. Whereas the population per doctor in Male in 1989 was 2,673, in the atolls it was 35,498. These ratios were derived from a 1989 total of sixteen physicians: twelve in Male and four in the atolls. Also, in 1989 only one dentist was located in Male.

Maldives' medical establishment in the early 1990s consisted of the Male Central Hospital, four regional hospitals, two in the north and two in the south, and twenty-one primary health care centers. The Central Hospital maintains ninety-five beds, and the four regional hospitals have a combined total of sixty-one beds. In 1992 thirty physicians and seventeen medical specialists worked in the Central Hospital. Furthermore, the government opened the Institute for Health Sciences in 1992, and the 200-bed Indira Gandhi Memorial Hospital was scheduled to open in 1994.

Each administrative atoll has at least one health center staffed by community health workers. Most of the inhabited islands also have traditional medical practitioners. However, it was reported in the early 1990s that the atoll hospitals and health centers could only treat minor illnesses. Routine operations could be performed only in Male Central Hospital, which had Russian physicians.

To provide better health facilities in the outer islands, the United Nations Children's Fund (UNICEF), in collaboration with the Maldives government, outfitted two boats to be used by mobile health teams. In 1985 two mobile health teams were dispatched from Male, one to the north and one to the south. Each team included a primary health care worker, a nurse, a family health worker, a malaria fieldworker, three community health workers, and a government official.

The services, they provided included immunization, communicable disease control, family health, nutrition, and health education. In the late 1980s, a third team was added.