Sustainable Delivery of Speech-Language Therapy Services in Small Island Developing States Using Information and Communication Technology – A Study of the Maldives

Mariyam Z. Zahir, Anna Miles, Linda Hand, Elizabeth C. Ward


Small Island Developing States (SIDS), a subgroup of Majority world countries, face complex challenges providing equitable access to speech-language therapy (SLT) services. Increasing use of information and communication technology (ICT) to enhance SLT services is seen in the Minority world. This study explored the potential of using ICT to provide sustainable SLT services in one SIDS, the Maldives. A mixed method approach was used integrating data from (a) 21 online documents, (b) interview with an ICT official, and (c) surveys of 13 island councillors and 73 parents of children with communication difficulties. Almost 100% of the population had access to mobile phones and mobile broadband internet. Most parents were active and frequent ICT users. The government provided financial aid for people with disabilities which could be utilised to access ICT for services. Asynchronous service delivery using accessible ICT and parents as agents of service delivery can potentially enhance SLT services.


Children; Information and communication technology; Majority world countries; Service delivery; Speech-language therapy; Underserved communities


Alexa. (2019). Alexa - Top Sites in Maldives - Alexa. Retrieved August 2, 2019, from

American Speech–Language–Hearing Association. (2016). Telepractice: Overview. Retrieved September 1, 2016, from

Asian Development Bank. (2012). Maldives: Information Technology Development Project. Retrieved from

Asian Development Bank. (2015). Maldives Overcoming the Challenges of a Small Island State - Country Diagnostic Study. Mandaluyong City, Philippines: Asian Development Bank. Retrieved from

Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(3), 27–40. Retrieved from

Buell, S. (2013). A perspective from Bolivia on the implications of the World Report on Disability for people with communication disabilities. International Journal of Speech-Language Pathology, 15(1), 32–36.

Cheng, L.-R. L. (2013). Knowledge transfer between minority and majority world settings and its application to the World Report on Disability. International Journal of Speech-Language Pathology. 15(1). 65-68

Cheng, L.-R. L. (2016). People with disabilities: The underserved and unserved. Medical Research Archives, 4(8).

Communications Authority of Maldives. (2003). Maldives Telecommunications Regulation 2003. Retrieved from

Communications Authority of Maldives. (2019). Telecom Statistics - 2019 Monthly Figures. Retrieved July 15, 2019, from

DHIRAAGU. (2018). Dhivehi Raajjeyge Gulhun Plc Annual Report 2018. Retrieved from Report_2018.pdf

DHIRAAGU. (2019). Fixed Broadband. Retrieved October 24, 2019, from

Doell, E., & Clendon, S. (2018). Upholding the human right of children in New Zealand experiencing communication difficulties to voice their needs and dreams. International Journal of Speech-Language Pathology, 20(1), 152–156.

Elbro, C., Dalby, M., & Maarbjerg, S. (2011). Language-learning impairments: A 30-year follow-up of language-impaired children with and without psychiatric, neurological and cognitive difficulties. International Journal of Language and Communication Disorders, 46(4), 437–448.

Fanta, G., Pretorius, L., & Erasmus, L. (2015). An evaluation of ehealth systems implementation frameworks for sustainability in resource constrained environments: A literature review. International Association for Management of Technology (IAMOT) 2015 Conference Proceedings. Cape Town.

Fontaubert, C. de. (1995). United Nations global conference on the sustainable development of Small Island Developing States. Ocean & Coastal Management, 24, 205–213.

Hootsuit, & We Are Social. (2019). Digital 2019 - Maldives (January 2019). Retrieved August 1, 2019, from

International Telecommunication Union. (2004). Information and communication technology in the atolls: Maldives case study. Retrieved from

International Telecommunication Union. (2006). Digital Life - ITU Internet Report 2006. Retrieved from

International Telecommunication Union. (2017a). ICT Facts and Figures 2017. Retrieved January 11, 2018, from

International Telecommunication Union. (2017b). ICT PRICES. Retrieved from

International Telecommunication Union. (2018). Measuring the Information Society Report Volume 2. ICT Country Profiles. Retrieved from

Internet Society. (2017). Ensuring Sustainable Connectivity in Small Island Developing States. Retrieved from

Internet World Statistics. (2019). Asia Internet Usage Stats Facebook and 2019 Population Statistics. Retrieved August 2, 2019, from

Keck, C. S., & Doarn, C. R. (2014). Telehealth technology applications in speech-language pathology. Telemedicine and E-Health, 20(7), 653–659.

Maldives Allied Health Council. (2017). Maldives Allied Health Council Annual Report 2016. Retrieved from

Maldives Allied Health Council. (2018). Maldives Allied Health Council Annual Report 2018. Retrieved from

Maldives Government Gazette. (2015). Maldives Telecommunications Law 2015. Retrieved from

McAllister, L., Wylie, K., Davidson, B., & Marshall, J. (2013). The World Report on Disability: An impetus to reconceptualize services for people with communication disability. International Journal of Speech-Language Pathology, 15(1), 118-126.

McLeod, S. (2018). Communication rights: Fundamental human rights for all. International Journal of Speech-Language Pathology, 20(1), 3–11.

Ministry of Education - Maldives. (2019). Education Sector Analysis Maldives. Retrieved from

Ministry of Environment and Energy - Maldives. (2017). Introduce legal framework to reduce plastic pollution. UN Ocean Conference | 5-9 June 2017. New York.

Ministry of Gender Family and Social Services - Maldives. (2018). Inaugurating the provision of free therapeutic services for people with disabilities, as part of the current administration’s first 30-day goals. Retrieved June 24, 2019, fromދުވަހުގެ-ތެރޭގައި-ހާސިލުކުރުމަށް-ކަ/

Ministry of Health - Maldives, & ICF. (2018). Maldives Demographic and Health Survey 2016-17. Retrieved from

Ministry of Transport and Communication - Maldives. (2006). Maldives Telecommunication Policy 2006-2010. Retrieved from

Molini-Avejonas, D. R., Rondon-Melo, S., Amato, C. A., & Samelli, A. G. (2015). A systematic review of the use of telehealth in speech, language, and hearing sciences. Journal of Telemedicine and Telecare, 21(7), 367–376. 1357633x15583215

Ministry of Transport and Communications - Maldives. (2014). National Broadband policy 2014-2018. (n.d.). Retrieved from

National Bureau of Statistics - Maldives. (2015). Population & Housing Census 2014- Statistical Release I- Population & Households. Retrieved from

National Bureau of Statistics - Maldives. (2018). Household Income and Expenditure Survey (HIES) Analytical Report: Household Income 2016. Retrieved from

National Centre for Information Technology. (2012). National Centre for Information Technology - About Us. Retrieved August 15, 2019, from

National Social Protection Agency. (n.d.). Disability Allowance. Retrieved June 24, 2019, from

Northcott, S., Simpson, A., Moss, B., Ahmed, N., & Hilari, K. (2017). How do speech-and-language therapists address the psychosocial well-being of people with aphasia? Results of a UK online survey. International Journal of Language and Communication Disorders, 52(3), 356–373.

Ooredoo Maldives. (2018). Annual Report 2018 Ooredoo Maldives Plc. Retrieved from

Ooredoo Maldives. (2017). Ooredoo’s Nationwide Submarine Cable lands in Thinadhoo!. Retrieved August 20, 2019, from

Ponto, J. (2015). Understanding and Evaluating Survey Research. Journal of the Advanced Practitioner in Oncology, 6(2), 168–171. Retrieved from

QSR International. (2017). The NVivo guide to mixed methods. Retrieved from

Speech Pathology Australia. (2014). Position Statement Telepractice in Speech Pathology. Retrieved from

Speedtest. (2019). Speedtest Global Index – Monthly comparisons of internet speeds from around the world. Retrieved August 2, 2019, from

Tashakkori, A., & Teddlie, C. (2008). Quality of inferences in mixed methods research: Calling for an Integrative Framework. Advances in Mixed Methods Research (pp. 101–119). London, United Kingdom: SAGE Publications Ltd.

Telegeography. (2018). Ooredoo launches fibre broadband in Dhuvaafaru. Retrieved October 24, 2019, from

United Nations. (1948). Universal Declaration of Human Rights. Retrieved from

World Health Organization., & World Bank. (2011). World report on disability. Geneva, Switzerland: World Health Organization.

Wylie, K., McAllister, L., Davidson, B., & Marshall, J. (2013). Changing practice: Implications of the World Report on Disability for responding to communication disability in under-served populations. International Journal of Speech-Language Pathology, 15(1), 1–13.




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