Hospital Practice 1 Health Services in Sri Lanka

Hospital Practice 1. Health Services in Sri Lanka

Organization of health Service § Health care is provided by both § Public Sector (for nearly 60% of population) & § Private Sector

Public sector health care § The Department of Health Services and the Provincial Health Sector encompass the entire range of § Preventive § Curative § Rehabilitative health care provision

Private Sector Health care § The private sector provides mainly curative care § Nearly 50% of the outpatient care of the population § Largely concentrated in the urban and suburban areas ?

Inpatient care § 95% of inpatient care is provided by the public sector § Services are provided by § Department of Health Services § Provincial councils § Local Authorities & Service provisions especially for § Armed forces § Police personnel § Estate population

Systems of Medicine § § § Western Ayurvedic Unani Siddha Homeopathy The public sector comprises Western & Ayurvedic systems. Western medicine is the main sector catering to the needs of the people.

Accessibility § Sri Lanka possesses an extensive network of health care institutions § The majority of the population has easy access to a reasonable level of healthcare facilities § Any health care unit can be found not further than 1. 4 km from any home § Free government western type health care services are available within 4. 8 km from home

National Health Policy § The broad aim of the heath policy is to § Increase the life expectancy § Improve the quality of life § This is to be achieved by § Controlling preventable diseases § Health promotion activities

Concern of the Government § § § To address health problems like Inequities in health service provision Care of elderly and disabled Non-communicable diseases Accidents and suicides Substance abuse and malnutrition

Thrust areas for implementation § Improve hospitals to reduce inequities § Expand the services to areas of special needs (e. g. the elderly, disabled, victims of war and conflict, occupational health problems, mental health, estate health services) § Develop health promotional programmes § Reforms of organizational structure to improve efficiency and effectiveness § Resource mobilization and management The government has taken efforts To maximize the financial allocations on health development

Health Administration § The health services function under a Cabinet Minister. § With the implementation of the provincial councils act the services were devolved to § Ministry of Health at the national level (Central) § Provincial Ministries of Health at the eight provinces (now nine)

Central Government Ministry of Health § MH /DGHS is primarily Responsible for the protection and promotion of people’s health. Its Key functions are § Setting policy guidelines § Medical and paramedical education § Management of teaching and specialized medical institutions § Bulk purchase of medical requisites

Provincial Ministries of Health § PMHS /PDHS are responsible for management and effective implementation of health services in the respective provinces § To manage the Provincial, Base and District Hospitals, Peripheral Units, Rural Hospitals, Maternity Homes and outpatient facilities such as central dispensaries and Visiting Stations

PDHS , DPDHS, MOH/DDHS PDHS DPHS MOH/DDHS

Ministry of Health & the Department of Health Services § In 1999, the Ministry of Health was restructured resulting the separation of the Department of Health Services from the Ministry of Health. § The Director General of Health Services heads the Department and has the immediate support from Deputy Directors general, each incharge of a special programme area. They have a number of Directors responsible for different programmes and organizations

Department of Health Services DDHS DDG(PHS)1 Director P 1 DDG(LS) Director P 2 DDG(PHS)2 DDG(MS 1) DDG(ET&R) Director Training

Health Facilities Consists of a Network of curative care institutions § Primary care Institutions § Central Dispensaries, Maternity Homes, Rural Hospitals, Peripheral Units, District Hospitals § Secondary care Institutions § Base Hospitals, Provincial Hospitals § Tertiary care institutions § Teaching Hospitals, Special Hospitals

Number of hospitals & beds § 15 teaching hospitals – 14, 695 beds in 2000 § Total beds in all hospitals – 57, 027 in 2000 § Ratio of beds per patients – 2. 9 per 1000 patients

The National Hospital of Sri Lanka § In 2000 – 2, 881 patient beds § Provides for number of specialties including subspecialties like neurology, cardio-thoracic surgery but excluding paediatrics, obstetrics, opthalmology and dental surgery. § Has a well equipped accident service and several intensive care units § The specialties not found in NHSL are provided by the two maternity hospitals, children’s hospital , eye hospital and the dental institute.

Provincial hospitals and Base Hospitals § § In 2000 There were 6 Provincial hospitals 36 Base hospitals with 9, 865 patient beds The provincial hospitals at Kalutara, Ratnapura, Matara and Badulla and Base hospitals at Kegalle and Gampola are under the Department of Health Services § Only in few base hospitals have basic specialties

Specialties at provincial hospitals § § § § § General medicine Surgery Obstetrics Gyneacalogy Opthalmology ENT Paediatrics Radiology Pathological laboratories & other auxiliary services

District Hospitals, Peripheral Units and Rural Hospitals § The distinction between DH, PU, and RH is made on their size and the range of facilities provided. DHs are the largest § The total care available in DHs and Pus is superior to RHs because the availability of nursing personnel § In 2000 were 156 DHs, 93 Pus (4, 586 beds), 167 RHs (4, 382 beds)

Preventive Services § 252 Health Units (MOH offices) headed by Medical Officers of Health, carry out preventive services. § The staff include PHIs, PHNs & Midwifves

Health Manpower § § § Medical officers – 7, 963 Persons per doctor – 2431 Number of Nurses per 100, 000 population – 76 § There was a shortage of Radiographers, Physiotherapists, Medical Laboratory Technicians, Pharmacists and ECG Recordists

Health Manpower Training Basic Training § Universities § NIHS -Kalutara § Training Schools Post Basic Training § PGIM § Abroad - Fellowships § PBS- Nursing § In-service Training Programmes

End of Lesson 1