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 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 & 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. 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 in-charge 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 P1Director P2 DDG(LS)DDG(PHS)2DDG(MS1)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

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