1. Climate change and healthcare organization: Sri Lanka s perspective 2008 Global Ministerial Forum on Research for Health - Bamako - 17-19 November 2008 - Dr Neelamani Rajapaksa Hewageegana Dr Sarath Samarage

2. Country Description

3. Sri Lanka 20 M population 62,705 Sq km Adult Literacy rate 90.7 Life expectancy at Birth 76.4- Female 71.7-Male Population growth 1.1 Total fertility rate 1.9 Human Development index 0.743

4. Vital Statistics Crude Birth rate 18.7 per population Neonatal Mortality rate 8.4 per 1,000 live births Infant Mortality rate 11.7 per 1,000 live births Maternal Mortality rate 14.3 per 100,000 live births

5. Diseases associated with Floods and Drought increased the occurrence of diarrhoeal diseases diseases transmitted by mosquitoes (among these, dengue and Chikengunya) agricultural pests (Leptospirosis) sand flies (Leishmanisis).

6. Health impacts of climate change Increased accidents due to Lightning and Tornadoes Increased road traffic accidents Psychological problems Loss of income loss or displaced families

7. Leading Causes of Hospitalization, 2006 SL Rank OrderCauses of Hospitalization 1 Traumatic injuries 2Diseases of the respiratory system, 3 Symptoms, signs and abnormal clinical and laboratory findings 4 Viral diseases 5 Diseases of the gastrointestinal tract 6&7 Direct and indirect obstetric causes 8 Diseases of the urinary system 9 Intestinal infectious diseases 10Diseases of the skin and subcutaneous tissue

8. Responding to climate change and health 1.Disease surveillancesurveillance 2.Expanded Programme on ImmunizationImmunization 3.Control of diarrhoeal diseases and acute respiratory infectionsdiarrhoealacute respiratory infections 4. Control of dengue haemorrhagic fever, Japanese encephalitis and rubella 5.Planning, monitoring and evaluation of the new, emerging and re- emerging iseases (NERD) dengueJapanese encephalitis rubellanew, emerging and re- emerging iseases (NERD) Establishment of epidemic preparedness, rapid response teams at central and divisional levels

10. The information flow of the notifiable diseases of Sri Lanka HospitalMOH Office Bed-head Tickets Notification Card Notification Register (Ward) Notification Register (Institution) Special Notifications Cholera Acute Flaccid Paralysis Neonatal tetanus Measles/Other EPI Diseases Japanese Encephalitis Dengue Haemorrhagic Fever Rabies Notification Register Weekly Return of Communicable Diseases Infectious Diseases Register EPIDEMIOLOGICAL UNIT PHI BY TELEPHONE/TELEGRAM FOR SURVEILLANCE INVESTIGATION

11. Responding to vector dynamics with respect to climate change Vector-borne diseases (Malaria, Filariasis, Chikun Gunya, Dengue, Japanese Encephalitis,Leptospirosis,Leis hmaniaisis) Premises Index Container Index Breatue Index

12. The Way Forward Need of research on climate change related health issues Improve health surveillance systems to allow assessment of the impact of climate variability and change on health. To facilitate better integration of data sets across sectors. Review and redistribute the existing roles and responsibilities of the community health worker the PHM and PHI in Sri Lanka.

13. Thank you.