1. EXTERNAL REVIEW- WAYAMBA PROVINCE Dr.Nihal Abeysinghe Chief Epidemiologist Ministry of Health

2. Distribution of curative services Type of hospitalKurunegalaPuttalam Teaching1 General01 Base22 District163 Rural165 Peripheral124 Central dispensary and maternity home 15 Central dispensary5020 Total9840

3. SERVICE UTILIZATION-Out patient Care Highest average attendance – tertiary & secondary care institutions Tertiary Care Institution 1& 2 quarters 2005

4. SERVICE UTILIZATION-Out patient Care Lower the level of hierarchical institution, daily average OPD attendance decreases In Puttalam district, proportionately more subsequent visits to primary care institutions than in secondary care institutions 1& 2 quarters 2005

5. SERVICE UTILIZATION-In patient Care Highest bed occupancy- tertiary and secondary care institutions Low daily average bed occupancy- lower level institutions Comparatively high value at RH Gonigoda ( 90.7) with other Primary Care Institutions Source 1& 2 quarters-2005

6. SERVICE UTILIZATION-In patient Care

7. Average duration of stay – higher in secondary and tertiary care institutions TH Kurunegala3.7days BH Kuliyapitiya3.3days GH Chilaw 2.7days BH Puttalam2.6days BH Marawila3.0days Primary Care institutions with high average duration of stay Kurunegala district- RH. Mahamukalanyaya( 3.8) RH. Delwita( 3.0) Puttalam districtDH Mundal( 2.9), RH Nawagattgama (2.6)

8. SERVICE UTILIZATION-clinic services Average clinic attendance in Puttalam district- 63.4 Institutions with high average clinic attendance PU Mundal114.4 DH Anamaduwa91.2 BH Marawila67.5 GH Chilaw53.4 Ratio of first visit to subsequent 1: 2 Irrespective of the hierarchical type of institutions, utilisation of medical clinics – very high (Average clinic attendance exceeds 100).

9. SERVICE UTILIZATION-clinic services Utilisation of diabetic clinics- high. Specialised clinics such as Surgical, Orthopaedic, Ophthalmology, ENT clinics - highly utilised ( average attendance exceeds 50) Universally available dental and Anti Natal clinics - highly utilised at GH Chillaw ( Dental- 55.3, ANC-73.8) Clinics at PU Mundal- exclusively subsequent users( 95%)

10. Human resources (per 10000 population) CategoryKurunegalaPuttalam Specialists0.21 Medical officers1.182.80 Dental surgeons0.300.32 RMO/AMO0.900.58 Nurses4.204.50 MLT0.210.34 Pharmacists0.160.33 Dispensers0.010.02 Radiographers0.030.05

11. Costing of anti rabies activities in Puttalam district 20032004Difference% increase /decrease R ecipients of ARV 69564082-2874-41.3 No of consumed vials 139617826-6135-43.9 Total cost for ARV 5672773.132592675.54-3080097.59-54.3 R ecipients of ARS 21951705-490-22.3 No of consumed vials 32182482-733-22.7 Total cost for ARS 2695042.853948590.451253547.6346.5

12. Trend of increase in transport cost of an ambulance per KM in Puttalam district

14. The highest total diet expenditure - BH Marawila – 2,969,057SLR In secondary care institutions, expenditure for patients was higher than that for the staff Institutions with higher expenditure of diet for staff than patients DH Anamaduwa(56%), PU Lunuwila(57%), PU Madampe(64%)RH Thabbowa (53%) RH Anawilanduwa(60%) CD& MH Mampuri(52%) CD& MH Alutwewa(95%) CD& MH Kottantivu(65%) CD& MH Mahakubukkadawela(95%) proportion of the diet cost for staff out of total cost is given in parenthesis Costing of diets in Puttalam district

15. Costing of diets in Kurunegala district The highest total diet expenditure - BH Kuliyapitiya – 3,468,855.33SLR In secondary care institutions, expenditure for patients was higher than that for the staff In all primary care hospitals, except for Dambadeniya and Rideegama, expenditure of diet of staff was higher than that for patients

16. Conclusion Lower the level of hierarchical institutions, the average daily OPD attendance tends to decrease in both districts. Out patient services at secondary care institutions had been exclusively used by users for first visits. Secondary visits were proportionately higher in primary care hospitals than in the secondary and tertiary care institutions. Higher daily average occupancy, average duration of stay and Bed occupancy rates in tertiary and secondary care institutions reflects the under utilization of smaller institutions and over crowding of specialized institutions in the province. In Primary Care institutions, a hospital bed on average has changed more occupants than in secondary and tertiary care institutions

17. higher clinic utilization at some Primary Health Care institutions and registered proportionately high subsequent visits at these places may be due to easy access Higher utilisation of clinics for non communicable diseases irrespective of the type of institution. Higher utilisation of specialised clinic services ( ex. Orthopaedic, ENT). Though, family planning and Ante natal clinics are universally available, high utilisation of these clinics at secondary care institutions reflect the by passing tendency by clients. Resources The available cadre is less than the approved cadre for many categories Similar rates of distribution of health personnel within the province except for some categories.

18. Costing of services ( Puttalam district) Two thirds of MOHs in Puttalam district have been able to curtail the average transport cost per MOH vehicle in 2004 while increasing the mileage in comparison to the previous year Lower the level of the hierarchical institutions, cost per a delivery increases