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6. HEALTH SERVICES
6.1 Health
education and promotion
The Health Policy of Sri Lanka has recognized health
education and promotion as a strategy for improving health of the people.
Legislations like Consumers Protection Act, Cosmetic Devices and Drugs Act
and the Food Act support this policy.
Health Education Bureau is the main organization under the
Ministry of Health, which is responsible for Health Education and Promotion.
The Health Education Bureau works in close collaboration with the Family
Health Bureau, Epidemiology Unit, Population
Division of the Ministry of Health, specialised
campaigns, training units and NGOs.
At the provincial level, there are Health Education
Officers attached to the offices of the Deputy Provincial Directors of
Health. They are responsible for providing technical assistance to the
Regional Health Education Officers in the performance of their functions.
Main Activities carried out by the Health Education
Bureau:
 Mass
Media Education
Promotion
of Estate Health
School
Health Education
Oral
Health Education Programme
Hospital
Health Education Programme
Reproductive
Health Education Programme
Research
and Evaluation
Related Links Health Education Bureau Health
Promotion, NCD WHO/SEARO Health Education WHO/HQ Health Promotion WHO/HQ
6.2 Maternal and
child health/family planning/adolescent health
Successive governments of Sri Lanka have shown greater
commitment to strengthen Family Planning and MCH services. Most areas in Sri Lanka
have fairly satisfactory access to MCH/FP services. But there are areas that
need more attention. This is evident from the district disparity of the
maternal mortality in 2001. The maternal mortality ratio of Sri Lanka in
2001 was 47/100,000 Live Births, while it was 169 for 100,000 Live Births in Nuwara Eliya district.
The MCH service has received very high priority and has
now been expanded to take on the broader concept of reproductive health.
The total fertility rate, which was 2.3 in 1993, has
progressively decreased over the years and has reached 1.9 (1995-2000). But
many studies have revealed that quite a large number of induced abortions are
taking place in the country despite legal restrictions. This indicates the
high proportion of unmet needs of family planning.
The prevalence for modern contraceptive methods was 49.5
percent and the overall contraceptive prevalence rate was 72 percent in 2001.
Well Women Clinics were incorporated into the Family
Health Services with the introduction of the concept of reproductive health
in 1996. At the end of year 2000, 295 Well Women Clinics were functioning in
the country, which were mostly based at MOH offices. These clinics provide
screening services for women over 35 years of age against common
non-communicable diseases. Of these 295 clinics established in 2000, 140
clinics provide pap smear screening facility.
The community involvement is a part of the implementation
of the family health activities. The Public Health Midwife (PHM) who is the grass root level family health worker,
works closely with village volunteers.
Monitoring and evaluation system is built into the MCH/FP
programme by the information system, which links service providers and
programme planners at all levels. But information system need to be further
strengthened and should be altered to cater for the changing needs of the
system.
Related Links MCHC Adolescent
Health – WHO/SEARO Child
Health – WHO/SEARO Child Adolescent health WHO/HQ Gender,
Women and Health WHO/SEARO Maternal
Health WHO/HQ Reproductive
Health WHO/SEARO Reproductive Health WHO/HQ Making Pregnancy safer WHO/SEARO Making Pregnancy safer WHO/HQ
6.3 Immunization
The immunization coverage against 7 diseases under the
Expanded Programme of Immunization (EPI) has been achieved and maintained
even in very remote under-served areas. Immunization coverage of all antigens
is 99% in 2005.
Tetanus
Immunization Coverage
The tetanus immunization coverage of pregnant mothers is
over 85 percent in all districts other than five districts out of which two
are from the central province.
Related Links Immunization
– WHO/SEARO Immunization – WHO/HQ
6.4 Prevention and
control of locally endemic diseases
The notifiable disease list of Sri Lanka has
22 diseases. The strategies adopted by Sri Lanka for the prevention and
control of communicable diseases are:
Immunization
against vaccine preventable diseases
Enhanced
disease surveillance and control of notifiable
diseases
Training
of medical and public health staff in prevention and control
Environmental
interventions related to health
The main constraints identified are inadequacy of the
environmental interventions, poor socio-economic conditions and the
nutritional status of the under-served and marginalized populations.
Related Links Communicable Disease Outbreak Epidemiology AI AI – WHO/SriLanka National plan for Dengue Dengue
– WHO/Srilanka)
Sexually
Transmitted Diseases (STD)/Acquired Immune Deficiency Syndrome (AIDS) Control
The National STD/AIDS Control Programme (NSACP) is
responsible for the implementation and coordination, at the central and
regional levels, of the activities related to prevention and control of STDs,
and AIDS. Early case detection and management, partner notification, contact
tracing, health education, counselling, condom
promotion, surveillance and dissemination of information are the major
strategies adopted by the NSACP. During 2001, 19 full-time STD clinics and 14
branch clinics functioned in the island.
Sri
Lanka is considered a low prevalence
country for HIV infection. Prevalence of HIV among pregnant mothers and
orphan of HIV related deaths are negligible in the country.
Related Links STI and HIV WHO
SEARO - HIV
Leprosy
During the last two decades, Sri Lanka has made much progress
in eliminating leprosy. The introduction and expansion of Multi Drug Therapy
(MDT) in 1982, an effective chemotherapy of short term duration and the
launching of the awareness campaign, and the social marketing campaign in
1990 to educate the general public about early signs of leprosy and to dispel
misconceptions surrounding the disease, have resulted in the achievement of
the WHO leprosy elimination goal at the national level in 1995. This is five
years ahead of the targeted year, 2000.
With the integration of leprosy services to the general
health services, new case detection has increased. But registration and
recycling of patients were observed in various districts. Percentage of
multi-bacillary patients remained same as the previous year. Both child and
deformity rates have come down indicating that transmission is disrupted and
patients are detected in the early stages respectively.
Related Links Leprosy WHO
SEARO Leprosy
Tuberculosis
The control of tuberculosis in Sri Lanka comes under the
National Programme for Tuberculosis and Control of Chest Diseases. The
resurgence of tuberculosis globally and its association with HIV, and the
emergence of multi-drug-resistant TB, top priority has been accorded for its
control.
During the year 2001, 8418 new cases of tuberculosis
cases, 410 relapses, and 31 treatment failures were registered. The
notification rate was 42.9 per 100,000 population.
Out of the new cases, 80.2 percent were cases of pulmonary TB. The total
number of deaths notified among the TB cases was 376.
Related Links TB
– WHO/SEARO TB – WHO/HQ
Malaria
Malaria continues to be a major public health problem and
socio-economic burden in Sri
Lanka.
Several countrywide epidemics have occurred in the past. The
activities of the Anti-Malaria Campaign (AMC) were decentralized in 1989.
Since then, the AMC Directorate has been involved in the formulation of the
national malaria control policy, and monitoring in the country.
During 2001, 1.35 million blood smears of fever patients
were screened in government medical institutions for malaria. Of these, 4.9
percent were positive, compared to 11.8 percent during 2000. Plasmodium vivax infections accounted for 84 percent of the caseload
and Plasmodium falciparum infections comprised the
balance. A 68 percent decrease in the total reported cases of malaria and a
decrease of 82 percent in P. falciparum infections
comprised the balance. Like in the previous years, 66 percent of patients
reported during 2001 were from the North and East provinces.
Related Links Malaria WHO SEARO - Malaria
Roll Back Malaria
Initiative
Sri Lanka
has been one of the first countries in Southeast Asia
to adopt the current priority programme of the World Health Organization’s
Roll Back Malaria Initiative. Five districts have been selected initially,
viz. Jaffna, Killinochchi,
Mullativ, Monaragala and Anuradhapura. A need
assessment was completed and a 5-year strategic plan for malaria control in Sri Lanka was
developed. Provincial and District core-groups were established. Different
elements of the Roll Back Malaria Initiative have been incorporated into the
Control Programme.
6.5 Prevention,
control and management of common diseases and injuries
Acute Respiratory
Infection (ARI)
The main objective of the ARI control programme is to
reduce the mortality from acute lower respiratory infections, in particular,
pneumonia in children under 5 years of age. The basic strategy of the
programme is the introduction of standard case management of ARI in children
within the whole healthcare delivery system. This included development of the
skills in the health personnel in early detection of pneumonia and reduction
of major risk factors like low birth weight, malnutrition, indoor air
pollution, parental smoking habits, and the highest possible quality coverage
in the Expanded Programme on Immunization.
Delay in implementation of the ARI activities in the
regional and peripheral level was mainly due to the non-availability of
coordinating officers at regional levels and poor cooperation from the
regional level staff.
Control of
Diarrhoeal Diseases
This programme was started in 1983 and implemented
throughout the country in 1985. The objectives of the programme were:
Reduction
of mortality due to diarrhoeal diseases
Reduction
of hospitalisation by proper management at home
Reduction
of morbidity due to diarrhoeal diseases
Improvement
in the nutritional status by early arrest of diarrhoeal diseases
The main approach in the standard case management of
watery diarrhoea was the introduction of oral rehydration therapy for all cases from the onset of
illness. In the management of dysentery, the main strategy was to use
appropriate antibiotics as early as possible. In both types of diarrhoea, maintaining the nutrition status was also
considered an important step in the management.
Training of hospital and field staff, establishment of
diarrhoeal training units, and educational activities through mass media
played a major role and resulted in early recognition of dehydration and its
correction, by using oral redydration fluid. All
these factors have led to significant reduction in the death rate due to
diarrhoeal diseases. But morbidity due to diarrhoeal diseases has not
decreased at a similar pace.
During the last 20 years, admission to government
hospitals due to diarrhoeal diseases has been fluctuating between 676.1 and
961.3 cases per 100,000 population. During 2001, the
cases treated in government hospitals for diarrhoeal diseases per 100,000 population increased to 857.3 from 742.8 in 2000, and
these ranked as the sixth leading cause of hospitalisation.
It is likely that diarrhoeal diseases will continue to be an important public
health problem in Sri
Lanka.
Measles
Measles is an important childhood disease in Sri Lanka.
According to hospital inward statistics, the annual prevalence of measles in Sri Lanka has
gone down after the introduction of measles vaccination. A measles outbreak
is observed in every 6 to 9 years.
During 2001, 267 cases of measles were notified to the
epidemiological unit, of which 131 cases were confirmed as measles. Analysis
of vaccination status of these cases showed that the vaccination were highest
among the age group1-4 years.
Service utilization across geographic regions
Out-patient
attendance in Government Hospitals
On an average, 2410 out-patient visits are made by 1000
population to government hospitals annually. This range varies from 1608 in Nuwaraeliya district to 3560 per 1000 population at Ampara district. Although this geographical disparity is
seen, the difficult geographical terrain in certain districts seems to have
no influence on the service utilization.
In-patients treated by Government Hospitals
On an average, 212.7 patients per 1000 population seeks in-patient care at government medical institutions.
However, a wide geographical variation in this figure is seen, which ranges
from 7.1 admissions in Killinochchi district to
307.2 admissions per 1000 population in Colombo
district. The low figure in Killinochchi district
could be due to gross under-reporting and shortage of in-patient care
facilities in the district.
Related Links NCD - WHO/SEARO Mental
Health WHO/SEARO Mental Health WHO/HQ Cancer WHO/HQ 
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