Hospital PracticeHospital Practice

1. Health Services in Sri Lanka1. Health Services in Sri Lanka

Organization of health Organization of health ServiceService

Health care is provided by bothHealth care is provided by both Public Sector (for nearly 60% of population)Public Sector (for nearly 60% of population)

&& Private SectorPrivate Sector

Public sector health carePublic sector health care

The Department of Health Services and The Department of Health Services and the Provincial Health Sector encompass the Provincial Health Sector encompass the entire range ofthe entire range of PreventivePreventive CurativeCurative Rehabilitative Rehabilitative

health care provisionhealth care provision

Private Sector Health Private Sector Health carecare

The private sector provides mainly The private sector provides mainly curative carecurative care

Nearly 50% of the outpatient care of the Nearly 50% of the outpatient care of the populationpopulation

Largely concentrated in the urban and Largely concentrated in the urban and suburban areas ?suburban areas ?

Inpatient careInpatient care

95% of inpatient care is provided by the public 95% of inpatient care is provided by the public sectorsector

Services are provided byServices are provided by Department of Health ServicesDepartment of Health Services Provincial councilsProvincial councils Local AuthoritiesLocal Authorities & Service provisions especially for& Service provisions especially for Armed forcesArmed forces Police personnelPolice personnel Estate populationEstate population

Systems of MedicineSystems of Medicine

WesternWestern AyurvedicAyurvedic UnaniUnani SiddhaSiddha HomeopathyHomeopathy The public sector comprises Western & The public sector comprises Western &

Ayurvedic systems. Western medicine is the Ayurvedic systems. Western medicine is the main sector catering to the needs of the main sector catering to the needs of the people.people.

AccessibilityAccessibility

Sri Lanka possesses an extensive network of Sri Lanka possesses an extensive network of health care institutionshealth care institutions

The majority of the population has The majority of the population has easy access to a reasonable level of easy access to a reasonable level of healthcare facilitieshealthcare facilities

Any health care unit can be found not further Any health care unit can be found not further than 1.4 km from any homethan 1.4 km from any home

Free government western type health care Free government western type health care services are available within 4.8 km from services are available within 4.8 km from home home

National Health PolicyNational Health Policy

The broad aim of the heath policy is toThe broad aim of the heath policy is to Increase the life expectancyIncrease the life expectancy Improve the quality of lifeImprove the quality of life

This is to be achieved by This is to be achieved by Controlling preventable diseasesControlling preventable diseases Health promotion activitiesHealth promotion activities

Concern of the GovernmentConcern of the Government

To address health problems likeTo address health problems like Inequities in health service provisionInequities in health service provision Care of elderly and disabledCare of elderly and disabled Non-communicable diseasesNon-communicable diseases Accidents and suicidesAccidents and suicides Substance abuse and malnutritionSubstance abuse and malnutrition

Thrust areas for Thrust areas for implementationimplementation

Improve hospitals to reduce inequitiesImprove hospitals to reduce inequities Expand the services to areas of special needs (e.g. the Expand the services to areas of special needs (e.g. the

elderly, disabled, victims of war and conflict, elderly, disabled, victims of war and conflict, occupational health problems, mental health, estate occupational health problems, mental health, estate health services)health services)

Develop health promotional programmesDevelop health promotional programmes Reforms of organizational structure to improve Reforms of organizational structure to improve

efficiency and effectivenessefficiency and effectiveness Resource mobilization and managementResource mobilization and managementThe government has taken efforts To maximize the The government has taken efforts To maximize the

financial allocations on health developmentfinancial allocations on health development

Health AdministrationHealth Administration

The health services function under a The health services function under a Cabinet Minister.Cabinet Minister.

With the implementation of the provincial With the implementation of the provincial councils act the services were devolved councils act the services were devolved toto Ministry of Health at the national level Ministry of Health at the national level

(Central)(Central) Provincial Ministries of Health at the eight Provincial Ministries of Health at the eight

provinces (now nine)provinces (now nine)

Central Government Central Government Ministry of HealthMinistry of Health

MH /DGHS is primarily Responsible for the MH /DGHS is primarily Responsible for the protection and promotion of people’s health.protection and promotion of people’s health.

Its Key functions areIts Key functions are Setting policy guidelinesSetting policy guidelines Medical and paramedical educationMedical and paramedical education Management of teaching and specialized Management of teaching and specialized

medical institutionsmedical institutions Bulk purchase of medical requisitesBulk purchase of medical requisites

Provincial Ministries of Provincial Ministries of HealthHealth

PMHS /PDHS are responsible for PMHS /PDHS are responsible for management and effective management and effective implementation of health services in the implementation of health services in the respective provincesrespective provinces

To manage the Provincial, Base and To manage the Provincial, Base and District Hospitals, Peripheral Units, Rural District Hospitals, Peripheral Units, Rural Hospitals, Maternity Homes and Hospitals, Maternity Homes and outpatient facilities such as central outpatient facilities such as central dispensaries and Visiting Stationsdispensaries and Visiting Stations

PDHS , DPDHS, PDHS , DPDHS, MOH/DDHSMOH/DDHS

PDHS

DPHS

MOH/DDHS

Ministry of Health & the Ministry of Health & the Department of Health Department of Health ServicesServices

In 1999, the Ministry of Health was restructured In 1999, the Ministry of Health was restructured resulting the separation of the Department of resulting the separation of the Department of Health Services from the Ministry of Health.Health Services from the Ministry of Health.

The Director General of Health Services heads The Director General of Health Services heads the Department and has the immediate the Department and has the immediate support from Deputy Directors general, each support from Deputy Directors general, each in-charge of a special programme area. They in-charge of a special programme area. They have a number of Directors responsible for have a number of Directors responsible for different programmes and organizationsdifferent programmes and organizations

Department of Health ServicesDepartment of Health Services

DDHS

DDG(PHS)1 DDG(PHS)2 DDG(MS1) DDG(ET&R)

Director P1

DDG(LS)

Director P2 Director Training

Health FacilitiesHealth Facilities

Consists of a Network of curative care institutionsConsists of a Network of curative care institutions Primary care InstitutionsPrimary care Institutions

Central Dispensaries, Maternity Homes, Rural Central Dispensaries, Maternity Homes, Rural Hospitals, Peripheral Units, District HospitalsHospitals, Peripheral Units, District Hospitals

Secondary care InstitutionsSecondary care Institutions Base Hospitals, Provincial HospitalsBase Hospitals, Provincial Hospitals

Tertiary care institutionsTertiary care institutions Teaching Hospitals, Special HospitalsTeaching Hospitals, Special Hospitals

Number of hospitals & Number of hospitals & bedsbeds

15 teaching hospitals – 14,695 beds in 15 teaching hospitals – 14,695 beds in 20002000

Total beds in all hospitals – 57,027 in Total beds in all hospitals – 57,027 in 20002000

Ratio of beds per patients – 2.9 per 1000 Ratio of beds per patients – 2.9 per 1000 patientspatients

The National Hospital of The National Hospital of Sri LankaSri Lanka

In 2000 – 2,881 patient bedsIn 2000 – 2,881 patient beds Provides for number of specialties including Provides for number of specialties including

subspecialties like neurology, cardio-thoracic subspecialties like neurology, cardio-thoracic surgery but excluding paediatrics, obstetrics, surgery but excluding paediatrics, obstetrics, opthalmology and dental surgery.opthalmology and dental surgery.

Has a well equipped accident service and Has a well equipped accident service and several intensive care unitsseveral intensive care units

The specialties not found in NHSL are The specialties not found in NHSL are provided by the two maternity hospitals, provided by the two maternity hospitals, children’s hospital , eye hospital and the children’s hospital , eye hospital and the dental institute.dental institute.

Provincial hospitals and Provincial hospitals and Base HospitalsBase Hospitals

In 2000 There were In 2000 There were 6 Provincial hospitals 6 Provincial hospitals 36 Base hospitals with 9,865 patient beds36 Base hospitals with 9,865 patient beds The provincial hospitals at Kalutara, Ratnapura, The provincial hospitals at Kalutara, Ratnapura,

Matara and Badulla and Base hospitals at Matara and Badulla and Base hospitals at Kegalle and Gampola are under the Department Kegalle and Gampola are under the Department of Health Servicesof Health Services

Only in few base hospitals have basic specialtiesOnly in few base hospitals have basic specialties

Specialties at provincial Specialties at provincial hospitals hospitals

General medicineGeneral medicine SurgerySurgery ObstetricsObstetrics GyneacalogyGyneacalogy OpthalmologyOpthalmology ENT ENT PaediatricsPaediatrics Radiology Radiology Pathological laboratories & other auxiliary Pathological laboratories & other auxiliary

servicesservices

District Hospitals, District Hospitals, Peripheral Units and Rural Peripheral Units and Rural HospitalsHospitals

The distinction between DH, PU,and RH The distinction between DH, PU,and RH is made on their size and the range of is made on their size and the range of facilities provided. DHs are the largestfacilities provided. DHs are the largest

The total care available in DHs and Pus The total care available in DHs and Pus is superior to RHs because the is superior to RHs because the availability of nursing personnelavailability of nursing personnel

In 2000 were 156 DHs, 93 Pus (4,586 In 2000 were 156 DHs, 93 Pus (4,586 beds), 167 RHs (4,382 beds) beds), 167 RHs (4,382 beds)

Preventive ServicesPreventive Services

252 Health Units (MOH offices) headed 252 Health Units (MOH offices) headed by Medical Officers of Health, carry out by Medical Officers of Health, carry out preventive services.preventive services.

The staff include PHIs, PHNs & The staff include PHIs, PHNs & MidwifvesMidwifves

Health ManpowerHealth Manpower

Medical officers – 7,963 Medical officers – 7,963 Persons per doctor – 2431Persons per doctor – 2431 Number of Nurses per 100,000 Number of Nurses per 100,000

population – 76population – 76 There was a shortage of Radiographers, There was a shortage of Radiographers,

Physiotherapists, Medical Laboratory Physiotherapists, Medical Laboratory Technicians, Pharmacists and ECG Technicians, Pharmacists and ECG Recordists Recordists

Health Manpower Health Manpower TrainingTraining

Basic TrainingBasic Training UniversitiesUniversities NIHS -KalutaraNIHS -Kalutara Training SchoolsTraining Schools

Post Basic TrainingPost Basic Training PGIMPGIM Abroad - FellowshipsAbroad - Fellowships PBS- NursingPBS- Nursing In-service Training ProgrammesIn-service Training Programmes

End of Lesson 1End of Lesson 1