Health Situation in Sri Lanka
The Government of Sri Lanka is committed to achieve the Millennium Development Goals with strengthening of Primary Health Care (PHC) as a key strategy. Progress in health and social development are evidenced in the vital health outcomes. The infant mortality rate (14.2 per 1,000 live births -2010) and the maternal mortality rate (39 per 100,000Live Births -2011) have been steadily declining since the beginning of the last century. Life expectancies for males & Females at birth are 70.7 and 75.4 years respectively according to health statistic. Sri Lanka has achieved the targets of universal child immunization with immunization coverage of children under three years reaching above 98.5%. Since 1986 Polio has not been reported and Sri Lanka is now on the way to reach another landmark, namely eradication of polio, and Malaria.
Sri Lanka is experiencing a shift in its disease patterns. Whilst still being affected by communicable diseases like Tuberculosis, Dengue fever, diarrhea and Acute and Chronic Respiratory infections; clearly evidence based studies showing a greater significance in the shift of the morbidity and mortality patterns. Non communicable diseases are on the rise and Road Traffic Accidents have claimed as the No1 killer today in Sri Lanka.
Communicable disease Prevention & Control efforts over the past several years have resulted a marked reduction of vaccine preventable and vector borne illness though Dengue fever epidemic is not under control.. However despite overall national downturns for disease such as malaria and tuberculosis, there are significant geographical variations demanding focused interventions in high disease prevalent districts.
The peoples of Sri Lanka enjoy an extensive network of public health clinics and hospital across the country (25 Districts), with most of the population (except in the North East) living within 5 Km of a facility. However, there is room for improvements related to organization and management of the health system. e.g. there are “ pockets” within the country , where there are less health personal per population and easy access to health facilities are hampered. It does occur that tertiary and secondary level hospitals (Teaching, general, and Base Hospitals) have occupancy rates of over 100% while the primary care hospitals (District and Rural Hospitals, and Peripheral Units) often barely have 30% occupancy (9).d
The most peripheral health worker in the health care system in Sri Lanka is the Public Health Midwife (PHM), who is paid by the Ministry of Health and ideally serves a population of approximately 3000 (although the number is often much greater). The PHM is the grass-roots infants, and maintains the link between the clinic and the community. She has a wide range of clinic based duties in addition to household visits. To support the Primary Health Care (PHC) functions and responsibilities of the PHMs, the Government initiated the training of voluntary health workers (VHWs) in the mid 1970s. However, the experience of the following there decades shows that this initiative has not yet fully achieved its goal of increased home visiting services and strengthening preventive health care services in the communities. The Public Health Inspectors (PHI) additionally plays an important role in PHC in Sri Lanka. The responsibilities of PHIs focus on all aspects of disease prevention and health promotion, including water and sanitation and environmental clean – ups.
NGOs and RC Movement contribution to health development
In the non government (NGO) sector, planning and implementation of most health programs have to date been carried out on a piecemeal basis, addressing community health problems identified according to criteria set by outside donors or in accordance with the mandate of a given NGO. However, the NGOs in Sri Lanka, as well as the RC Movement, who target poor and venerable communities for health promotion and disease prevention, and in some instances health care provision, have great potential to contribute towards improving health care.
Sri Lanka Red Cross Society (SLRCS) has an extensive network of volunteers and a branch in each of the 25 districts of the country. It has experience in community-based health activities including first, health promotion, blood donor recruitment and HIV/AIDS.
The role of Red Cross Red Crescent is to support and contribute to strengthen the linkage between communities and health services by facilitating contact when and if needed, provide essential health messages in remote and rural areas, conduct health prevention and promotion activities and to empower people to make informed decisions about their own health. It is to promote healthy life styles and encourage healthy practices and behavior the following diagram shows the relationship between Red Cross Red Crescent and Ministry of Health (including district health services), and the roles of each
SLRCS has been providing health services to the targeted communities through supply of water and sanitation facilities, promoting hygiene, improving psychosocial wellbeing and generating awareness on primary health care issues such as immunization, nutrition, family planning, communicable diseases and also special emphasis to the development of First Aid skills, blood donation camps/drives and HIV/AIDS Programes.
SLRCS is working very closely with the vulnerable communities in establishing healthy living habits with special reference in bringing down the disease burden of non communicable diseases. Emergency First Aid programme and provision of mobile health facilities in conflict affected areas and health in emergency programme is also initiated.
SLRCS was engaged in piloting eye care service in one of the most rural communities and it has shown very good impact to those who are vulnerable. Some of our branches involved in ambulance service especially in the conflict affected areas and very urban setting where the gaps exist.
HIV and AIDS prevention, with special reference to the neglected estate sector is one of the key Programmes of SLRCS HIV prevention unit apart from covering some other target interventions. SLRCS involves with care and support services for the PLHIV.
Blood donor recruitment is the other main Programme in the SLRCS health department which is aiming to become the main partner of MoH in recruiting its regular non-paid donors through our extensive branch coverage using mainly the club twenty five concepts in future. Club 25 concept fits to the local needs and situation. The Blood Donor Programme is covering all the SLRCS branches, looking at the sustainability of the programme. VNRBDR Programme is one of the areas that sustainability can be assured with minimum or least financial resources.
In the recent years SLRCS has contributed in collecting around 7000 pints of blood for the National Blood collection and has supported the National Blood Transfusion Service with country wide felicitation of Donors for the world blood donor day.
Now SLRCS together with MoH, piloting the VNRBDR programme in two districts affected by war. Organizing blood donor camps/drives in all other 24 branches of the 23 districts.
SLRCS has been applying community based approach in implementing health and care activities like CBH, CBHFA, Water and Sanitation, PSP, HIV prevention.
Community Based Health (CBH)
CBH is one of the key successful projects for SLRCS in the past covering 17 Districts. The other strong health Programme is the first aid Programme having an island wide coverage both in community first aid as well as general first aid.
HIV prevention project started in two districts covering mainly the neglected estate communities now after achieving its expected results it has expanding in to more districts and wider target groups under the guidance of SARD. One of the key areas for the SLRCS is to strengthen its relationship with PLHIV networks.
First Aid activities are run by the SLRCS since its inception. Emergency First Aid (EFA) services were also initiated to provide prompt and effective First Aid services in conflict-affected districts. SLRCS is now in the process of establishing First aid teams to provide first aid services, rescue and evacuation support in times of emergency, internal violence, natural disasters and other emergencies.
SLRCS have now its training curriculums in general first aid trainings. SLRCS is in the process of adopting CBHFA new approach to all our community health projects in order to make this approach a success.
standardizedSLRCS is now rapidly scaling up its commercial first aid sector having a more dedicated team both at central and branch level, are also in the process of developing new materials to support this new initiatives.
SLRCS has now build up capacity in addressing psychosocial issues after completing a three year Programme in six Tsunami affected districts, and now planning to utilize the present capacity in conflict affected areas.
In future through its CBHFA programmes and IPA, SLRCS is looking forward to address the emerging health issues such as issues due to global warming, change of demographic pattern, and migration.