According to WHO, the Sri Lankan health system ranks at 76 out of 190 and has actually ousted its regional counterpart India which ranked at 112. While global and regional statistics comparisons might put us in a rosy position, it is ultimately the perception of the quality of health services in the people of the Sri Lanka that matters. We are used to seeing a doctors, nurses or support staff striking at least every 3 months. People are constantly complaining of overpriced pharmaceuticals. And politicians keep promising a National Drugs Act shaped after the policies of the late Senaka Bibile.
While these more socialized and market oriented issues attract much public and media attention, there are more complex challenges that health policies must address. As the Health Sector Master Plan (2006-2017) in Sri Lanka comes to end, we need to realize these challenges which await us and how to deal with them. Specifically, such challenges are:
Tropical diseases such as Leptospirosis/ ‘mee una’:
Next, through a clean, safe supply of water, the transmission of Leptospirosis can be reduced to a large extent as the bacteria rely on a contaminated water supply for its transmission. It’s not only Leptospirosis which can be transferred through contaminated water supplies, but other Sri Lankan tropical diseases such as Dengue/Malaria. The constraint to fighting ‘mee una’ is the fact that the water supply to paddy fields cannot be cleaned constantly. Farmers working on fields with open wounds are most at risk of infection.
Doxycycline has been recognized as an effective antibiotic in treating Leptospirosis. However, considering that it is indeed an antibiotic, the respective bacterium can develop Anti-Microbial Resistance (AMR) through natural selection.
If such a super bacteria does come into being in the future, ‘mee una’ can pose an even greater challenge to our healthcare system than at the current moment. It is thus, vital that the healthcare system stays vigilant on the nature of the bacterium and carry out consistent research.
The continuous rise of non communicable diseases:
Non-communicable diseases continue to be the leading cause of mortality. According to a World Health Organization (WHO) report, non communicable diseases such as Cancer, diabetes and Cardio Vascular disease (CVDs) contribute to 70% of the annual deaths. A same pattern is seen in Sri Lanka.
Reducing the deaths by such non communicable diseases involves a pivotal role by the education sector. Essentially, the public needs to be educated of the determinants and the causes for such diseases. This is not limited to school or university education which has a limited reach. It also involves consumer education and making more information about the food they consumer available to them at the point of purchase. One of the recent initiatives taken to tackle diabetes is through the color coding of beverages according to their sugar content.
The changing demographics and epidemiology of the Northern and Eastern provinces:
The use of health information systems and the research facilities are the primary ways to address the changing socio-economic status of the Northern and Eastern regions. Simply put, this is public health intervention. Public health intervention itself is a very broad topic and not as simple as it sounds. It consists of sub terms such as Outreach and Case-finding to name a few. To be simplistic, in its most basic definition is the surveillance of health in a given area through scientific collection, analysis and interpretation of health related data.
Improving healthcare in rural areas of Northern and Eastern provinces:
The time it would to take to build a completely new health system in such areas would be abundant. Hence, based on the feedback which we have received for the current health system, we would have to make the necessary changes to deliver effective healthcare. For example, the Jaffna Regional Directorate of Health Services (RDHS) has stated that they face shortage of resources such as mosquito nets and coils for dengue prevention.
The lack of resources can be due to the financial status of such communities. Using financing methods such as microfinance can be effective in helping provide local communities with basic banking services such microcredit to help initiate local and small businesses.
Reducing the number of traumatic accidents – the leading cause of hospitalization
As for the traumatic accident, any individual who has been in Sri Lanka for a substantial period of time would know that the driving habits of Sri Lankans can be quite dangerous and chaotic. Therefore, it is up to the government to ensure that there is greater regulation of safe driving habits. A higher degree of penalization for misconduct in driving is an obvious solution. However, given the inefficiencies in the current fine collection system people have taken to bribing policeman. This in turn reduces the effectiveness of the regulation of road safety. The solution is not to simply educate people, but to improve the current system.
Use of electronic payment connected to one’s driver’s license can reduce inefficiency and reduce the chances for corruption in road safety. The government will also be able to increase its fine based revenue in the long run by reducing corruption. This money can then be used to improve capacity in the policy, in the national ambulance network and road safety education. What this signals is that doctors and medicine are not the only tools to improve the health of a country.
In conclusion, the collection of health-related data, access to a safe supply of water, health education, community development and individual responsibility will play a key role in advancing the Sri Lankan health system. However, Sri Lanka puts low prioritization to medical data, research and innovation. Most of our medical innovations are imported along with our daily ‘parippu’. Changing this attitude towards medical R&D and innovation, even among our doctors, will go a long way in improving our healthcare system.
Understanding that there is a substantial amount to improve, the key is getting started without delaying it any further. I emphasize on that because some of the above factors are annexed with one another. It’s reasonable to expect a greater degree of community development when we provide a safe supply of water. Thus, the health of the country will be vital in creating equitable development in Sri Lanka; not the just the old story of ‘Kolambata Kiri, Gamata Kekiri’.
The article was written by Sanjana Kolongoda and edited and added on to by Thilina Panduwawala. The article carries opinions on Sri Lanka’s healthcare system and not all of them are verified medical facts.