Hospital Practice 1. Health Services in Sri Lanka.
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Transcript of Hospital Practice 1. Health Services in Sri Lanka.
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