DR. CHITHRAMALEE DE SILVA

FAMILY HEALTH BUREAU

MINISTRY OF HEALTHCARE AND NUTRITION

THE IMPACT OF FAMILY HEALTH PROGRAMME ON FAMILY WELL-BEING

SRI LANKA

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Population: 19.6 million(2005)

Women in reproductive age : 5.4 million (27.7%)

Married women : 3 million (14.5%)

Mean Age at Marriage for Females: 25.5 yrs (1994)

Birth rate : 18.8 /1000 LB

MMR: 37.8 / 100,000 LB (2004)

Institutional births: 95%

IMR : 11.2 /1000 LB (2003)

Family Health Centered towards…………..

Health and well-being of the mother

Health of the children

Participation of father and family members inwellbeing of the family

Thereby improve the quality of life of the family3

Vision of the Family Health Programme

A Sri Lankan nation where healthy families and individuals play a pivotal

role in human development

Mission

To contribute to the attainment of the highest possible levels of health by individuals, families and communities through provision of comprehensive, sustainable, evidence-based, equitable, and quality maternal and child health services.

Family Well being thro’ Family Health

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Care for E ligiblecouples

Care for pregnant mothers Domiciliary & clinic care

Intra natal carePost natal care

Organized and continued MCH care

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Secretary of Health

Director General of Health Services

Deputy Director Generals• Public Health Services• Medical Services• Planning• Administration• Finance• Lab Services

Epidemiologist Director MCHDirector HEB

EpidemiologicalUnit

Family HealthBureau

Health EducationBureau

ORGANIZATIONAL STRUCTURE OF FHPCentral Level

Provincial Director of Health Services

MO. MCH

ORGANIZATIONAL STRUCTURE OF FHPProvincial Level

Regional Director of Health Services

RSPHNO

RE SSO/HEO

MOH

PHNS SPHM PHI PHMSPHI

1. Ensure a safe outcome for both mother and newborn through provision of best available care during pre-pregnancy, pregnancy, delivery and post partum period.

2. Ensure survival and optimal health for all neonates through provision of best possible care.

Maternal and Newborn health

Antenatal Care Provided through clinic based and home based care

Registration of pregnant mothers preferably before 8 weeks

Domiciliary care at the door step by PHM on regular basis

Routine Antenatal care includes Regular monitoring of wellbeing of the mother and the foetusNutritional assessment and supplementationHigh risk screening and appropriate referralImmunization against tetanus

Approximately 98% receive care from Government Programme

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Intranatal Care

Mainly in Institutional setting75% occur in institutions with comprehensive EmOCfacilities

98% receive trained assistance at delivery

95% in hospitals3 % by PHM at home

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Enable all children to survive and reach their full potential for growth and development through provision of optimal care.

Enable marginalized children and those with special needs to optimally develop their mental, physical and social capacities to function as productive members of society.

Expansion of the child health programme to incorporate services to optimize development (ECCD programme)15

Child health

Provision of domiciliary and clinic care

Registration of infants for child care services and regular follow up

Necessary education and advice on breast-feeding, complementary feeding and immunization etc.

Routine immunization at child health clinics

Regular monitoring of growth and development regularly

Provision of food supplements at clinics

Monitoring psycho-social development

Provision of instructions on prevention and control of diarrhoealdiseases and ARI

Referral of any abnormalities/complications to higher level institutions for appropriate management.

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Trends in IMR since 1945 - 2003

Source- Registrar General’s Dept

0

10

20

30

40

50

60

70

1975-76 1977-78 1980-82 1987 1993 1995-96 2000

Year

Perc

ent

Underweight Stunting Wasting

Source: MRI database & DHS survey

Trends in under-nutrition among < 5 yr children

SCHOOL HEALTH PROGRAMME SCHOOL HEALTH PROGRAMME 1. 1. Engages health and education officials, teachers,

students, parents, and community leaders and other relevant organizations in efforts to promote health.

2. 2. Strives to provide a safe, healthy environment, both physical and psychosocial

3. 3.Provides skills based health education

4. Reorientation of school Health services

5. Implementing health promoting practices

6. Empower children to act as change agents of community Health

Enable all couples to have a desired number of children with optimal spacing

Cafeteria approach to Family Planning Modern temporary methods provided through MCH clinic services & NGOsPermanent methods through Govt. hospitals and NGOsSignificant proportion use traditional & natural methods

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Family Planning

A choice of contraceptivesTemporary

Hormonal

IUD

Barrier

Permanent

Male

Female

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Decline in Total Fertility Rate 1953 - 2000

0

1

2

3

4

5

6

52/54 62/64 70/72 80/82 85/87 91/93 98/99

Tota

l Fer

tility

Rat

e

Trends in Contraceptive use – National surveys

010203040506070

WFS

1975

CP

S19

82

DH

S19

87

DH

S19

93

DH

S20

00

Percent currently using

Any Modern Method Any Traditional Method Any Method

Unmet need

Unintended pregnancies

Unwanted pregnancies

ABORTIONS(Illegal, maternal morbidity & mortality)

Addressing special reproductive health needs of women

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Established in Sri Lanka in 1996

Screening services for women over 35 years

Women are screened for common NCDsand reproductive cancers

Pap smear screening facilities available in all districts

• Diabetes Mellitus• Hypertension• Breast malignancies and abnormalities• Cervical cancers

Well Woman Clinics

Trends in establishment of Well woman clinics

397

446

350

418

240

310330

349379

168140

305

260247

0

50

100

150

200

250

300

350

400

450

50020

00

2001

2002

2003

2004

2005

2006

No. of WWCsNo. with Pap facilities

Promote gender equity and equality in relation to MCH.

Develop MCH-related gender equity and equality.Ensure gender main streaming in health services

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Family health programme linked to MDGs

Improve maternal Health with reduction of Maternal MortalityReduction of Infant MortalityIncrease skilled attendance at deliveryReduction of Child malnutrition

MCH related MDG Targets for 2015

Indicator Current Year Target Year

Infant mortality rate 13.3 2000 9.0 2015

Maternal mortality rate 53.6 2002 36.0 2015

Contraceptive Prevalence RateModern methods 49.5% 2000 60.0% 2015

Nutrition status of children aged 3-59 months

2015

underweight 29.4% 2000 15% 2015

Deliveries attended by unskilled personnel (%)

1.8% 2000 <1.0% 2015

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