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Annual Health Summit2005

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Vision

ASSURE A HEALTHY , PRODUCTIVE LIFE BY IMROVING PHYSICAL, SOCIAL, MENTAL

AND SPIRITUAL WELL-BEING OF THE PEOPLE

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Mission To make curative care User friendly, More accessible, Comprehensive cost efficient and, to the satisfaction of the people in North Western Province of Sri Lanka

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North Western Province of Sri Lanka consists of two districts, Kurunegala and Puttlam.

Population in NWP = 2,157,711 Population in K’gala = 1,452,369 Population in Puttlam = 705,342

Persons per Sq. km : Kurunegala – 314 Puttlam - 245

( Colombo - 3305 Kandy - 664 Gampaha - 1541 )

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Government curative care network at present One Teaching Hospital – at Kurunegala,

administered by line ministry. One General Hospital – at Chilaw ( Putlam District )

Two Base Hospitals in Kurunegala District, Kuliyapitiya Nikaweratiya Two Base Hospitals in Puttlam District, Puttlam Marawila.

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Government curative care network at present

Kurunegala District 15 District Hospitals 12 Peripheral Units 14 Rural Hospitals 01 CD & MH 54 CDs

Puttlam District 04 District Hospitals:

03 Peripheral Units:

06 Rural Hospitals: 05 CD & MH:

19 CDs : Other : STD, Chest, Filaria, Malaria and Leprosy ClinicsOut reach Specialized Clinics:Maternal care:.DH Dankotuwa and DH Mundalama

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Distribution of specialists per 100,000 population

Kurunegala – 2.13 Puttlam - 2.26 ( Colombo – 8.72, Kandy – 6.83, Gampaha – 3.43 ) Distribution of Medical Officers per 100,000 population

Kurunegala – 25.8 Puttlam - 29.8 ( Colombo – 112.1, Kandy – 68.1, Gampaha – 30.3 ) Distribution of Dental Surgeons per 100,000 population

Kurunegala -- 3.6 Puttlam - 2.7 ( Colombo – 9.1, Kandy – 4.2, Gampaha – 2.4 ) Distribution of Nurses per 100,000 population

Kurunegala – 83.2 Puttlam - 43.7 ( Colombo –167.8, Kandy – 141.5, Gampaha – 52.4)

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Government Hospital Bed Strength per 1000 population

Kurunegala – 2.8 Puttlam - 2.2 (Colombo – 4.9, Kandy – 4.2, Gampaha – 2.4 ) Out-patient attendance by district per 1000 population

Kurunegala – 2627.5 Puttlam - 1969.0 (Colombo – 2417.2, Kandy –2670.4, Gampaha –1640.1 ) In-patients treated by district per 1000 population

Kurunegala – 224.0 Puttlam - 163.6 (Colombo – 307.2, Kandy – 267.9, Gampaha – 144.5 ) Number of patients transferred for specialized care Kurunegala – Puttlam - Average Bed Occupancy rate Kurunegala – Puttlam -

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Major issues identified

Over crowding of secondary and tertiary care institutions and under utilization of primary care institutions.

Emergency care services are not well established in all institutions to deliver necessary care to the people who deserve emergency attention.

In- adequate staff skills and poor attitudes of some categories to provide quality , user satisfied care.

Cost benefits of some supportive services such as laboratory, ambulance, and cleaning are low

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Over crowding of secondary and tertiary care institutions and under utilization of primary care institutions.

Major institutions Individual attention is low High incidence of cross

infections Congested environment Long waiting time Essential problems are not

dealt with Opportunity cost is high for

patients In-adequate basic facilities High incidence of mistakes

due to over work

Primary care level Cost per patient is high Staff is idling Certain malpractices

Solutions suggest Back & forward referral system Improve facilities in primary

care level Appoint necessary cadre to

Divisional & PMCU level

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Emergency care services are not well established to deliver necessary care to the people who deserve emergency

attention. Death within one hour after

admission is high Customer satisfaction is low Rush to private sector paying

high cost expecting quick care

Transfer rate of lower level institutions is high

Available skill is not utilized Big hospital overcrowding

would go down Utilization of lower level would

go up

Poor staff skill development

Solutions suggest Assure ETUU in all health

care institutions Appoint qualified cadre Provide necessary

equipment Continuous skill

development programmes Ambulance facilities

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Conflicts are high Customer satisfaction is low Low quality service delivery More patients seek care

from bigger institutions Poor Image to the hospital

Solutions suggest Adopt proper recruitment

procedures Introduce performance

appraisal system Regular staff development

progrannes

Poor commitment and skills of some categories o staff to provide quality , user satisfied care.

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Cost benefits of some supportive services such as cleaning, diet and laboratory are low

Cleaning work force idling Poor cleaning of

environment

Solutions suggest Proper recruitment Out-sourcing

Laboratory Operational cost is high Regular breakdown Non skilled operation due to

shortage of technical knowledge

Solutions suggest Building up close link with

private sector Staff development

programmes

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Objectives

•To provide Infra – structure facilities to obtain expected services from identified institutions•To improve service provision according to the need and to the satisfaction of the people•To develop staff skills and attitudes to deliver quality service•To achieve close link with other health partners to make health services more accessible and qualitative•To develop a system to monitor and evaluation of services giving more attention on regular medical audit

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Proposed hospital network

General Hospital Chilaw and Kuliyapitiya

Base Hospitals: Puttlam, Nikaweratiya, Marawila and Galgamuwa

Divisional Hospitals: All existing District, Peripheral Units and Rural Hospitals.

Primary Medical Care Units; CDs and CD/MH

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Expected services from different category of Hospitals General Hospitals Make available comprehensive emergency care

through out the day Assure availability of residential specialized care

and out door care in all major specialties Assure a wide range of investigation facilities Provide comprehensive care to all needy people

in minimum waiting time Facilities to staff skill development provide information on any health related matter

by a special unit established

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Expected services from different category of hospitals

Base Hospitals Make available emergency care by a separate

unit 24 hours a day Assure availability of selected minor specialized

fields with high demand (out-door and in-door care) in addition to basic fields

Assure availability of a wide range of investigation facilities

Provide comprehensive care to all needy people in minimum waiting time

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Expected services from different category of hospitals Divisional Hospitals Limited emergency care for 24 hours. In-ward facilities for common minor illnesses Poly clinic facilities with, out - reach

specialized clinics Maternity care and labour room facilities Medical recording and referral centre Dental unit Availability of ambulance through a radio link

with other institutions

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Improve the efficiency of supportive services

CLEANING

Proper recruitment or out - source of services is recommended for cost effective & high quality service with management with ease

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Improve the efficiency of supportive services

DRUGS Assure availability of essential drugs in all

health care institutions

Establish a Drug Management unit at each DPDHS Office under direct supervision of Divisional Pharmacist

A Pharmacist/RMO of Drug Management Unit should order, transport from MSD to RDS, and handed over to store keeper at RDS

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Improve the efficiency of supportive services DRUGS Store keeper should take care of all the drugs

and issue to relevant institutions according to the instructions of Drug Management Unit.

improve drug transport facilities Improve facilities of stores in institutions to

reduce pilferage and spoilage Issue drugs in envelops with instructions of use Make people aware of cost of drugs

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Improve the efficiency of supportive services DIET Special Dietary Units are established in all

hospitals, above Base Hospital level, under supervision of a nutritionist

Most suitable diet is given to individual patient

Wastage is reduced by restructuring of diet schedules for staff and patients

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POLICY DIALOG PAPERS

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Develop a system to monitor and evaluation of services

Number of new specialized units started during the year

No of out reach clinics commenced for the year per district

Percentage of institutions above divisional Hospitals do have 24 hour ETU facilities

Percentage of Primary Care Units with Medical recording and referral unit

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Develop a system to monitor and evaluation of services

Number of deaths within one hour after admission per year

Number of public complaints received per month

Number of drugs out- of stock marked on prescriptions per month

percentage of institutional heads received management training per year

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DR. RESHAN AMARASEKERA – DMO Kuliyapitiya

DR. DEMATAPITIYA – DMO Nikaweratiya

DR. M.FAREED – DMO Puttlam

DR. U.R. SIRIMANNE – DMO Galgamuwa

DR. D.K.SIRIMANNE – VP Chilaw

DR. M.A.M.FERNANDO – V Paed. Kuliyapitiya

DR. A PANADARE – VOG Nikaweratiya

DR. J.RANATUNGE – DMO Gokarella

DR. U.S.B.RANASINGHE – DMO Dankotuwa