Annual Health Summit 2005

1. Wayamba Annual Health Summit2005 Curative Care

2. Vision ASSURE A HEALTHY , PRODUCTIVE LIFE BY IMROVING PHYSICAL, SOCIAL, MENTAL AND SPIRITUAL WELL-BEING OF THE PEOPLE

3. 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

4. SITUATION ANALYSIS • 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 )

5. 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.

6. 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 : Government curative care network at present Primary health care institutions • Other : STD, Chest, Filaria, Malaria and Leprosy Clinics • Out reach Specialized Clinics: • Maternal care:.DH Dankotuwa and DH Mundalama

7. Human resource distribution in NWP • 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)

8. Utilization statistics of health care institutions • 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 -

9. 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

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

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

12. 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.

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

14. Our plan

15. 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

16. 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

17. 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

18. 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

19. 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

20. Improve the efficiency of supportive services • CLEANING • Proper recruitmentorout - source of services is recommended for cost effective & high quality service with management with ease

21. Improve the efficiency of supportive services DRUGS • Assure availability ofessential drugsin 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

22. 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

23. 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

24. POLICY DIALOG PAPERS

25. 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

26. 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

27. Thank you !

28. Good Day ! by Dr. U.S.B.Ranasinghe

29. 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 OUR TEAM