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EXTERNAL REVIEW- WAYAMBA PROVINCE Dr .Nihal Abeysinghe Chief Epidemiologist Ministry of Health

EXTERNAL REVIEW- WAYAMBA PROVINCE Dr .Nihal Abeysinghe Chief Epidemiologist Ministry of Health. Distribution of curative services. SERVICE UTILIZATION- Out patient Care. Highest average attendance – tertiary & secondary care institutions Tertiary Care Institution. 1& 2 quarters 2005.

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EXTERNAL REVIEW- WAYAMBA PROVINCE Dr .Nihal Abeysinghe Chief Epidemiologist Ministry of Health

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  1. EXTERNAL REVIEW- WAYAMBA PROVINCE Dr .Nihal Abeysinghe Chief Epidemiologist Ministry of Health

  2. Distribution of curative services

  3. SERVICE UTILIZATION-Outpatient Care Highest average attendance – tertiary & secondary care institutions Tertiary Care Institution 1& 2 quarters 2005

  4. SERVICE UTILIZATION-Outpatient Care • Lower the level of hierarchical institution, daily average OPD attendance decreases • In Puttalam district , proportionately more subsequent visits to primary care institutions than in secondary care institutions 1& 2 quarters 2005

  5. SERVICE UTILIZATION-Inpatient Care • Highest bed occupancy- tertiary and secondary care institutions • Low daily average bed occupancy- lower level institutions • Comparatively high value at RH Gonigoda ( 90.7) with other Primary Care Institutions Source 1& 2 quarters-2005

  6. SERVICE UTILIZATION-Inpatient Care

  7. SERVICE UTILIZATION-Inpatient Care • Average duration of stay – higher in secondary and tertiary care institutions TH Kurunegala 3.7days BH Kuliyapitiya 3.3days GH Chilaw 2.7days BH Puttalam 2.6days BH Marawila 3.0days • Primary Care institutions with high average duration of stay Kurunegala district- RH. Mahamukalanyaya( 3.8) RH. Delwita( 3.0) Puttalam district DH Mundal( 2.9), RH Nawagattgama (2.6)

  8. SERVICE UTILIZATION-clinic services • Average clinic attendance in Puttalam district- 63.4 • Institutions with high average clinic attendance PU Mundal 114.4 DH Anamaduwa 91.2 BH Marawila 67.5 GH Chilaw 53.4 • Ratio of first visit to subsequent 1: 2 • Irrespective of the hierarchical type of institutions, utilisation ofmedical clinics – veryhigh (Average clinic attendance exceeds 100).

  9. SERVICE UTILIZATION-clinic services • Utilisation of diabetic clinics- high. • Specialised clinics such as Surgical, Orthopaedic, Ophthalmology, ENT clinics - highly utilised ( average attendance exceeds 50) • Universally available dental and Anti Natal clinics - highly utilised at GH Chillaw ( Dental-55.3, ANC-73.8) • Clinics at PU Mundal- exclusively subsequent users( 95%)

  10. Human resources (per 10000 population)

  11. Costing of anti rabies activities in Puttalam district

  12. Trend of increase in transport cost of an ambulance per KM in Puttalam district

  13. Costing of diets in Puttalam district • The highest total diet expenditure - BH Marawila – 2,969,057SLR • In secondary care institutions , expenditure for patients was higher than that for the staff • Institutions with higher expenditure of diet for staff than patients DH Anamaduwa(56%), PU Lunuwila(57%), PU Madampe(64%) RH Thabbowa (53%) RH Anawilanduwa(60%) CD& MH Mampuri(52%) CD& MH Alutwewa(95%) CD& MH Kottantivu(65%) CD& MH Mahakubukkadawela(95%) • proportion of the diet cost for staff out of total cost is given in parenthesis

  14. Costing of diets in Kurunegala district • The highest total diet expenditure - BH Kuliyapitiya – 3,468,855.33SLR • In secondary care institutions , expenditure for patients was higher than that for the staff • In all primary care hospitals, except for Dambadeniya and Rideegama, expenditure of diet of staff was higher than that for patients

  15. Conclusion • Lower the level of hierarchical institutions, the average daily OPD attendance tends to decrease in both districts. • Out patient services at secondary care institutions had been exclusively used by users for first visits. • Secondary visits were proportionately higher in primary care hospitals than in the secondary and tertiary care institutions. • Higher daily average occupancy , average duration of stay and Bed occupancy rates in tertiary and secondary care institutions reflects the under utilization of smaller institutions and over crowding of specialized institutions in the province . • In Primary Care institutions , a hospital bed on average has changed more occupants than in secondary and tertiary care institutions

  16. higher clinic utilization at some Primary Health Care institutions and registered proportionately high subsequent visits at these places may be due to easy access • Higher utilisation of clinics for non communicable diseases irrespective of the type of institution. • Higher utilisation of specialised clinic services ( ex. Orthopaedic, ENT). • Though, family planning and Ante natal clinics are universally available, high utilisation of these clinics at secondary care institutions reflect the by passing tendency by clients. • Resources • The available cadre is less than the approved cadre for many categories • Similar rates of distribution of health personnel within the province except for some categories .

  17. Costing of services ( Puttalam district) • Two thirds of MOHs in Puttalam district have been able to curtail the average transport cost per MOH vehicle in 2004 while increasing the mileage in comparison to the previous year • Lower the level of the hierarchical institutions, cost per a delivery increases

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