Ministry of Healthcare

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Mahinda Chintana - Vision for a New Sri Lanka
A Ten Year Horizon Development Framework 2006 -
2016

• Ministry of Healthcare
• Nutrition

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• Peoples Needs

• Changing /developing world
• Continuing /emerging /evolving
• problems

• Available resources

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Challenges

• Health Services
• Human Resources for Health
• Health Sector Management and Stewardship
• Tsunami and Conflict-affected Areas
• Optimizing the Private Sector Contribution

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Challenges cont..

• Focusing on Vulnerable Groups
• Inter-sectoral Collaboration
• Demographic and Epidemiological Transition
• Health Financing and Resource Allocation

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Health Financing and Resource Allocation 1939 to
2003
Figure 01
MOH Health Expenditure combines Recurrent
Capital Expenditures , 2003 is based on Estimates
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Health financing and resource allocation
Source MOFP
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Method of financing-2006
Source MOFP
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Strategic Framework for Health Development
Inter-relationships among the Five Strategic
Objectives
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The Way Forward

• Platform building for political commitment
  endorsement
• Institutionalization of the Health Sector Master
  Plan
• Social consensus building through social
  mobilization activities
• Formulation of action plans for priority/anchor
  projects
• Capacity building for program management
• Pursuance of financial resource mobilization
• Establishment of a monitoring system for program
  implementation
• Organizational arrangement for program
  implementation

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thank you!
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STRATEGIC OBJECTIVE 1 TO IMPROVE COMPREHENSIVE
HEALTH SERVICES DELIVERY AND HEALTH ACTIONS,
WHICH REDUCE THE DISEASE BURDEN AND PROMOTE HEALTH

• Immediate Objectives
• To rationalize and strengthen the network of
  health facilities and services (that includes
  allopathic and indigenous as well as public and
  private services)
• To introduce technology assessment at the central
  MoH and access appropriate technologies
• To ensure adequate drugs, other medical supplies
  and equipment are in place
• To enhance the quality of service delivery
  (assuring responsiveness to needs)
• To reduce priority diseases/conditions through
  strategic interventions
• To improve the health status of vulnerable
  populations (including marginalized and
  underprivileged groups)
• To promote inter-sectoral coordination for
  disease control and prevention
• To increase public confidence and patient/client
  satisfaction in the health services.

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STRATEGIC OBJECTIVE 2 TO EMPOWER COMMUNITY
TOWARDS MORE ACTIVE PARTICIPATION IN MAINTAINING
AND PROMOTING THEIR HEALTH

• Immediate Objectives
• To monitor public perception of their needs and
  of the health system towards serving as input for
  improvement.
• To improve participation of civil society and
  non-governmental organizations in promoting
  behavioural and lifestyle changes.
• To improve public awareness of their rights,
  responsibilities and options for care as well as
  to establish an ombudsman system.

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STRATEGIC OBJECTIVE 3 TO IMPROVE THE MANAGEMENT
OF HUMAN RESOURCES FOR HEALTH

• Immediate Objectives
• To improve the technical and managerial
  competencies of health staff in both curative and
  preventive sectors.
• To rationalize the development and management of
  human resources for health.
• To improve the performance of human resources in
  the health sector.

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STRATEGIC OBJECTIVE 4 TO IMPROVE HEALTH
FINANCE MOBILIZATION, ALLOCATION AND UTILIZATION

• Immediate Objectives
• To increase government financial support at all
  levels to strengthen the financial sustainability
  of the health sector
• To improve allocative efficiency and equity
• To identify and test alternative financing
  mechanisms (including various forms of health
  insurance, possible fees, co-payment, earmarked
  taxes and others) with a view towards national
  implementation. Adopt best option.
• To make optimal use of financial resources
  (through cost-effective strategies that will be
  identified, adopted and re-evaluated for the
  management of priority diseases/conditions).
• To optimise private sector contribution,
  initially establishing an information-sharing
  mechanism to include reporting on service use and
  quality as well as financing.
• To strengthen financial management (including
  capacity, authority, autonomy, monitoring and
  supervision, and use of available resources).

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STRATEGIC OBJECTIVE 5 TO STRENGTHEN
STEWARDSHIP AND MANAGEMENT FUNCTIONS OF THE
HEALTH SYSTEM

• Immediate Objectives
• To institutionalise effective mechanisms for
  policy development within existing units.
• To enhance efficiency, effectiveness and
  accountability of the MoH and decentralised
  units,
• autonomy in management
• To strengthen managerial performance at national
  and decentralised levels.

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STRATEGIC OBJECTIVE 5 contdTO STRENGTHEN
STEWARDSHIP AND MANAGEMENT FUNCTIONS OF THE
HEALTH SYSTEM

• Immediate Objectives
• To strengthen and introduce monitoring and
  evaluation of performance, which are related to
  health outcomes, in all health institutions.
• To strengthen the system for regulating the
  services of public and private providers.
• To strengthen health information system.
• To strengthen capacity in health research.

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Doctors and Nurses in the Health Sector over the
years.
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Human Resource
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Doctor-patient ratio, particularly in rural areas
to be improved through recruitment and
improvement of facilities.

• Doctor Patient Ratio
• Population 19,500,000
• Doctors in public sector 10,850
• Doctors in the private sector 2,500
• Total 13,350
• 1 Doctor per 1,460 population (whole country).
• 2016 Doctors recruited during from Dec 2005 to
  Nov. 2006.

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Medical and other health employee cadre vcancis
in North to be filled expeditiously

• Vacancies filled in North East.
• No. of vacancies exposed for Doctors 561
• No. of Doctors posted 449
• No. of Doctors did not take up 150
• No of dental surgeons posted 20
• No. of Nurses posted 225
• No. of Midwives posted 145

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Present Hierachy of Hospitals
NHSL
TEACHING HOSPITALS
GENERAL HOSPITALS
BASE HOSPITALS
DISTRICT HOSPITALS
PERIPHERAL UNITS
SPECIAL HOSPITALS
RURAL HOSPITALS
CD MH
CD / MH / BD /VS
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The nomenclature of hospitals to be changed as
follows
To rationalize and strengthen the network of
health facilities and services
Provincial
Teaching / Provincial H.
District
District General District Base
Divisional
Divisional Hospitals
Village
Primary Health Care Units
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Issues and Challenges

• Communicable diseases are still prevalent
• Increasing Incidence and prevalence of
  Non-communicable diseases
• High prevalence of malnutrition and other
  nutritional disorders
• Emergence of diseases of old age
• Service limitations in relation to Child,
  Adolescent and Reproductive Health services
• Health services not responsive to patients needs
  (curative preventive)
• Shortages of skilled Human Resources
• Weak provincial /district health management
• Lack of Emergency Preparedness and Response
  mechanisms
• Limitation of financing resources leading to
  increased numbers experiencing catastrophic
  expenditure and out-of-pocket expenditure

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Mahinda Chinthana Projects Programmes.

• 21 projects and programmes pronounced in the
  declaration.
• Grouped under 5 Health areas based on the nature
  of services.
• Maternal Child Health.
• Eg providing expectant mothers with free basket
  of nutritional food items .
• Disease Prevention
• Eg implementing a programme to eradicate
  polio,malaria,dengue and rabies.
• Drug Policies.
• Eg Senaka Bibile Drug Policy to be reactivated
• Health Service Access improvement.
• Eg Maternity clinics and medical advice to be
  available in every village.
• Facility improvement in underserved areas.
• Eg Residential facilities to doctors to be
  increased

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Estimated Growth of Health Expenditure by
Government of Sri Lanka 2001-2015
Source Health sector master plan study 2003
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VISION

• The government aims to foster a healthier
  nation that contributes to its economic, social,
  mental and spiritual development.

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MISSION

• To achieve the highest attainable health
  status by responding to peoples needs, working
  in partnership, to ensure access to
  comprehensive, high quality, equitable,
  cost-effective and sustainable health services.

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GOAL

• A strengthened health system that
• strives for excellence to improve the
• health outcomes of the people in
• Sri Lanka.

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Government Policy
ENSURING GOOD HEALTH
I consider it my responsibility to preserve the
free health service and safeguard the right of
every citizen for the benefits there under. In
this regard immediate action will be taken to
enhance these services both qualitatively and
quantitatively through increased budgetary
provisions.
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Investment in 2006

• National level Rs. Mn of Total
• Curative services 28,022 78.0
• Preventive services 2,758 08.0
• Nutrition 870 02.0
• Health sector training 2,154 06.0
• Health Research 118 0.6
• Estate health 55 0.2
• General health services 1,174 3.0
• Budget proposals 2,027
• Provincial level
• Provincial Councils 19,777

Source MOFP
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Residential facilities to doctors to be increased.

• New residential facilities coming up in 17
  Hospitals.
• Total estimated cost Rs. 208 m.
• Revised estimate Rs. 160 m.
• Amount paid Rs. 131.7 m.
• 14 projects are in progress(13 will be completed
  by Dec ).
• 3 projects (Mannar, Thelippalai, Point Pedro) not
  yet commenced.
• Quarters for doctors are constructed in GH
  Badulla (22Mn), Gampola BH(5.4Mn), Matara
  BH(3.1Mn), Castle Street HW (29.8Mn), Aluthgama
  BH (1Mn).
• 10 vehicles purchased to transport of Doctors.(60
  Mn)

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Tsunami Rehabilitation of Health Sector

• Healthcare institutions damaged- 104
• All were undertaken by donors.
• Non damaged institutions from both affected
  and non affected districts undertaken by donors-
  32
• Completed damaged Healthcare institution-49
• (39 Gramodaya Health centers,1 GH,3 DH,2 CD,1
  PU, 3 MOH offices)
• Projects ongoing-55