Injury is one of the commonest causes of morbidity and mortality in the ages between 15 to 44 years. In Sri Lanka, injuries (particularly, due to motor vehicle accidents) rank as the 11th commonest cause of death. The loss of young and economically active members of society has resulted in lost productivity at work as well as high societal cost in terms of consumption of medical services.
Apart from strengthening the clinical management of these injuries, Health Minister Rajitha Senaratne, recently highlighted the importance of injury prevention and control as one of the multipronged approaches in dealing with this emerging trend.
To tackle the problem, the Minister said that a National Policy and strategic framework on injury prevention and management will be introduced soon. However, on August 3, 2010, the Ministry of Health under the previous Government also released a similar National policy. It is not clear whether the present Government is going to adapt that policy (with or without revisions), or generate completely a new one taking into consideration today’s scenario.
There is no credible information that the 2010-policy was activated. If it had been implanted with a genuine cross sectoral involvement and whole-hearted coin an adequately resourced whole of government commitment to implementing that policy, by now, it would have created a big impact on the population level indicators of injury.
National policy
This article is written on the assumption that a new policy would be forthcoming. In such a scenario, this writer wishes to present few broad measures to be undertaken in creating an effective platform for the reduction of the burden of injury in Sri Lanka.
According to the Health Ministry sources, every year nearly a million people are treated for injuries in emergency departments and majority of them require long-term hospitalization. The unintentional injuries and related deaths in the last 20 years have been increasing year after year, yet the resources directed at reducing injury were not commensurate with the burden it posed to the society.
There are number of reasons for this tragic situation. Most prominent among them are unsafe conditions at home, road and workplace, lack of access to high-quality treatment and rehabilitation services, limited stakeholder involvement, inadequate allocation of resources and an absence of performance measures.
Public health model
Any framework for reducing injuries should be based on the public health model – a model that is used for preventing many other diseases. The public health approach includes identifying the magnitude of the problem through surveillance and data collection, identifying risk and protective factors, and, on the basis of this information, developing, implementing, and evaluating interventions, and promoting widespread adoption of evidence-based practices and policies.
Interventions can be implemented during various time frames before, during, or after an adverse event. For example, safety latches on medicine cabinets provide protection before an injury event, child safety seats minimize injury during the injury-causing event, and effective emergency response speeds treatment and improves outcomes after an injury event has occurred.
The intended policy should lay out a vision to guide actions that are pivotal in reducing the burden of injuries in Sri Lanka. These guidelines should be relevant to all those with an interest in citizens’ health and safety, including, local government bodies, philanthropies, businesses and NGOs, schools, educators and private health care providers and policymakers.
Focus
The plan also should help align priorities, to capitalize on existing strengths, to fill gaps, and to spark action across the nation. Such action will result in measurable reductions in death and disability, and diminish the financial and emotional burden of childhood injuries in families and society. Needless to say, this outcome can only be realized if all relevant stakeholders act on the plan.
The priority focus of the policy needs to be on actions that would influence (1) those injuries that are most burdensome to society, (2) those for which there are feasible evidence-based interventions, (3) those for which outcomes can be most easily measured, and (4) those for which partners and stakeholders are likely available. Such injuries include, motor vehicle-injuries, suffocation, drowning, poisoning, burns, falls etc.,
Six fields
According to this writer’s opinion, the Policy could be structured across six fields, which eventually becomes a blueprint for action. Each field may consist of three to five objectives. The actions recommended in each objective lay out broad areas for improvement.
Data and surveillance
Systematic surveillance is essential for accurate needs assessment. Only with good data can one estimate the relative magnitude of problems in order to set priorities. Current data collection systems in our health sector are imperfect and incomplete. Better data can lead to better decisions, increased effectiveness (doing what works) and efficiency (avoiding waste).
We should have better data standardization, (so that it is comparable across geography and time), better data quality, (so that it is reliable and believable), and filling gaps, (information about circumstances of injury events, outcomes, costs, and other information). Information systems must allow for making existing data more available to those who can use and share it to design and implement interventions.
Some of the actions include developing an online access to key databases, collecting better data on the costs of injury, improving links between police, hospital, and emergency department data, and standardizing data collection and reporting.
Research
Effective research to improve the prevention efforts is needed at three different levels: (1) foundational research (how injuries occur), (2) evaluative research (what works and what doesn’t work to prevent injuries), and (3) translational research (how to put proven injury prevention strategies into action throughout the nation).
Because research is a shared public, academic, and private endeavour, better coordination of research efforts will minimize waste and maximize return.
Research can also help reduce health disparities through better understanding of the relationship between injuries and factors such as socio-economic status, demographics, race and ethnicity.
Some of the actions should include creating a national injury research agenda, developing a national clearinghouse of injury research, identifying key indicators related to injury disparity, and increasing the number of injury researchers through training grants.
Communication
Raising awareness about injuries is important at multiple levels. It can often trigger action, or support policies intended to reduce injuries. Better communication will better inform the actions by policy makers (enacting legislation), organisations (approaching injury prevention in a coordinated way), and by families (implementing evidence-based injury prevention strategies at home, on the road, on the playground, and in the community).
A balanced, coordinated communication strategy must be culturally appropriate, and use both traditional and innovative channels ranging from public relations campaigns to social media.
Various strategies can be used to deliver health messages to specific audiences. Some of the actions include creating and implementing local and national campaigns on safety, establishing web-based communications tool kits, finding local young people to be spokespersons for prevention, and using local businesses to support communication efforts to employees and their families.
Education and training
Education and training is a cross-cutting strategy that can impact other facets of injury prevention. While some overlap between communications and education exists, education is considered here in a more formal context, with the intention to motivate change.
Training specifically refers to the acquisition and use of skills. Education and training in injury prevention can benefit patients, health care providers, public safety officials, and other professionals such as engineers, architects, journalists, teachers, and scientists.
Education and training are intertwined because educators need to not only be deeply familiar with the topic they are teaching, but they need to know how best to transfer that information to the client (skill training). Identifying educational gaps and developing training capacity are current challenges.
We need to integrate injury prevention education into broader educational programs, develop effective educational materials, cataloguing and sharing what works (best practices) with others, and paying attention to educational needs and gaps at all levels from primary education to professional continuing education.
The use of community based organisations to deliver education and training are also important to make educational opportunities more accessible to public health practitioners.
Health systems and health care
Health care providers (both public and private) treat injuries, but they are also partners in prevention through health care systems. While responding to and treating trauma, health care providers are critical for accurately documenting external causes of injuries and circumstances.
Beyond the clinical setting, health care providers are credible advocates for safety and can facilitate change in communities and families. Health care systems can address injury by providing anticipatory guidance to health care providers and collecting clinical data.
Trends and changes to health care delivery models, including adoption of electronic medical records and quality improvement efforts should all be utilized to augment injury reduction goals and objectives by improving data collection. Best practices for delivery of preventive services should be identified and disseminated. Furthermore, opportunities exist for new technologies and information systems to improve injury outcomes.
Information systems can equip providers with evidence-based data to strengthen the quality of clinical decision-making and improve trauma care.
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