Sri Lanka has a competent health service. It has won laurels internationally. Should we sit on our laurels and be complacent? Naturally, it cannot be so. On the other hand, everyone has a right to a decent life. That means, first of all a healthy life. It is the duty of the State to provide it. Viewed in this light, experience shows that we have a long way to go to guarantee that right to everyone, especially the poor and the marginalized.
Perusing media reports we find that suicides have become a common occurrence. It is said that Sri Lanka has the fourth highest suicide rate in the world. Though not recognized, mental illnesses are common. The tragedy is that even those that are affected do not recognize it as an illness and seek treatment, unless it becomes acute. In the latter case such persons are ridiculed and harassed by ignorant onlookers. There is a social stigma attached to mental disorders. The busy and competitive lifestyles, tension at home or at the work place, trauma resulting from war or natural disasters –all yield to depression and other types of mental illnesses. Of late the competition for educational achievements and parental and peer compulsion leads to psychological imbalances among schoolchildren and young adults. Cultural prejudices and social stigma has many unmarried mothers to mental stress that they either take their own life or abandon the newborn.
There are also new challenges for the health services. The growing numbers of the elderly (those over 60 years of age) and the danger of new diseases emerging, non-communicable diseases such as diabetes, ischemic heart disease and chronic kidney disease coming to the forefront as prime killers are some of these challenges. Though the elders are increasing in number and their health conditions deteriorating faster, our hospitals are not yet geared for such a rapid need for geriatric care.
The sad situation is that it is the poor and the poorest of the poor that are worst affected by such calamities. The State health service is yet deficient in human and physical resources. For example, it lacks an adequate number of specialists to treat mental patients. On the other hand, there is no rational and equitable distribution of human and material resources that are already in its possession. It is Kolombata Kiri, gamata kekiri (Plums for Colombo and crumbs for villages). Prospects for private practice in the city and reluctance to work in the peripheries due to poor facilities at work as well as good schooling for their children compel many consultants to stay in Colombo or the few other General Hospitals in other cities. Poor administration makes things worse.
Budgetary allocations for health services
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There are new challenges for the health services. The growing numbers of the elderly (those over 60 years of age) and the danger of new diseases emerging, non-communicable diseases such as diabetes, ischemic heart disease and chronic kidney disease coming to the forefront as prime killers are some of these challenges. Though the elders are increasing in number and their health conditions deteriorating faster, our hospitals are not yet geared for such a rapid need for geriatric care |
Though the present government has marginally increased the budgetary allocations for health services most of it is spent on recurrent expenditure leaving inadequate resources for capital expenditure including human resources development. Politicians and administrators often display statistics in absolute terms as to show that we have the best health service in the world.
Statistics misinterpreted could easily fool the people. It is not rare for politicians to quote statistics just like the devil quoting Holy Scriptures. To the man in the street, who is unaware of the totality of the picture the mere visual of an infrastructure facility or the provision of a grant of a few million rupees for a provincial hospital very many defects of the establishment are hidden. The media has periodically reported instances of either equipment lying idle for want of personnel to handle them or personnel remaining idle for want of equipment.
A more rational affordable health service could be developed if priority is given to preventive medicine over curative medicine. While curative medicine is a necessity it would be less expensive in the long-term to give preventive medicine priority status. It would also be beneficial to have an integrated system of medicine combining the Ayurveda, Yunani, traditional medicines and homeopathy with allopathic medicine after due studies and research.
The Yahapalana government came to power promising the formulation of national policies for all major issues facing the country. Now more than two and half years after coming to power, it has not yet formulated a single policy. The formulation of a national health policy cannot be postponed any longer.
Sri Lanka’s experience has been to handle issues singly or in isolation. This excludes many inter-connected factors that could be considered. Hence, what is required is a holistic approach to policy formulation. Health is a subject related to many other aspects of life. It is not a subject for health services personnel or the Ministry of Health alone. The case of dengue control is a fine example. It needs the coordinated efforts of health, education, environment, Provincial Councils and Local Government Ministries, Private sector, Universities, civil society organisations including trade unions etc. On the other hand, the deficiencies in implementing certain remedies considering a single issue is highlighted by its effect on the tea plantations and oat cultivations.
Lack of transparency
One cannot minimize the important role of the mass media in mobilizing the masses in the promotion of health policies and practices among the population. One factor that undermines even the good work of the government is the lack of transparency and its arrogant tendency not to trust the masses once in power.
Media also has a pivotal role in eradicating unscientific beliefs and practices among the population and enlighten them on best practices in personal hygiene.
Unfortunately our legislators and politicians give priority to sectarian party and personal interests with no concern for the people, especially the poor. What is necessary today is a pro-poor health policy like in any other sphere. It is not to discount the rest of the population. They of course have other opportunities to obtain health facilities in the outside the State health system. Often they patronize private sector health institutions. It would be unfriendly to the poor to assist the private sector development using state funds without improving the state health service system. After all, it is the general public and not the rich that provide almost 80 percent of the government revenue (custom duties, etc.). The present system is a classic case of robbing Peter to pay Paul.
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