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| Sunday, 24 April 2005 |
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Editorial |  |
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Please forward your comments to the
Editor, Sunday Observer. E-mail: [email protected] Snail mail : Sunday Observer, 35, D.R.Wijewardana Mawatha, Colombo, Sri Lanka. Telephone : 94 11 2429239 / 2331181 Fax : 94 11 2429230 Health Sector: Some concerns The health sector is a sick giant. Obviously this does not augur any good for the citizens. There are perennial strikes, sometimes on trivial issues. There are professional wars between different categories of employees. Shortages of personnel, drugs and equipment are eternal woes that afflict state health institutions. There is also the larger problem of mismanagement, lack of planning and corruption. To cap them all we have conflicts between the provincial and central health authorities. Above all we need a health policy. One that was formulated some time ago met with stiff opposition from doctors and other concerned health professionals and the public. As long as there is no recognised national health policy chaos in the health sector would continue. This does not mean that the adoption of such a policy would automatically solve all problems. Certainly the implementation of it would redress matters to a great extent. We would like to draw attention to some issues of concern. First of all, it is necessary to be clear about the strategy approach to health issues. We say that preventive medicine should get priority over curative medicine. The neglect of preventive medicine costs the government as well as the public more. Needless to say this involves well-orchestrated public awareness programs, employment of media as a conduit to carry health messages and health education primarily at school and community levels. It is also necessary to look for areas beyond health services that could contribute to better preventive medicine practices. For example, campaigns against smoking could be assisted by state taxation policies that discourage the production and sale of tobacco. Another issue of concern is the relation between state and private sector in health services. Commercial profit should not be the sole basis of the private health sector. Service and productivity should be equally important criteria in running private medical institutions. There should be strict monitoring of their services to ensure quality of service and prevent mercenary exploitation of patients. Since the private health sector also receives state assistance by way of duty concessions and the service of state medical officers they should be compelled to have special services to the low-income patients at no cost or subsidised rates as is found in many foreign private sector health institutions. In developing specialised services for which large capital outlays are required there should be a division of responsibilities between the state and private sectors for speedy development. The Government should assist poor patients who need treatment in such specialised private institutions by way of grants and subsidies. Whatever the merit of the open economy we have seen a gradual erosion of state expenditure on health services over the last decades. Health like education remains primarily a responsibility of the state especially in view of the overwhelming poverty that affect millions in our country. Hence it is imperative that a higher percentage of the GDP should be allocated to health in the annual budget. At present there is no rational basis in which state health facilities are utilised. Even the affluent who could get treatment in the private sector get free treatment at state institutions. It would be better to introduce a universal health insurance with state subsidised premiums for the people on a graded scale according to their income. If there is a will there is a way. The government could introduce a levy similar to the defence levy it introduced during the fratricidal war and find necessary funding for a special health fund. There does not seem to be any serious planning in developing the health infrastructure. That is why we find instances where infrastructure facilities like operating theatres are kept idle for want of surgeons, anesthetists and supporting staff or this staff idles due to lack of infrastructure facilities. Instances of poor maintenance of infrastructure facilities causing breakdowns in services are also not rare. Another issue is the development of alternative systems of medicine - Ayurveda, Unani and Homeopathy. What is required is a holistic approach that takes into account all these different systems of medicine and the popular demand for each of them. Also required is a program that identifies the big killers like accidents, heart diseases, and diabetes and improve both preventive and curative facilities. Most of them are related to the life styles of people. Obesity causing sedentary life style, for example is a contributory factor for both diabetics and health ailments. Here public education could do a lot to change the life styles and arrest the upward trend of these diseases. An alarming growth is the tendency to fall prey to these diseases at a younger age than before. An unfortunate situation in our society is the virtual neglect of mental illnesses and the social stigma attached to them. |
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