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Allopathic medicine panacea for all ills

Until our own national flag was hoisted on February 4, 1948, every sector of the country was under the influence of the ruling Britishers. Being under foreign domination for over four and half centuries under the Portuguese first, Dutch and British later, the country took on a new road to stand up on its own.

Country's health sector before the colonial rule was predominantly the Ayurvedic system passed down the generations. Despite the foreign influence, the majority depended on Ayurveda.

Although, a tiny island in the Indian Ocean, Sri Lanka had a highly developed medical system and according to Mahawansa and ancient inscriptions on rock surfaces, an organised medical services did exist for centuries.

The hospitals established during the foreign rule served mainly the military and their officials but not the local. But undoubtedly, the Civil Medical Department set up in 1858 was the beginning of the health services.

The first village level dispensary was opened in 1877 and concentration was given to improve healthcare facilities to south Indian immigrant labourers in coffee and tea plantations.

The specialised campaigns to control the major diseases like malaria, tuberculosis, leprosy, filariasis and venereal diseases were carried out and the first international organisation, the Rockefeller Foundation, arrived the country to assist in the prevention programs.

However, between 1870 to 1948, the death rate there was a marked drop from 22.8% to 13.2% and infant mortality from 158 to 92 per 1,000 due to good progress in the health sector facilities.

These rates dropped as a result of combined outcome of malaria control, improved nutrition, better environmental sanitation, expansion of health facilities and provisions of maternal and child care including immunisation, improved quality, efficiency and effectiveness of health care and delivery system.

"There were two types of hospitals, General and Special in 1948 with a bed capacity of 18,585. Since independence all the successive governments took steps to expand curative and preventive services.

As a whole, health sector in Sri Lanka has shown a considerable progress since independence'', said Deputy Director General of Health Services (Planing) Dr. Sarath Samarage.

At independence the Ministry of Health managed six hospitals in Colombo with a total bed strength of 2,600.

Today the total number of beds in state hospitals has shot up to 61,835 and the total number of hospitals including central dispensaries is 604. The National Hospital alone has 2,926 beds.

According to Dr. Samarage, universal child immunization that Sri Lanka achieved in 1989 was one of the major achievements the country could boast of. "The other achievements since independence are the increased life expectancy, reduced birth and death rates, declining infant and maternal mortality rates, elimination of small pox and poliomyelitis and marked reduction in the number of cases of leprosy", he said.

Dr. Samarage also added that significant increase in number and different categories of human resources of health improvements in health administration, technical innovation, expansion and strengthening of health infrastructure had also contributed to the progress in health, after Independence.

Under free education and with a high literacy rate, the health sector, compared to other countries in the region, has improved as it had helped to launch awareness campaigns successfully.

The basic health massages reached the people to all four corners of the country and this helped to contain most of the communicable diseases.

Specialised campaigns for the control of diseases which were considered of major public health importance were established from time to time ; the Anti-malaria campaign in 1922, the anti-filariasis campaign in 1947, the Anti-TB campaign in 1952, the Anti-VD campaign in 1952, the Anti-leprosy campaign in 1954 and the Rabies Control campaign in 1953.

The secrets behind this very successful immunization, where over 89 per cent of children under one year of age were protected against TB, diphtheria, tetanus, polio and measles was purely because of strong political commitment to immunization after independence with adequate number of trained staff, necessary funding and the support of mothers.

The activities that led to the successful immunization campaign were commenced after the independence and it became a success following the introduction of the Expanded Program on Immunization in 1978.

The BCG vaccination against TB was introduced in 1949, Triple vaccination against diphtheria, whooping cough and tetanus in 1961, oral polio vaccine in 1962, BCG vaccination for new born babies in 1963, Tetanus toxoid administration to pregnant mothers was introduced in 1969 and measles vaccination in 1984.

After independence maternal and child health took a new turn. With the increase of number of trained manpower (midwives), the health care services reached the grass root level.

The establishment of Family Health Bureau helped to strengthen the health infrastructure to provide an efficient and effective family health services throughout the country. Several programs to improve the health of the mother and child had launched and while promoting breast feeding to reduce the malnutrition a greater emphasis was given to improve the nutritional status of the girl child.

Among the achievements in maternal mortality and morbidity of 16 in 1945 to the present level of 0.6 per 1,000 live births, reduction of stillbirths - 20 per 1,000 births, reduction of stillbirths - 20 per 1,000 births, reduction of infant and neonatal morbidity and mortality.

The main focus of the health sector is ensuring equity through easy access to quality and modern health care services, mainly to the lower income groups and the most vulnerable groups.

Human resources in the health sector is another vital section that had improved since independence. The free education system helped to produce our own medical staff. The gradual increase in the health cadre with planned training programs to enhance their quality of work has contributed immensely to the progress of the sector since 1948.

Today there are over 10,500 doctors, 19,700 nurses in the health sector. The country has been able to produce consultant doctors in different sectors in medicine and 85 new consultants have been added to the cadre in 2006.

Establishment of nurses training schools were also an achievements in the health sector. A total of 9,500 student nurses follow training at 14 institutes at present.

Since independence every successive government have given attention to develop the primary health care services.

The gradual development in the sector had resulted in carrying out the health message through the health staffers, who are specially trained to look after the health of the rural people.

Last year only 567 Public Health Midwives and 169 Public health Inspectors were recruited to strengthen the primary health care services in the country.

Upgrading the 140 year-old Colombo General Hospital to a National Hospital is one major milestone in the health history.

Establishment of the Medical Supplies division, National Drugs Quality Assurance Laboratory, the State Pharmaceutical Corporation, and Medical Research Institute were also other major milestones.

With increased budgetary allocations each year, the modern facilities have been added to the state health sector and major disease identifications in various sectors including cardiology and neurology have done due to the availability of modern medical equipment like CT scanners.

Over Rs. 381.2 million had spent last year to purchase medical equipment to hospitals and Rs. 1348.8 million for construction and rehabilitation of health institutions, last year.

Development of the best and modern blood bank in South Asia at a cost of Rs. 311 million, the first ever 'Linear Accelerator' for cancer treatment at Maharagama Cancer Hospital, Cardiology Unit at the Lady Ridgeway Children's Hospital, which is considered to be the largest children's hospital in South East Asia, are a few major achievements in the health sector since independence.

Tsunami disaster was one major challenge that was faced by the health sector. The first ever and the worst disaster destroyed over 104 health care institutions. And many of them have been rehabilitated and reconstructed spending over Rs. 5,257 million.

With the considerable improvement in the health sector after independence the country faces new challenges with an increase in non-communicable diseases. There was marked increase in diabetes, hypertension, heart diseases, cancer, thalassaemia, kidney diseases, mental illnesses.

The National Authority on Tobacco and Alcohol was established.

Introducing new policies and legislations to strengthen and improve the health services were another also step taken to develop the country's health sector.

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