Sri Lanka Health Services care for civilians and terrorists!

Nadira GUNATILLEKE

ECOSOC Annual Ministerial Review, the regional ministerial meeting on `Financing Strategies for Health Care’ will be held at Cinnamon Grand Hotel, Colombo from March 16 to 18 with the participation of 120 delegates from 11 countries.

There will be finance ministers, Foreign Affairs Ministers and Health Ministers will be among them. Sri Lankan Government hosts this event.

The event has been organised in cooperation with the United Nations Department of Economic and Social Affairs (UNDESA), the World Health Organization (WHO) and the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP), the meeting is part of the preparatory process for the 2009 Annual Ministerial Review (AMR).

Topics to be addressed by expert panellists during the meeting will include domestic and external financing for healthcare, as well as challenges for health systems in countries in or following crisis. A special session will also be held to highlight good practices and new initiatives on financing health care.

There will be four Panels and the first panel will be on `Domestic financing for health care’. Professor of Economics, University of Colombo, Prof. Weligama D. Lakshman will be the moderator of this panel.

The discussion of the panel will be focused on the trends in the region regarding levels and sources of domestic financing, the strategies and policies can Government implement to raise adequate funds for national health systems, the mechanisms can be employed to pool risk, the actions can be taken by Governments to ensure the equitable and efficient provision of service.

The same action on how are countries coping with the impact of financial crisis on financing of health care, how can public-private partnerships, domestic NGOs and local communities best complement national efforts to provide quality primary health care to all.

The second panel will be on `External financing for health care’ and it will be moderated by Director, Department of Health Systems Financing (HSF), World Health Organisation (WHO), Dr. David B. Evans.

The discussion will be based on the trends in the region regarding sources, quantity and quality of foreign aid for health, how can Governments ensure that inflows of external funds support the development of the domestic financing system and institutions, rather than weaken it, the impact of vertical funds on national health systems, the impact of the current financial crisis on global funding for health care, how should it be addressed, what steps can the international community take to increase or - in light of the current economic and financial crisis - maintain international funding for the social sector.

The third panel will be on `Challenges for health systems in countries in or certain crisis’. Deputy Regional Director, Regional Office for South East Asia, WHO, Dr. Poonam Singh will moderate this panel.

The discussion will be based on what actions can Governments take to prepare for, respond to and recover from crisis, specifically with regard to health systems, how effective have humanitarian actors been in providing emergency assistance to meet urgent health needs and support health systems in terms of capacity, predictability, effectiveness and accountability, to what extent have emergency funding mechanism met demand and expectations and how can they be improved.

The final panel will be on `Progress and challenges in achieving the Millennium Development Goals and it will be moderated by the Minister of Health and Family, Maldives (TBC), Dr. Aminath Jameel. The discussion will be on the actions Governments have to take to promote Millennium Development Goals (MDGs), the progress Governments have made and the impediments and challenges to achieve the MDGs.

Closing statements of the event will be delivered by Assistant Secretary General, United Nations Department of Economic and Social Affairs (UNDESA), Thomas Steltzer and Foreign Affairs Minister of Sri Lanka Rohitha Bogollagama.

At the end of the sessions, the delegation will visit Dalada Maligawa, Kandy to observe special evening ritual. They will also visit Giragama tea factory, a handicraft centre in Pilimathalawa, Pinnawala elephant orphanage and several other significant places in Sri Lanka. Apart from those special visits, three other field visits have also been organised for them to choose from.

The first field visit includes Peradeniya Teaching Hospital, Medical Faculty of the University of Peradeniya and Peradeniya Botanical Garden. The second field visit includes Primary Healthcare Regional Training Centre, Kadugannawa Divisional Hospital and Kadugannawa MOH Office.

The third field visit includes Doluwa MOH Office, primary health workers in action and indigenous medical practice at the community level.

According to ECOSOC the theme for the 2009 ECOSOC Annual Ministerial Review (AMR) is “Implementing the internationally agreed goals and commitments in regard to global public health”.

The AMR process features three main elements: national voluntary presentations, country-led regional reviews and a global review, based on a comprehensive report by the Secretary-General. These elements are complemented by an innovation fair; and, prior to the session, by a global preparatory meeting and e-forums on the theme of the AMR.

In 2009, in addition to the regional meeting in Sri Lanka, regional consultations will be held on “Promoting Health Literacy” in China and on “Preventing and Controlling the Growing Burden of Non Communicable Diseases” in Qatar.

The resources available for health in many of the world’s countries remain extremely limited. Despite a welcome and substantial increase in external assistance for health since the Millennium Declaration was signed, discussed in the next section, total health expenditure per person - from all sources including external assistance and loans - remained lower than US$30 per capita in 33 of the world’s countries in 2006. Among Asian countries, there is considerable diversity in national incomes and health expenditures, says ECOSOC.

Each year, millions of people are prevented from seeking and obtaining needed health care because of they cannot afford to pay the costs.

At the same time, millions more are forced to seek care and suffer severe financial problems because they need to meet the resulting costs of treatment out of their own pockets. These are some of the reasons why many countries are not yet on track to achieve the health-related Millennium Development Goals.

According to `Sri Lanka:`Good Practice’ in Expanding Health Care Coverage’ authored by Ravi P. Rannan-Eliya and Lankani Sikurajapathy, the expansion of health care coverage in Sri Lanka with its focus on the poor dates from the 1930s and many of the initial motivations continue to be important influences. By far the most important one for health services has been democracy.

Sri Lanka’s health indicators were worse than much of South Asia’s in the 1920s but its health reforms in the 1930s quickly reduced mortality rates.

After world war II, mortality rates rapidly fell for a decade before entering a slower but still rapid and continuing phase of decline. Prior to the 1990s substantial reductions in infant, child and maternal mortality were responsible for most of the declined.

Life expectancy has continuously risen but gain since the 1970s have been confined largely to women and male life expectancy has stagnated, the two authors say.

According to the Healthcare and Nutrition Ministry sources Sri Lanka’s average life expectancy rate is 71 years at the moment and it was only 46 years in 1948. The life expectancy for women is 76 years and it is 74 years for men.

At the moment Sri Lanka records only 14 deaths of children bellow the age of five per every 10,000 live births and 0.1 maternal deaths per every 10,000 births.

According to the same sources Sri Lanka records 3.2 hospital beds for every 10,000 persons and there are 6 doctors and 14 nurses for every 10,000 persons. The bed strength of some of the other South Asian countries are Indonesia 0.6, Maldives and Thailand 2 and Bangladesh 3.43.

Sri Lanka’s current HIV/AIDS prevalence rate is only 0.01 and it is one of the lowest in the world. Sri Lanka has already eradicated certain diseases such as Failaria, Leprosy and Polio. The country is about to eradicate Tuberculosis (TB) and Malaria.

Sri Lanka has the best health care service in the region and also set a world record by treating the LTTE (a terrorist organisation fighting against the State)free of charge for three decades continuously.

Still the Government supply all required drugs and medical equipment to them with the intention of saving innocent civilians who are living as hostages of the LTTE. At present Healthcare and Nutrition Minister of Sri Lanka Nimal Siripala De Silva holds the post of Chairman of the Executive Board of the World Health Organisation (WHO).