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Sunday, 3 April 2011

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Government Gazette

Upgrading rural hospitals

Sri Lanka has a world renowned healthcare system on par with those of the developed world. Not many other developing or emerging countries can boast of having a free healthcare system that takes care of its citizens literally from the cradle to the grave. The foundation of this system is the Government hospital.

Government hospitals and dispensaries are scattered throughout the country, even in some of the most remote areas. They are the first port of call for many villagers in the case of sudden illness or accident. It goes without saying that these hospitals should be maintained to the best possible standards to serve the public.

It is in this context that we should commend Health Minister Maithripala Sirisena's directive to health officials to re-open 95 state hospitals that had been closed down for years. They will all be upgraded with the latest facilities according to news reports.

According to a Health Ministry spokesman, all 95 hospitals had been closed due to lack of human and other resources to serve the public.

All those hospitals are located in the Northern Province, Eastern Province and in the estate sector and such hospitals were mainly serving the poor.

The spokesman was quoted as saying that the re-opening will be done within this year. This has been deemed essential since the percentage of patients in Sri Lanka has increased by 20 percent in the past three years. It is thus essential to have more state hospitals.

Priority will be given to these 95 hospitals by posting newly recruited doctors, nurses and all the other health staff. They should be given the latest diagnostic and surgical equipment as well as pharmaceuticals. Anti-venom and anti-rabies vaccinations must also be provided in abundance. Fully equipped ambulances too must be given.

The expansion of the rural healthcare system is a sound move that will augment the country's health sector and reduce the strain on the bigger provincial hospitals, especially in the North and the East. A hospital will thus be within easy reach of every Sri Lankan man, woman and child.

Most of the private hospitals are confined to the Colombo metro area.

They should be encouraged to set up hospitals in the outstations as well. It is heartening to note that at least one private healthcare operator plans to open a hospital in Jaffna. The private sector could ideally complement the State health sector by opening more healthcare facilities especially in the emerging North and the East. Their facilities should be reasonably priced to suit the spending power of the rural population.

Access - and accessibility - to both public and private hospitals in rural areas must be granted. Some of the roads leading to rural hospitals are in a dilapidated condition and even an ambulance may have to slow down on these pot-holed roads.

A difference of a few minutes could be a matter of life and death for a critically ill patient. Thus roads leading to rural hospitals must be repaired and maintained in good condition. The hospitals should also have 24/7 access to communications facilities - where wireline communications are either not feasible or not cost effective, cellular or microwave wireless communications should be provided.

Accessibility is another important issue that should be taken into account when upgrading rural hospitals. The hospitals should be accessible to all differently abled persons. Wheelchair access is generally 'built-in' in any hospital, but they should have other facilities such as wheel-chair friendly washrooms, tactile physical features for the blind etc.

All hospitals having two storeys or more should have automated passenger and service lifts. Fire protection measures/alarms and other security measures such as CCTV cameras are also needed.

However, it is important to spread the word that all these rural and estate hospitals are fully equipped and geared to meet any eventuality. Unfortunately, there is a notion among most Sri Lankans that they should visit the hospitals in Colombo, public or private, to get the best medical attention and care.

They have a habit of coming to Colombo even for a minor ailment that could easily be addressed at the nearest hospital. They spend a lot of money to travel to and from Colombo, which could have been used to treat the illness in the first place.

The same goes for the channelling of doctors. Some rural patients spend more than Rs. 1,000 to channel a doctor at a private hospital in Colombo and on top of that, thousands more to buy expensive drugs even for minor ailments, not to mention travelling costs for the patient and guardians. If they had visited the nearest rural hospital or even a bigger provincial hospital instead, there is every chance that they could have saved a considerable amount of money because even indoor (residential) treatment at any government hospital is completely free.

True, it would be hard to efface the channelling mentality from the Sri Lankan mindset, but a start has to be made through a vigorous campaign to the effect that it is not always necessary or beneficial to channel a doctor privately.

One other reason for the preponderance for channelling is the widespread belief that all the best and most experienced doctors are in Colombo and suburban hospitals.

The authorities must therefore make sure that equally competent doctors (and other healthcare personnel) are appointed to all hospitals islandwide, regardless of location.

While upgrading hospitals is a welcome move, the strengthening of the Public Health Inspectors' service is equally crucial. These are the personnel on the ground, who have a very good idea about the health shortcomings and needs in their own areas. They should have a more vibrant role in the community and a closer rapport with the villagers.

The dengue menace, for example, would not have reached such proportions if the grassroots community healthcare system was more effective. Health is very much a community-based issue and the burden on rural hospitals could be reduced if early action is taken to prevent the spread of diseases at village level. A healthy village holds the key to a healthy nation.

 

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