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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