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| Sunday, 30 November 2003 |
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Towards a better managed health service Concluding excerpts of Sri Lanka Medical Association E. M. Wijerama Endowment Lecture 2003 delivered by Dr. Lucian Jayasuriya at SLMA auditorium on Friday, November 14. I discussed the subject of doctor population ratios in a leading article in the Ceylon Medical Journal in March 2000. In that article I said: "the number of doctors in Sri Lanka will more than double in 10 years, while the population will increase only by 9.7%. The population per doctor will fall from 2397 to 1267 during this period." I also said that "Sri Lanka has invested too much on training doctors compared to the training of other categories of health care workers." I am aware that some universities have embarked on awarding diplomas and degrees to some of these categories, who are already trained by the Health Ministry. This is not sufficient. What I advocate is that the numbers trained be increased and to hand over the training of these categories to the universities. This will also prevent overlap of training by the universities and the Ministry of Health. Policy making in the health service We have no system of policy making in the health service. Decisions are made ad-hoc when issues arise. It is common knowledge that the Ministry of Health has no time to think. Once it goes through the daily routine of fire-fighting, micro-managing the health service and several meetings a day, there is no time left. The establishment of a National Health Commission was proposed by the Presidential Task Force on Health Policy Implementation in 1999. During the last regime, a cabinet paper was prepared to get this implemented. But it did not go further. The present government has appointed an Advisory Committee to the Minister of Health. It consists of former Ministers of Health of the United National Party, former Secretaries of Health, former Directors General and some eminent doctors who have worked in the WHO. It meets for half a day, once a month. It has only a staff assistant. With all due respect to all who are involved in it - some of whom are here - my perception is that it has functioned poorly. It is not because of the persons concerned, but it is because this advisory body has no statutory powers. It has no funds. In addition to the establishment National Health Commission, the ministry should give-up micro-managing health institutions. It should become a policy making body. It should get on to stewardship. This brings me to my last topic. Strengthening Stewardship This item is given prominence in the strategy document. Seven sub-items are included under it. With respect, I must say that the ministry has done nothing much about stewardship except regulating western medical drugs in this country. Even regarding drugs, the Cosmetics Devices and Drugs Authority (CDDA) has concentrated on registration of drugs and not on supervision of pharmacies and drug stores. The DRA classifies drugs as OTC or prescribed only. This is a farce. Today, any person can buy any medicine over the counter. In 1996/97, I chaired a committee appointed by the Minister of Health Hon. A. H. M. Fowzie, which drafted an act for a National Medicinal Drugs Authority. This was to be a statutory body under the Ministry of Health. Among the advantages would be that there would be greater flexibility in management. money collected by way of registration of drugs, and licensing of pharmacies would remain with the body, (It is estimated that the CDDA makes a profit of Rs. 30 million a year) and the DGHS would not be burdened with drug registration matters. This was accepted by the Minister but fell by the wayside when a new Minister took over. The SLMA has discussed this proposal during the last year and recommended it to the present Minister. We hope that he will give positive consideration to this proposal. Coming to the other areas of stewardship, the Ministry of Health has been very lethargic. The Private Medical Institutions Act has been discussed for the last 15 years. It is still with the Legal Draftsman. Therefore at present, there is virtually no supervision of private medical institutions. Recommendations appeared on Sunday Observer of Nov.23 Conclusion Preparation of the 'strategy document' has cost a large sum of money. A master plan on implementation is to follow. I hope that the issues that I have surfaced will also be addressed in the master plan. It is most important that action be taken on the master plan. It is important for all of us to realize that everything is not satisfactory with the health service, and that there is much room for improvement. We have to maintain our government health service so that it could serve our people especially the poor and the lower middle class that are its major clients. It is necessary that the dominance of the government health sector remains and continues for the sake of equity of health care. The doctors in the government service should lead the way by giving the greatest cooperation to make the health service more effective, efficient and sensitive to the needs of the public within the constraints of limited resources. Dr. Lucian Jayasuriya, MB, BS, DTPH, FCMA, FCV, FCGP Hon is Medical Advisor, GlaxoSmithKline and Chairman, Postgraduate Institute of Medicine. He was Director General of Teaching Hospitals (1984-89), Additional Secretary, Ministry of Health (1995-97), President, Sri Lanka Medical Association (1995), President, College of Medical Administrators (1997), and Founder President, College of Venereologists (1995-97). |
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