Migrant sensitive health system:

The challenging factor in public health - President CCPSL

By Anuradha KODAGODA

Public health professionals are not only to deal with people. They have to be seen as advocates to change the mindsets of the entrepreneurs who are especially in the food industry.

Dr. Susie Perera

Therefore we believe we have to come strongly as advocates to the public health to influence this existing environment, said the new President of the College of Community Physicians of Sri Lanka (CCPSL) Dr. Susie Perera. She was addressing the audience after being inducted as the new president of CCPSL in the presence of Minister of Health Maithripala Sirisena last week.

Dr. Susie revealed the global challenge for migrant sensitive health system, is the most challenging factor in public health in today's world.

"The College of Community Physicians of Sri Lanka (CCPSL) probably deals with the public health of the country. Public health is the branch of preventing and promoting medicine. The CCPSL delivers its service mainly through Medical Officer of Health (MOH) in each and every local government division of the country.

Through over 300 MOHs which are active around the country, so far we have successfully facilitated the public by promoting and preventing medicines for the sanitation, immunisation, maternity health, child health, and communicable diseases and for many other public health needs. Investment on health has brought about a good level of maternal and child health care resulting in low maternal and infant mortality rates, high immunisation coverages, resulting in the control and virtual elimination status of some of the vaccine preventable diseases and also other diseases like leprosy, malaria and also we are considered as a low prevalent country for TB."With that today we could largely control so many diseases and as a country we are in a satisfactory level in public health," said Dr. Perera.

The CCPSL originated as the 'Society of Medical Officers of Health' in 1927 and was the second professional body in the medical sciences in Sri Lanka following the establishment of the Ceylon Medical Association (CMA) branch of the British Medicine Association (BMA) in 1887.

The association was subsequently established as a college with the incorporation by an Act of Parliament in 1995 with the primary objective of fostering public health in the country.

Health Minister Maithripala Sirisena and the community health physicians listening to the presentation of Dr. Susie Perera

"However, unlike earlier days, today the public health has grown. The inputs and public health specialists' involvement is much more compared to early days. Therefore, today the public health is expanded into programs such as non-communicable diseases, mental health and cancer. Even though cancer patients are being treated by oncologists, as public health physicians we have a huge responsibility in educating the general public in terms of promoting the idea of preventing cancer," Dr. Susie said.

"Together with the former president of CCPSL Dr. Vinya S. Ariyaratne, we made a strategic plan for the next five years for the public health of the country. Through this we have a wider possibility in approaching the general public for their community health problems.

We are seriously working to change the current public understanding of a community physician which is another clinician where people can only get medicines for their day-to-day needs. But a community physician means much more to the community. His ultimate responsibility is to prevent the communities from diseases rather than curing.

It is not an easy task to achieve considering the current lifestyle of the people. Today we are facing a huge risk of non-communicable diseases where it is mainly due to the false food habits. It is not simply tackled by only medicine. That is where we see huge importance of preventing and promotion.

"Public health professionals are not only to deal with people. They have to be seen as advocates to change the mindsets of the entrepreneurs who are especially in the food industry.

Because as we think it is not possible to change the food culture by only advising the consumers, but traders also have to have the same understanding of these important factors to eliminate these non-communicable diseases which are spreading like a virus nowadays. Therefore we believe we have to come strongly as advocates to the public health to influence this existing environment,"

"Therefore in the near future we hope to come up with new ideas of promoting healthy food habits among the public and we hope to hold a health festival with the message of 'Super 8' which we hope to announce for the general public," Dr Susie said. "In 1951 the World Health Assembly adopted the International Sanitary Regulations which in 1969 were revised and renamed as The International Health Regulations (IHR). Its main purpose was to reduce the risk of international spread of diseases of global public health importance. Whilst IHR are to contain spread of disease across borders, Migration Health has emerged as a specialised field of health sciences that addresses the individual health concerns of migrants as well as public health issues related to the migration process of people.

On-the-job training conducted for public health field staff

Therefore the subject of Migration health has two major concerns being that of preserving or improving the public health of countries as well as the health of migrants' per-se.

"Today, more than ever, people are on the move be it within the country or to and from a country, whether it is for a short duration like a couple of days or several years. The world today has a 7 billion population. It is estimated that at a given time 1 billion of the world population are migrants."The recently concluded population census in Sri Lanka revealed that we have a population of 202,775,971. These were the citizens residing in the country on the day of the censes. In addition, 1.9 million of our population is currently employed overseas and a smaller percentage leaves the country as students. Overall, a little more than 10 percent of Sri Lankans are employed overseas.

"There are also people who stay away from their homes for a longer period but are moving internally. Again it is for work purposes and there is also a large student population. These different types of migrants make a significant contribution to the Sri Lankan Economy.

"However, it remains that many developed countries are concerned mainly with who is coming into their country. They are challenged with containment or reducing disease burdens. Often border protection or immigration control is seen to be linked with health interventions that range from assessing health certificates for immunisation on specific diseases like yellow fever or comprehensive health assessments such as those undergone for work purposes.

In fact, for some countries where their migrant population forms a considerable percentage of their overall population it becomes a critical challenge.

"Sri Lanka faces a similar situation and our economy is heavily dependent on outbound, inbound and internal migration.

"Therefore, there is a definite need to standardise and improve pre-departure health assessment. The review of bilateral agreements and also the study on returned migrants revealed that the Health protection is inadequately addressed in host countries - 27.8 percentage of those who returned stated the reason as being sick and 18.8 percentage who were hospitalised had to pay back the hospitalisation charges to their employer. Also 60.5 percentage stated that they did not inform their employer if not well due to fear of being dismissed," Dr. Susie said.