ICTA CEO to resign if SL ICT connectivity the same by end-2016
The Chief Executive Officer of the ICT Agency (ICTA) of Sri Lanka, Muhunthan Canagey, put his job on the line last week, stating he would voluntarily quit by the end of 2016 if the country did not significantly improve its connectivity and/or digital infastructure.
Mr. Canagey made this comment at the eHealth Asia 2015′s “Roundtable on Future of Digital Health in Sri Lanka”, which was hosted by the Health Informatics Society of Sri Lanka (HISSL), in collaboration with the Sunday Times Business Club, wherein he was joined on the panel, and in the audience, by a number of medical professionals in forecasting possible scenarios for local healthcare over the next five to 10 years.
Adding to this, he also revealed that, three weeks ago, Sri Lanka’s cabinet had approved a cross government platform and network to be rolled out island-wide, which would include a government cloud and a government connectivity network. This would encompass 3,500 state institutions, including hospitals, to be connected completely via Wi-Fi access, so there would be no technical issues in terms of networking, etc but rather it could be used by anyone with their own notebooks and tabs, at speeds of 100 Mbps.
Mr. Canagey also commented that the government cloud would comprise two components, to be deployed by February or March of 2016. The first was the complete virtualisation computing resource platform and the other was big data analytics, further indicating that the government had gone in for one petabyte data storage to start off with, and 35 data nodes which were still to come, to be used on a cross government basis. He added that, now, it no longer mattered how citizens interacted with the system because with their access to 3,500 locations there was going to ample connectivity, so even health-based applications on this system could have all hospitals using it.
Also speaking, HISSL President, and frequent Business Times columnist, Prof. Vajira Dissanayake noted that Sri Lanka was going through a major demographic transition, with it now featuring the fastest ageing population in Asia, except for Japan, in terms of proportion of population. But Sri Lanka was ageing with a much lower GDP base than Japan, which meant all these people who were getting older, and not working, would have to be looked after, with less available resources than Japan.
Further, he signalled that the pattern of disease was also changing. While Sri Lanka had already eliminated several diseases, these had been easiest to tackle as they featured acute episodes that could be treated and cured. But today the concerns are more related to non-communicable diseases, which are often incurable and have to be lived with and managed over one’s entire life. He also highlighted another paradigm shift that healthcare in Sri Lanka was facing, namely that in terms of patients with non communicable disease such as diabetes who took up a single available hospital bed, with estimates that there were around 70,000 hospital beds in Sri Lanka presently, there were a further 1,000 patients that needed to be managed within the community itself taking up even more resources.
Prof. Dissanayake additionally commented that the field of medicine itself would also change because of the shift in how healthcare was being delivered. As a result of significant advances in genomics, more personalised healthcare could be deployed by using genomic profiles, so how this could be better integrated had to be considered.
And, Prof. Dissanayake also opined that it was only a matter of time before the government would cease to be the dominant healthcare provider, adding that the private sector already believed that they would soon be the dominant play. In terms of outpatient care, the private sector already leads while, for in-patient, the private sector encompasses maybe 25 to 30 per cent of patients. However, the private sector had plans in place to take it up to 70 to 80 per cent in the near term. In five to 10 years, the private sector would undoubtedly be more prevalent, with economists indicating that once the US$4,000 per capita mark was reached, people preferred to pay out of their own pocket for medical expenses, instead of depending on the social care model, with that threshold already upon Sri Lanka.
Additionally speaking, the Ministry of Health’s Dr. Pradeep De Silva commented that the public sector should, at first, aim at utilising limited resources in a more efficient manner. The government is at present working to developing basic information systems and maybe, in five to 10 years, the private sector would lead patient care. However, innovations used in patient care, at that later date, would then be first tried and tested out at government institutions, before being spread across private sector facilities for use with patients. He also gave the current example of the In-door Morbidity and Mortality Report (IMMR) that was now being collected and aggregated in real time in Sri Lanka. However, this was only for the curative sector and this Ministry was looking into how to do the same for preventative sector. “By 2017, I am 100 per cent sure we are going to cover the whole of the island,” said Dr. De Silva.
Commenting further, ICTA’s Sriyananda Rathnayake revealed that, based on health expenditure today, 47 per cent was in government hospitals and 53 per cent in the private sector. And, for the private sector, more than 80 per cent was paid out of pocket by patients or families. Considering the efficiency and quality of healthcare in the private sector, the tendency of patients moving from government to private will continue. At the same time, cost is a major threat going forward for the healthcare sector as a whole, especially since with the cost of private healthcare being high, unlike in the government sector, patients will only have access to healthcare on a piecemeal or ad hoc basis so the population will ultimately suffer. And that lack of a systemic approach means that non-communicable diseases will not be managed properly as a result. He also signalled that the fundamental requirement for the health sector was to have a basic foundation of having a health record across both the government and private sectors and, once that happened, many lucrative applications will be built on top of that foundation, to give better facilities to citizens.