Lanka’s ailing health sector
By Apsara Kapukotuwa
The woes of the public health sector are not limited to the lack of frontline medical personnel. However, if that is the starting point, what recourse is there for the hapless patient who is forced to rely on the Government-aided medical facilities for his or her well being?

Granted, the preventive health sector of this country was quite good for a developing nation, the limited resources available to service the 250 Medical Officers of Health (MOH) areas were utilized maximally even reaching breaking point.

However, many questions arise in the curative aspect of health care. In Sri Lanka the need for a larger medical consultant cadre is apparent when one looks at the lack of much needed specialists.

In fact the situation is so critical that should any remedial action initiated this year would only reap its benefits in 2015. That is mainly due to the time needed to train a specialist which usually varies between seven and eight years.

A study done by the Government Medical Officers Association in 2002, had revealed that the minimum number of medical consultants (specialists) needed to meet the shortfall was 3500.

Meanwhile a cadre of 2301 has been recommended for 2015. According to GMOA spokesman Dr. A. Padeniya, at present Sri Lanka has only 663 specialists.

The document prepared by the GMOA – at the time Dr. A.L.M. Beligaswatte was the Director General of Health Services – was revised and presented in October 2004 to Healthcare, Nutrition and Uva-Wellessa development Minister Nimal Siripala de Silva.

This document which has come to the attention of the Public Services Commission is being keenly looked into. A discussion in this regard was held on Thursday with the present Director General of Health Services Dr. Athula Kahandaliyanage.

The Postgraduate Institute of Medicine is responsible for the training of specialist medical officers. While in some important specialties there is a shortage of manpower, for some others the cadre requirement for the next few years has already been trained.

Better patient care needs more nurses
The Karapitiya Teaching Hospital’s Deputy Medical Director speaking to The Sunday Times agreed with Dr. Weerasinghe’s comments and said a referral system for patients was a must as this would fully utilise the medical assets of the country. Patients from Hambantota and Wellawaya come to the Karapitiya hospital by passing a well equipped General Hospital in Hambantota.

He said the hospital was short of 150 nurses and paramedical employees including X- ray and ECG machine operators. The hospital has 1,500 beds and occupancy was in the region of about 85%.

Each day about 350 in-patients and 900 out-patients are treated at the Karapitiya Hospital where a single nurse takes care of a cubicle with six beds. Due to the shortage of nurses we face severe problems when handling patients and face grave difficulties when assigning nurses for night shifts, the operating theatres and the emergency and intensive care units.

The Deputy Medical Director said he believed one of the solutions should be a long term plan as stop gap measures have failed to solve this problem.
He said one of the measures adopted was to re-appoint retired nurses to the hospital but this was no help as they were inefficient and had various health and personnel problems. “We need energetic young people willing to do hard work”, he said.

The DMD said the training programme for nurses takes three years to complete after which we hope to recruit a new batch of nurses in November but only about 65% of the students pass the final exam.

He said there were 14 nursing schools in the country but was still not enough to cater to the health care needs as Sri Lanka needs 15,000 more nurses if the government hospitals are to provide an efficient service to the patients.

Referral system better for patients, hospitals
By Danusha Pathirana
The Colombo National Hospital Medical Director of Dr. Hector Weerasinghe speaking to The Sunday Times said that due to the non existence of a referral system for patients the main hospitals in the country were facing an appalling situation.

He said patients from all over the country come to the Colombo National Hospital hoping to receive more specialised treatment than those provided by the General Hospitals in their area.

“Thus the CNH is compelled to cater to virtually the entire island. The General Hospitals in areas like Anuradhapura and Kalutara among some others were well equipped to treat patients nearer to their homes but most patients continued to make their way to Colombo.

There must be a system where the patients receive the medications from hospitals within their region as done in other countries”, he said. Dr. Weerasinghe said with a total of 3000 beds, the occupancy rate in the hospital ranges between 110% and 120% with some 300 to 400 patients sleeping on the floor and we treat about two million out-patients and 200,000 in-patients annually.

“This is quite a large amount of patients to cater to. During the year we carry out some 60,000 surgical operations and 80,000 laboratory tests but due to the lack of nurses and paramedical employees the situation is severely aggravated”, he said. Dr. Weerasinghe said the hospital required 600 more nurses as the present cadre of nurses have to attend to more patients than they can be expected to reasonably serve.

He said at present the hospital employs 1300 nurses with each nurse having to serve at least nine patients at a time. “Due to the high cost of living in Colombo and other personal reasons, nurses ask for transfers to hospitals situated closer to their homes. In such a scenario even if we manage to recruit 100 nurses a year, we still have to transfer some 120 annually. This results in our losing about 20 nurses every year”, Dr. Weerasinghe said.

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