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Taking hospital services to the doorstep of the villagers
A success: The PSSP in progress in Gomarankadawala
The Gomarankadawala Divisional Hospital, in a very remote setting in a corner of the Trincomalee district, is currently treating 100 patients with COVID-19.
“We have had only two deaths,” says Dr. Shoba Kumburegama of the Gomarankadawala Hospital.
She draws a strong link between the low number of deaths and the Gomarankadawala Divisional Secretariat area being one of 64 dotting the countryside to be integrated into the ‘Primary Healthcare System Strengthening Project’ (PSSP) in 2019.
Under the PSSP, hospital staff, without awaiting the arrival of patients with non-communicable diseases (NCDs) at the hospital, has gone into the villages in this divisional secretariat area to screen all those over 35 years for conditions such as diabetes, high blood pressure, cardiovascular disease and kidney disease.
The basic concept is taking hospital services to the doorstep of the villagers, it is learnt, to catch NCDs early.
While COVID-19 is rampaging across the country and felling people with NCDs, Gomarankadawala Divisional Secretariat area’s early initiative of getting into the net all those who are vulnerable to NCDs has paid off. The control of such NCDs has helped them to deal better with the communicable disease (CD) of COVID-19 which has caused much severe disease and death among those having NCDs.
Dr. Kumburegama talks of how they carried out their programme under the PSSP.
Already 60% of this area which comprises the 10 Grama Niladhari (GN) Divisions of Gomarankadawala, Mallawewa, Pamburugaswewa, Medawachchiya, Kivulakadawala, Galkadawala, Bakmeegama, Pulikandikulama, Kandamalawa and Kalyanapura has been covered.
These 10 GN Divisions have a total population of 7,382 of which 3,034 are over 35.
Citing the example of Gomarankadawala village, Dr. Kumburegama explains how a message had been sent to the people asking them to fast for 12 hours the night before. Early the next morning, a hospital team comprising two doctors, two nurses, a health assistant and a data collecting officer had piled into a vehicle with all the necessary tools and equipment and headed for the village.
Arriving in the village by 6 a.m., they had drawn blood from all the relevant people by 8 a.m., sending these samples back to the hospital for testing. All data had been collected and personal health record books filled in, taking detailed case histories. Thereafter, each and every one had been screened thoroughly.
Tired but fulfilled, the team had then headed back to hospital late at night. The village visit had been followed up promptly with an analysis of the laboratory reports and screening records, to predict the 10-year cardiovascular risk of each villager. Thereafter, those in grave danger had been informed to report to hospital immediately and the others later to be aware of their health status and follow-up.
The project started in 2019 but we had to suspend it due to COVID, says Dr. Kumburegama.
Under this World Bank supported PSSP project which is being implemented by the Health Ministry, the main objective is to increase the utilization and quality of primary health care services, with an emphasis on the detection and management of NCDs in high-risk population groups.
Currently the PSSP has been implemented in 350 hospitals across the country but due to the COVID-19 pandemic, some hospitals are facing challenges, it is learnt, with around 300 hospitals carrying out this work smoothly.
The Head of the PSSP, Dr. Jayasundara Bandara says that they wish to reorganize the primary healthcare system. What usually happens is that a person will come to the hospital only when a condition crops up.
“We want to change that outpatient department (OPD) system to a population targeted, risk-based primary care health system. We want to change the healthcare delivery system through the project,” he says.
Referring to the systems development at primary healthcare level, he says the different pillars are: Population Empanelment; Population Based Screening and Follow up; Health Information Management System; Laboratory Networks; Citizen Engagement Committee; and Medical Supplies Management System.
It was on Population Empanelment and the Health Information Management System that he focused on Thursday, explaining that all the people coming under this system would have a personal health record.
When asked about data security and confidentiality, Dr. Bandara said that it is on the government cloud and thus secure. No one other than the person who is in possession of the Personal Health Number (PHN), which is the patient or the doctor he/she gives it to, can access his/her information.
Conceding that the PSSP needs close monitoring, the Director-in-Charge of Health Informatics, Dr. Palitha Karunapema explained that as it is a web-based system, from his desktop or from a national or regional level, they can keep track of how many data entries were done by how many hospitals and how many patients came in on a particular day and what their blood pressure levels were, etc.
“It can take months to evaluate paper records, but we can carry out detailed ground-level monitoring using information technology,” he said.
From the small hospital of Uda Walawe in the Ratnapura district but borders both Moneragala and Hambantota districts, Dr. Wasantha Kumarasiri gives his experiences on the implementation of the PSSP.
The Uda Walawe Hospital established in 1963 caters to a diverse population of around 10,000, he said, adding that people access the hospital only when they fall ill.
“Now we go to them to diagnose any conditions present and direct them to the relevant clinics, thereby guiding them towards a healthy lifestyle,” he said.