Transcript Annual Health Summit 2005

Annual Health Summit
2005
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Vision
ASSURE A HEALTHY , PRODUCTIVE LIFE
BY IMROVING PHYSICAL, SOCIAL,
MENTAL AND SPIRITUAL WELL-BEING OF
THE PEOPLE
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Mission
 To make curative care
 User friendly,
 More accessible,
 Comprehensive
 cost efficient and,
 to the satisfaction of the people
in North Western Province of Sri Lanka
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 North Western Province of Sri
Lanka consists of two districts,
Kurunegala and Puttlam.
 Population in NWP
= 2,157,711
 Population in K’gala = 1,452,369
 Population in Puttlam = 705,342
 Persons per Sq. km :
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Kurunegala – 314
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Puttlam
- 245
 ( Colombo - 3305
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Kandy
- 664
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Gampaha - 1541 )
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Government curative care network at
present
 One Teaching Hospital – at Kurunegala,
administered by line ministry.
 One General Hospital – at Chilaw ( Putlam District )
 Two Base Hospitals
in Kurunegala District,
Kuliyapitiya
Nikaweratiya
 Two Base Hospitals in Puttlam District,
Puttlam
Marawila.
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Government curative care network at
present
 Puttlam District
 Kurunegala District
 15 District Hospitals  04 District Hospitals:
 03 Peripheral Units:
 12 Peripheral Units
06 Rural Hospitals:
 14 Rural Hospitals
05 CD & MH:
 01 CD & MH
 19 CDs :
 54 CDs
Other : STD, Chest, Filaria, Malaria and Leprosy
Clinics
Out reach Specialized Clinics:
Maternal care:.DH Dankotuwa and DH Mundalama
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Distribution of specialists per 100,000 population
Kurunegala – 2.13
Puttlam 2.26
( Colombo – 8.72, Kandy – 6.83, Gampaha – 3.43 )
Distribution of Medical Officers per 100,000 population
Kurunegala – 25.8
Puttlam - 29.8
( Colombo – 112.1, Kandy – 68.1, Gampaha – 30.3 )
Distribution of Dental Surgeons per 100,000 population
Kurunegala -- 3.6
Puttlam 2.7
( Colombo – 9.1, Kandy – 4.2, Gampaha – 2.4 )
Distribution of Nurses per 100,000 population
Kurunegala – 83.2
Puttlam - 43.7
( Colombo –167.8, Kandy – 141.5, Gampaha – 52.4) 7
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Government Hospital Bed Strength per 1000 population
Kurunegala – 2.8
Puttlam 2.2
(Colombo – 4.9, Kandy – 4.2, Gampaha – 2.4 )
Out-patient attendance by district per 1000 population
Kurunegala – 2627.5
Puttlam - 1969.0
(Colombo – 2417.2, Kandy –2670.4, Gampaha –1640.1 )
In-patients treated by district per 1000 population
Kurunegala – 224.0
Puttlam - 163.6
(Colombo – 307.2, Kandy – 267.9, Gampaha – 144.5 )
Number of patients transferred for specialized care
Kurunegala –
Puttlam  Average Bed Occupancy rate
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Kurunegala –
Puttlam 8
Major issues identified
 Over crowding of secondary and tertiary care
institutions and under utilization of primary
care institutions.
 Emergency care services are not well
established in all institutions to deliver
necessary care to the people who deserve
emergency attention.
 In- adequate staff skills and poor attitudes of some
categories to provide quality , user satisfied care.
 Cost benefits of some supportive services such as
laboratory, ambulance, and cleaning are low
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Over crowding of secondary and tertiary care
institutions and under utilization of primary
care institutions.
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Major institutions
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Individual attention is low
High incidence of cross
infections
Congested environment
Long waiting time
Essential problems are not
dealt with
Opportunity cost is high for
patients
In-adequate basic facilities
High incidence of mistakes
due to over work
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Primary care level
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Cost per patient is high
Staff is idling
Certain malpractices
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Solutions suggest
Back & forward referral system
Improve facilities in primary
care level
Appoint necessary cadre to
Divisional & PMCU level
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Emergency care services are not well
established to deliver necessary care to the
people who deserve emergency attention.
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Death within one hour after
admission is high
Customer satisfaction is low
Rush to private sector
paying high cost expecting
quick care
Transfer rate of lower level
institutions is high
Available skill is not utilized
Big hospital overcrowding
would go down
Utilization of lower level
would go up
Poor staff skill development
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Solutions suggest
Assure ETUU in all health
care institutions
Appoint qualified cadre
Provide necessary
equipment
Continuous skill
development programmes
Ambulance facilities
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Poor commitment and skills of some
categories o staff to provide quality , user
satisfied care.
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Conflicts are high
Customer satisfaction is low
Low quality service delivery
More patients seek care
from bigger institutions
Poor Image to the hospital
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Solutions suggest
Adopt proper recruitment
procedures
Introduce performance
appraisal system
Regular staff development
progrannes
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Cost benefits of some supportive services
such as cleaning, diet and laboratory are low
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Cleaning
work force idling
 Poor cleaning of
environment
Solutions suggest
 Proper recruitment
 Out-sourcing
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Laboratory
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Operational cost is high
Regular breakdown
Non skilled operation due to
shortage of technical
knowledge
Solutions suggest
Building up close link with
private sector
Staff development
programmes
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Objectives
•To provide Infra – structure facilities to
obtain expected services from identified
institutions
•To improve service provision according to
the need and to the satisfaction of the people
•To develop staff skills and attitudes to deliver
quality service
•To achieve close link with other health
partners to make health services more
accessible and qualitative
•To develop a system to monitor and
evaluation of services giving more attention
on regular medical audit
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Proposed hospital network
 General Hospital Chilaw and Kuliyapitiya
 Base Hospitals: Puttlam, Nikaweratiya,
Marawila and Galgamuwa
 Divisional Hospitals: All existing District,
Peripheral Units and Rural Hospitals.
 Primary Medical Care Units; CDs and CD/MH
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Expected services from different
category of Hospitals
 General Hospitals
 Make available comprehensive emergency care
through out the day
 Assure availability of residential specialized care
and out door care in all major specialties
 Assure a wide range of investigation facilities
 Provide comprehensive care to all needy people
in minimum waiting time
 Facilities to staff skill development
 provide information on any health related matter
by a special unit established
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Expected services from different
category of hospitals
 Base Hospitals
 Make available emergency care by a separate
unit 24 hours a day
 Assure availability of selected minor specialized
fields with high demand (out-door and in-door
care) in addition to basic fields
 Assure availability of a wide range of
investigation facilities
 Provide comprehensive care to all needy people
in minimum waiting time
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Expected services from different
category of hospitals
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Divisional Hospitals
Limited emergency care for 24 hours.
In-ward facilities for common minor illnesses
Poly clinic facilities with, out - reach
specialized clinics
 Maternity care and labour room facilities
 Medical recording and referral centre
 Dental unit
 Availability of ambulance through a radio link
with other institutions
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Improve the efficiency of supportive
services
 CLEANING
 Proper recruitment
or out - source of services
is recommended for cost effective & high
quality service with management with ease
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Improve the efficiency of supportive
services
DRUGS
 Assure availability of
essential drugs in all
health care institutions
 Establish a Drug Management unit at each
DPDHS Office under direct supervision of
Divisional Pharmacist
 A Pharmacist/RMO of Drug Management Unit
should order, transport from MSD to RDS,
and handed over to store keeper at RDS
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Improve the efficiency of supportive
services
 DRUGS
 Store keeper should take care of all the drugs
and issue to relevant institutions according to
the instructions of Drug Management Unit.
 improve drug transport facilities
 Improve facilities of stores in institutions to
reduce pilferage and spoilage
 Issue drugs in envelops with instructions of use
 Make people aware of cost of drugs
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Improve the efficiency of supportive
services
 DIET
 Special Dietary Units are established in all
hospitals, above Base Hospital level, under
supervision of a nutritionist
 Most suitable diet is given to individual patient
 Wastage is reduced by restructuring of diet
schedules for staff and patients
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POLICY DIALOG PAPERS
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Develop a system to monitor and
evaluation of services
Number of new specialized units started
during the year
 No of out reach clinics commenced for the
year per district
 Percentage of institutions above divisional
Hospitals do have 24 hour ETU facilities
 Percentage of Primary Care Units with
Medical recording and referral unit
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Develop a system to monitor and
evaluation of services
 Number of deaths within one hour after
admission per year
 Number of public complaints received per
month
 Number of drugs out- of stock marked on
prescriptions per month
 percentage of institutional heads received
management training per year
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DR. RESHAN AMARASEKERA – DMO Kuliyapitiya
DR. DEMATAPITIYA – DMO Nikaweratiya
DR. M.FAREED – DMO Puttlam
DR. U.R. SIRIMANNE – DMO Galgamuwa
DR. D.K.SIRIMANNE – VP Chilaw
DR. M.A.M.FERNANDO – V Paed. Kuliyapitiya
DR. A PANADARE – VOG Nikaweratiya
DR. J.RANATUNGE – DMO Gokarella
DR. U.S.B.RANASINGHE – DMO Dankotuwa