The government has recognised that in order to achieve the United Nations health related sustainable development goals (SDGs) and universal health coverage, a stronger primary healthcare system is essential. The Ministry of Health and Ministry of Provincial Councils and Local Government in Sri Lanka has embarked on a 5-year project to strengthen primary healthcare. The development objective of the project is to increase the utilisation and quality of people-centered primary healthcare services.
It is essentially a home-grown model for reorganizing primary medical care services, that comes under the banner ‘Reorganizing Primary Health Care in Sri Lanka-Preserving our progress, Preparing our future’. The move is also a means of furthering our health gains and thereby preparing the local health care system in meeting evolving challenges, notably the burden of NCDs. Diabetes, cardiovascular diseases, ischemic heart diseases, stroke, respiratory conditions and cancers are notable among these.
This approach is backed by strong evidence and highlights 3 thematic areas of the PSSP :
- Reorganizing primary healthcare to meet Sri Lanka’s needs.
- Improving information management systems for people-centric services.
- Strengthening the health sector through key system improvements.
The PSSP aims to address both the demand and supply-side constraints of a comprehensive PHC system :
- On the demand side, it includes proactive outreach activities and strong citizen feedback mechanisms to change health-seeking behaviour.
- On the supply side, it incentivizes the use of PMCIs by improving their capabilities and responsiveness to population demands.
The successful implementation of this project will allow Sri Lanka to :
- Equip primary healthcare providers with improved skills in team management and patient-centered service delivery.
- Effectively manage and control the rise of NCDs.
- Establish population-based information management systems for NCD programmes.
Key Areas for Reform
Action Area 1
Reorganisation of Primary Healthcare - defining policy and standards
- To provide an overall strategic focus for PHC reorganization.
- To provide detailed policies, standards and implementation guidelines.
Action Area 2
System improvements-strengthening provider functions and capabilities
- Establish necessary PMCI capabilities for delivering quality service packages.
These include :
- Having a minimum number of trained staff.
- Having a minimum set of operational diagnostic equipment.
- Having a minimum availability of essential drugs and lab testing capacity.
- Establishing a supportive supervision mechanism.
- Support provision of more patient-friendly services such as :
- Provision of NCD drugs through one-month supply blister packs.
- Establish laboratory-networking systems at PMCIs.
- Allow patients to obtain prescriptions from pharmacies for publicly financed drugs free of charge.
- Establish a system for appointment booking at PMCIs.
- Enable a public-private partnership environment through promotion of patient friendly services (NCD screening) in cooperation with the private sector, whenever possible and based on need.
- Establish operational appointment systems and proactive outreach services to address the gender gap in utilization of NCD care services.
Action Area 3
Information management to improve health services in real time-development of supportive systems
Information management to improve health services in real time-development of supportive systems
- To develop a personal health records system to facilitate coordinated patient care.
- To improve the national procurement and supply chain system to ensure timely and efficient drug supplies.
Action Area 4
Information management to improve health services in real time- empowering and responding to population demands
- Develop community engagement mechanisms and increase accountability for the health sector.
- Implement a communications strategy to inform stakeholders and the public of changes in the PHC system.
- Establish a Grievance Redress Mechanism (GRM) to respond to public feedback on health services.
- Establish direct links between PMCIs and communities they serve through “Friends of the Facility” committees.
Action Area 5
Increase in utilization and quality of PMCIs- emphasis on detection and management of NCDs
- Increase utilization of PHC services, particularly prevention/management of NCDs in high-risk groups.
- Increase screening for Non-Communicable Diseases
- Develop user friendly protocols and guidelines for NCD screening and management
