Non-Communicable Diseases (NCDs) have become a global concern, and Sri Lanka is no exception. With NCDs accounting for a staggering 81% of total deaths and 77% of disability-adjusted life years (DALYs) in the country, it is crucial to address the growing morbidity and mortality associated with these conditions. To tackle this challenge, the primary healthcare (PHC) system in Sri Lanka is being strengthened to provide comprehensive care for NCDs, including preventive services and early detection, as well as a continuum of quality care for those affected by NCDs.
Reorganizing the Primary Healthcare System
The reorganization of the PHC system in Sri Lanka involves delivering community-based NCD risk factor preventive services, early detection of NCDs, and ensuring a seamless continuum of care for patients. This includes linking NCD patients to appropriate treatment and providing regular follow-ups throughout their lives. Additionally, the system focuses on the early detection and management of life-threatening complications through well-established referral systems. This ensures that patients can be referred to secondary or tertiary care facilities when needed, while also allowing for back referral to primary care once complications have been effectively managed.
Bridging the Gaps
Despite the efforts made to integrate NCD care in the PHC system, Sri Lanka has encountered several challenges. Studies have revealed critical gaps in infrastructure, trained manpower, and services, compared to the standards prescribed in policies. These deficiencies have resulted in underutilization of NCD care services and a preference for seeking care at higher-level healthcare facilities, leading to increased out-of-pocket expenditure. As a result, there has been a lack of continuous, coordinated, and patient-centered NCD care.
Primary Healthcare Systems Strengthening Project
To address these deficiencies, the Ministry of Health (MOH) in Sri Lanka implemented the Primary Healthcare Systems Strengthening Project (PSSP) in 2018. The project aims to enhance care provision at primary medical care institutions (PMCIs), which include district-level hospitals and primary medical care units. With financial support from the World Bank, the MOH implements the project based on the achievement of predetermined indicators. These indicators encompass areas such as defining and providing quality care, integrating prevention and treatment for NCDs through healthy lifestyle centers, streamlining referrals, strengthening the health management information system (HMIS), improving supply chain management, and enhancing laboratory service capacity.
Assessing the Progress
After two years of implementation, a systematic assessment was conducted to evaluate the status of the project and provide evidence for its future scale-up. The assessment focused on facility-level infrastructure, empanelment coverage, NCD care provision processes, and patient experiences at PMCIs supported by the PSSP. Both quantitative and qualitative techniques were used to gather data, including screening for NCD risk factors, the linkage with care, and the outcomes of care for those enrolled in diabetes and/or hypertension care. Provider and patient perspectives were also explored to gain insights into the challenges faced in NCD care provision. The findings from this assessment will enable program managers to identify context-specific solutions and further enhance NCD care in primary care settings, aligning with the recommendations of the World Health Organization.
Moving Forward
The battle against NCDs requires a comprehensive and integrated approach. Strengthening the PHC system in Sri Lanka represents a significant step in this direction. By reorganizing the system, bridging gaps in care provision, and implementing the PSSP, the country aims to improve the overall quality of care for NCDs and enhance patient outcomes. With continuous monitoring and evaluation, policymakers can ensure the sustainability and effectiveness of this initiative. It is essential to remember that the success of these efforts lies not only in the implementation of healthcare projects but also in raising awareness among the population about the importance of preventive measures and healthy lifestyle choices. Together, we can combat NCDs and pave the way for a healthier future.
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