Climate change and healthcare organization: Sri Lanka’s perspective

2008 Global Ministerial Forum on Research for Health - Bamako - 17-19 November 2008 -

Dr Neelamani Rajapaksa Hewageegana

Dr Sarath Samarage

Country Description

Sri Lanka 20 M population 62,705 Sq km Adult Literacy rate 90.7

Life expectancy at Birth 76.4-

Female 71.7-Male Population growth 1.1

Total fertility rate 1.9 Human Development index

0.743

Vital Statistics Crude Birth rate

18.7 per population Neonatal

Mortality rate 8.4 per 1,000 live births

Infant Mortality rate 11.7 per 1,000 live births

Maternal Mortality rate 14.3 per 100,000 live births

Diseases associated withFloods and Drought

• increased the occurrence of diarrhoeal diseases

• diseases transmitted by• mosquitoes (among

these, dengue and Chikengunya)

• agricultural pests (Leptospirosis)

• sand flies (Leishmanisis).

Health impacts of climate change

Increased accidents due to Lightning and Tornadoes

Increased road traffic accidents Psychological problems

Loss of income loss or displaced families

Leading Causes of Hospitalization, 2006 SL

Rank Order Causes of Hospitalization

1 Traumatic injuries

2 Diseases of the respiratory system,

3 Symptoms, signs and abnormal clinical and laboratory findings

4 Viral diseases

5 Diseases of the gastrointestinal tract

6&7 Direct and indirect obstetric causes

8 Diseases of the urinary system

9 Intestinal infectious diseases

10 Diseases of the skin and subcutaneous tissue

Responding to climate change and health

1.Disease surveillance

2.Expanded Programme on Immunization

3.Control of diarrhoeal diseases and acute respiratory infections

4. Control of dengue haemorrhagic fever, Japanese encephalitis and rubella

5.Planning, monitoring and evaluation of the new, emerging and re-emerging iseases (NERD)

Establishment of epidemic preparedness, rapid response teams at central and divisional levels

Provincial Level

Regional and Divisional Level

Updated on August 2004

MO Special Clinics(STD/Chest)

Supervising SchoolDental Therapist

DivisionalPharmacist

RegionalSupervising Public

Health NursingOfficer

DivisionalRegistered Medical

Officer

Statistical SurveyOfficer

Supervising PublicHealth Inspector

(Divisional)

Food & DrugInspector

Health EducationOfficer

Provincial Planing Unit

Planing & Prog.Officer/Planing &

Prog.Assistant

Provincial

Accountant

DS AdolesentDental Clinics

Public HealthNursing Sister

Divisional Director of HealthServices/Medical Officer of Health

Deputy Provincial Director ofHealth Services

Assistant Medical Officer of Health

Supervising PublicHealth Inspector

Provincial Secretary (Health Services)

Provincial Director of Health Services

Deputy Provincial Director

Administration (SLAS)

Organization Chart for the Health Services Under Provincial Councils

RegionalEpidemiologist

Regional DentalSurgeon

Medical Officer(MCH)

MS DistrictGeneral Hospital

DMO DistrictHospital

MO P

Field Staff Regional MalariaOfficer

Provincial Minister of Health (Health Services)

Planning andProgramming

Officer

PHI (ControlProgrammes)

Public HealthMidwife

MS ProvincialHospitals

Public HealthInspecor

Supervising PublicHealth Midwife

MS BaseHospitals

MO I/C RuralHospitals

A.M.C. & A.F.C.

SDT SchoolDental Clinics

Annex 1.

MO/RMO/AMOCentral

Dispansary

Visiting Stations& Clinics

BranchDispensary

MobileDispensary

MO/RMO/AMOCD & MH

MO I/CPeripheral Unit

The information flow of the notifiable diseases of Sri Lanka

Hospital MOH Office

Bed-head Tickets

Notification Card

Notification Register(Ward)

Notification Register

(Institution)Special Notifications

CholeraAcute Flaccid Paralysis

Neonatal tetanusMeasles/Other EPI DiseasesJapanese EncephalitisDengue Haemorrhagic Fever Rabies

Notification Register

Weekly Return of Communicable Diseases

InfectiousDiseasesRegister

EPIDEMIOLOGICAL UNIT

PHI

BY TELEPHONE/TELEGRAM

FOR SURVEILLANCE INVESTIGATION

Responding to vector dynamics with respect to climate change

Vector-borne diseases

(Malaria, Filariasis, Chikun Gunya, Dengue, Japanese Encephalitis,Leptospirosis,Leis

hmaniaisis)

Premises Index Container Index Breatue Index

The Way Forward

Need of research on climate change related health issues

Improve health surveillance systems to allow assessment of the impact of climate variability and change on health.

To facilitate better integration of data sets across sectors.

Review and redistribute the existing roles and responsibilities of the community health worker the PHM and PHI in Sri Lanka.

Thank you.