Research project on Sri-Lanka

Project by: Fathima Shazna Saleem 631D Yeap Dee Sheng 631D Hong Chia Hao 631D Shylagan Aruran 631D

Contents

• Introduction• General info and Economy- Fathima Shazna Saleem• Population statistics - Hong Chia Hao• Characteristics of the Population – Shylagan Aruran• Organization of Healthcare service – Yeap Dee Sheng

General information- Fathima Shazna Saleem

• Sri-lanka is a socialist democratic republic and is the oldest democracy in Asia. It was the first country to conduct elections under the British colonial rule in 1931 and by doing so elected Sir Don Baron Jayathilake as Sri-lanka’s first ever Leader of the House.

• Today, His Excellency Maithripala Sirisena serves as the President of Sri-lanka with Hon. Ranil Wickremesinghe serving as his deputy and the current Prime Minister of Sri-lanka.

• President, directly elected for a six-year term, is head of state, head of government, and commander in chief of the armed forces.

• The President leads the executive branch of the Sri Lankan government and is the commander-in-chief of the Sri Lankan Armed Forces. He is the head of the Cabinet, appoints the prime minister, and could dissolve parliament (after one year has passed since the convening of parliament after a parliamentary election).

• Sri Lankan presidents are involved with every aspect of the government decisions and are able to hold cabinet portfolios, or can bypass the cabinet posts by delegating decisions to the Presidential Secretariat.

• They can place the country in a state of emergency, under which they can override any law passed and place any regulation without needing legislative approval.

• The Prime Minister is the leader of the Cabinet business and also functions as a deputy to the President. In the event a president dies in office, the Prime Minister becomes the acting president until the Parliament convenes to elect a successor or new elections can be held to elect a new president. This was the case in 1993, when President Ranasinghe Premadasa was assassinated and Prime Minister Dingiri Banda Wijetunge took office as President

His Excellency President Maithripala Sirsena

Hon. Chairman Ranil Wickremasinghe

Territorial Subdivisions

The country is divided into 25 districts, each of which has a district secretary (the GA, or Government Agent) who is appointed. Each district comprises 5–16 divisions, each with a DS, or divisional secretary.

The Island consists mostly of flat to rolling coastal plains, with mountains rising only in the south-central part. It has a total area of 65,610 km². The highest point is Pidurutalagala, reaching 2,524 meters above sea level. The climate is tropical and warm, due to the moderating effects of ocean winds. Sri Lanka's climate can be described as tropical, Mean temperatures range from 17 °C in the central highlands, where frost may occur for several days in the winter, to a maximum of 33 °C in other low-altitude areas. Average yearly temperatures range from 28 °C to nearly 31 °C. Low Day and night temperatures may vary by 14 °C to 18 °C.Sri-lanka hosts many tourists each year to Sigiriya, Polonnaruwa, World’s end, Bakers falls and Kandy. In 2013, Sri-lanka welcomed 1.5 million tourists including 47,200 Russian nationals

Economy

• In 2015, SL boasted a total revenue of 80.591$ Billion and a per capita GDP of about $11,068.996 . The main economic sectors of the country are tourism, tea export, apparel, textile, rice production , agricultural products and IT. In addition overseas employment contributes highly in foreign exchange, 90% of expatriate Sri Lankans reside in the Middle East

• Sri-lanka is currently the world’s fourth largest supplier of tea• The average Growth for the year 2015 was 6.3%

There are about 900 factories throughout country serving companies such as Victoria's Secret, Liz Claiborne and Tommy Hilfiger

Out of the total population in Sri Lanka, 31.8% engages in agricultural activities

EU was the biggest apparel export destination in 2014 closely followed by the US

• Sri-lanka’s major market for export comes from the US with around $1.8 Billion in 2002 which equates to nearly 38% of all exports

• Sri Lanka has met the Millennium Development Goals (MDG) target of halving extreme poverty and is on track to meet most of the other MDGs, outperforming other South Asian countries

• Moreover, in 2014 the largest foreign-investment deal was signed with China for $1.4 billion for a Colombo port expansion- Colombo Port City, which will also include a Formula one track. This project once completed is expected to generate at the minimum 83,000 jobs and investments totaling $13 billion

Year Gross Domestic Product(GDP) USD - LKR

1980 66 167 16.53

1985 162 375 27.20

1990 321 784 40.06

2000 1 257 637 77.00

2005 2 363 669 100.52

Population statistics- Hong Chia Hao

Population Statistics

• With a population of approximately 21 million people, Sri-lanka is the 57th most populated country in the world. The population growth percentage of the nation is approximately 0.73% and encompasses Sinhalese the majority, Srilankan Tamils, Muslims, Moors and other minority groups.

• The Sinhala language is spoken by the Sinhalese people, who constitute approximately 75% of the national population and total about 13 million.

• The Tamil language is spoken by Sri Lankan Tamils, as well as by Tamil migrants from the neighboring Indian state of Tamil Nadu and by most Sri Lankan Moors. Tamil speakers number around 4.7 million.

• The Muslim community in Sri Lanka widely uses Arabic for religious purposes. Seldom used nowadays is Arwi, a written register of Tamil that uses the Arabic script and has extensive lexical influences from Arabic.

• There are more than 50,000 speakers of the Sri Lankan Creole Malay language, which is strongly influenced by the Malay language. There are also a large Maldivian population and they speak Dhivehi as their primary language

Statistics

• Total population (February 2016) 21,128,754• Gross national income per capita (PPP international $, 2013)

9• Life expectancy at birth m/f (years, 2013 72-78

• Probability of death between 15 and 60 years m/f (per 1 000 184/75• population, 2013) • Total expenditure on health per capita (Intl $, 2013)

304• Total expenditure on health as % of GDP (2013) 3.2 **Latest data available from the Global Health Observatory,2013

Sri Lanka’s population density is 321.6 people per square kilometer as of February 2016. Density of population is calculated as permanently settled population of Sri Lanka divided by total area of the country. Total area is the sum of land and water areas within international boundaries and coastlines of Sri Lanka. The total area of Sri Lanka is 65,610 km2 according to the United Nations Statistics Division

Demographics

Population (thousands) 2013, total 21,128,754Current male population (49.3%) 10,424,581Current female population (50.7%) 10,704,174Net migration 2013 -45 150 people

Population (thousands) 2013, under 18 6261.5Population (thousands) 2013, under 5 1874

Population annual growth rate (%), 2012-2030 0.5 Crude death rate, 2012 7Crude Death Rate , 2014 6.06

Crude birth rate, 1970 30.6Crude birth rate, 1990 20.6Crude birth rate, 2012 18.1Crude Birth Rate, 2014 est. 16.24 Life expectancy, 1970 64.1Life expectancy, 1990 69.5Life expectancy, 2012 74.1

Total fertility rate, 2012 2.3Urbanized population (%), 2012 15.2Average annual growth rate of urban population (%), 1990-2012 0.3Average annual growth rate of urban population (%), 2012-2030 2

Infant Mortality Rate (per 1000 live births) (2014 est.) 9.02 [Male - 9.98 Females-8.02]

Adult literacy rate: females as % of males 2008-2012 97.2Survival rate to the last grade of primary: females as a % of males 2008-2012 94.6Contraceptive prevalence (%) 2008-2012 68.4Antenatal care (%) 2008-2012, At least one visit 99.4Antenatal care (%) 2008-2012, At least four visits 92.5Delivery care (%) 2008-2012, Skilled attendant at birth 98.6Delivery care (%) 2008-2012, Institutional delivery 98.2Delivery care (%) 2008-2012, C-section 23.8Maternal mortality ratio , 2008-2012, Reported 39.3Maternal mortality ratio , 2010, Adjusted 35Maternal mortality ratio , 2010, Lifetime risk of maternal death 1 in 1200

Conclusion: The decrease in crude birth rates in the earlier comparison may be a consequence of increase population awareness and sex education. Moreover, even use of contraception and family planning would have played roles.

Life expectancy had seen an increase due to significant improvements in Health care, number of qualified personnel and dedicated funding for specified sectors. Achievements in terms of improved markers of Neonatal and maternal mortality can also be attributed to the same.

Majority of numbers of migrations that had occurred prior to 2010 were a result of the 30 year civil war. The Civil war had officially ended in May 2009

Characteristics of population- Shylagan Aruran

Top causes of death in Sri- Lanka

Conclusion:Ischaemic heart disease was the leading cause of death, killing 32,6 thousand people in 2012! Such numbers can be a result of the western trend in diet and lifestyle

Conclusion: In terms of the number of years of life lost (YLLs) due to premature death in Sri Lanka, ischemic heart disease, self-harm and cerebrovascular disease were the highest ranking causes in 2012

Conclusion:We can conclude that in both female and male groups the majority of deaths were due to increase of CV diseases and oncological problems with reduce in other diseases

Conclusion: This chart compares Sri Lanka with other regional countries and it can be noted that the highest cause of disability is self harm( inclusive of the 30 yr civil war) and typhoid fever compare to other countries. In addition, other causes like COPD, IDA, Asthma and migraine are quite common.

Age specific disability and place

Conclusion: It can be derived from the above table that the majority of disability comes to the working class individuals and incidentally via road injuries.

Infectious Diseases

Sri-Lanka is classified as a High risk zone as per the Mundi Index(**). It shares most of its major infectious diseases with Malaysia, that is currently classified as an Intermediate risk zone. This difference may be attributed to the lack of primary care in specific rural areas, insufficient medical staffing and Insufficient funding

**

In addition, HIV and Tuberculosis are important causes of Infectious disease mortality. In recent years the increasing prevalence of seasonal H1N1 Flu has also been a cause of significant mortality. Vector borne diseases such as Filariasis and Malaria are prevalent. The Anti-Malarial campaign has successfully eradicated Malaria in Sri-lanka since 2012. Filariasis is currently at an all-time low as a result of the Anti-Filariasis campaign.

Conclusion:Sri-Lanka is classified as a high risk zone as per the Mundi Index(**). Bacterial diarrhea, hep A, dengue, leptospirosis, rabies, hiv, TB and H1N1 are all the common infectious disease happened in Sri Lanka.

List of Notifiable Diseases

Tuberculosis

TB in Sri-LankaCase Detection of TB by District of Registration in 2013

Conclusion:We can see that the TB cases in Sri Lanka happened mostly in Colombo which is 2300 cases.

TB in Sri-Lanka

Conclusion on TB in Sri-Lanka:

Overall treatment success rate of 82.9% (7743 cases) was recorded for 2013.

MDR-TB is not a big threat to Sri Lanka when compared to other countries in the SEARO region. Only Four cases of MDR-TB were reported in year 2013 and all of them were enrolled for treatment.

TB/HIV Co-Infection HIV testing of all TB patients was made mandatory since 2013. In 2013, 4646 TB patients were screened for HIV. Of these patients, 6 patients were found positive. In addition, there were 9 patients with known HIV status at the time of diagnosis of TB, contributing to a total of 15 patients with HIV/ TB co-infection in 2013

H1N1

Conclusion:In year 2015, we can see that the most common influenza is influenza B, especially in January and March while in March and April there is outbreak and increasing of number of cases of H1N1.

Dengue

*From Kalubowila South teaching hospital, Colombo 2015

Conclusion:Dengue cases in Sri Lanka is 29777 in a year. The highest cases occurred in January. From the picture we can see that the highest incidence rates were recorded in Colombo which is 2849 cases.

Leptospirosis

** www.epid.gov.lk 2015

Conclusion:We can conclude that leptospirosis cases in Sri Lanka in a year is 4402 cases. The highest incidence happen in November. The majority or nearly all the cases were of farmers and individuals living in farming zones with exposure risk

Oncology

Most commonly detected cancer in males is Oral ca. which can be attributed to betel leaf, smoking and alcohol use which are independent risk factors.

In females, Breast Ca. forms the majority.

Prevalence of Non-communicable diseases:

• Cerebrovascular Accidents (Strokes & TIA’s) – 170000 (1999) and 210000 (2005)

• Hypertension (Essential HTN) - > 20 years old 10.3% Admissions increased from 86 to 226 per 100000 persons in almost two decades• Chronic Respiratory Diseases – Bronchial asthma 20-25% among adults depending on the

geographical location

• Smoking – as per 2008 MOH, 22.8% of males and 1% of females smoke

• Alcoholism – is a huge problem due to Cirrhosis and dependence

Conclusion: Alcoholism results in social and personal despair. Its inevitable sequelae to Cirrhosis and Cancer makes it a huge burden to the nation, that can be reduced with more stringent laws. As evident from the comparison above the abuse of alcohol by males in the country is greater than double the set value for SE Asia by WHO

Healthcare system- Yeap Dee Sheng

“Health is defined as the a state of complete physical, mental and social well-being and not merely the absence of disease ” – WHO 1948

Healthcare system in Sri-Lanka

The Healthcare system encompasses all agencies, facilities and all providers of healthcare in a defined geographic area. In Sri Lanka, the healthcare system can be subdivided at different levels:

Primary care

Secondary care

Tertiary care

Minister of HealthDr.Rajitha Senaratne

Deputy minister of healthHon.Faisal Cassim

Director of Health servicesDr.P.G.Mahipala

Scheme representing Structure of MOH

Primary care is where every individual usually enters the healthcare system. It mainly deals with early Detection and Prevention of disease in general. It also includes the regular screening and follow-up of common health problems & chronic illnesses that can be managed at home or on an out-patient basis.

Providers : MOH, Community health centers/clinics, hospital OPD, GPs, industrial health units, and school health units etc.

“ Easily Accessible, Acceptable, Affordable and Appropriate’’-WHO

Primary Care

Secondary Care

Secondary or acute care is concerned with emergency treatment and critical care involving intense and elaborate measures for the diagnosis and treatment of a specified range of illness or pathology.

Provider groups for secondary care include both acute- and long-term care hospitals and their staffs.

Tertiary Care

Tertiary care includes highly technical services for the treatment of individuals and families with complex or complicated health needs.

Providers of tertiary care are health professionals who are specialists in a particular clinical area and are competent to work in such specialty agencies Ex. psychiatric hospitals and clinics, chronic disease centers, and the highly specialized units of general hospitals; for example, a coronary care unit.

National Hospital 01Teaching Hospitals 20Provincial General Hospital 03District General Hospital 18Base Hospital Type – A 22Base Hospital Type – B 46Divisional Hospital type – A(More than 100 patients Beds) 42Divisional Hospital type - B(Between 50 to 100 patients Beds) 129Divisional Hospital type - C(Less than 50 patients Beds) 322Primary Medical Care Unit(Central Dispensaries & Maternity Homes) 474Board Managed Hospitals 02Special Hospitals 05

Total Number of Medical Institutions 1084

National Hospital Srilanka

Lanka Hospitals group

Neville Fernando Teaching Hospital

*2012

Local Brain drain

Health care to Urban population:

• Health care services have been organized with the various levels in sync with administrative activities i.e. central, provincial, district and divisional levels.

Central level- ex: organization of programs like anti-malnutrition, anti-Filariasis, anti-malarial campaigns and their surveillanceDistrict level- ex: consists of a healthcare specialist, a health education officer, an epidemiologist, health inspectors and may or not involve head nursesDivisional level- Level where the actual implementation takes place, ex: includes divisional Medical house officer(MOH), Public Health Nursing Sister (PHNS), Public Health Inspectors (PHI) and Public Health Midwives (PHM) responsible for approximately thousands of people living in the specified area. Right now 330

• The Private sector that mainly consists of Lanka Hospitals ltd, Durdans hospitals, Nawaloka Hospitals, Oasis hospital, Golden ENT hospital, also contribute a significant amount to the population. It is a common trend to seek private health care rather than govt. institutions due to ease of access

• Anti Leprosy Campaign• Anti Malaria Campaign• Anti Filarial Campaign• Tuberculosis Control Chest D

iseases• Epidemiological Unit• Public Health Veteranary Ser

vices• Environment &

Occupational Health• Quarantine Services

• Youth, Elder, Disabled & Displaced

• Estate & Urban Health• Maternal & Child Health• Nutrition Coordination Unit• Nutrition Division• Health Education Bureau• Nursing (Public Health)

PHS-I PHS - II

DGHS- Director general of health service

Health care to Rural population

• Though health care is free across the country, various other factors play a role in its ineffectiveness

• Certain objectives such as 100% coverage, supply on demand for nation’s obligatory list of medicines still have not been fruitful

• In addition, the health care centers are located at considerable distances from villages and hence adds to the problem

• Problems with availability of laboratory and radiological diagnostic testing which translates into poor detection and subsequently poor treatment.

• Widespread educational programs are seldom organized within the rural population. This trend appears to have changed now

The pre-hospital care sub-committee has established minimum standards for EMT education in Sri Lanka. Currently, EMTs and Pre-Hospital personnel are currently working in four distinct areas: 1. Fire Brigades 2. Hospitals 3. Community based relief Organizations 4. Private services

EMT training is divided into four training levels:

EMT-Level 1: Referred to as Medical First Responders. Typically, first responders may be fire fighters, police officers, lifeguards, coaches, or teachers. Level 1 EMTs are trained in basic rescue, oxygen use, CPR, splinting, and safe ambulance operations.

EMT-Level 2: Level 2 EMTs are sometimes referred to as EMT-Basics or EMT-Ambulance Officers. Some examples of the skills of an EMT include

Principles of Emergency Care Organization

Airway management with the use of oral and nasal airways - Automatic External Defibrillators - Extrication of Trauma Patients with spinal injuries - Medical & Trauma Patient Assessments - Assisting patients with prescribed medications (NTG [gtn], Aspirin, albuterol inhalers) - Spinal Immobilization - Assessment of Vital Signs - Assisting with unexpected emergency deliveries during transport

EMT-Level 3: Level 3 EMTs or EMT-Intermediate Level is a more advanced professional level of pre-hospital care providers. Typically, level 3 EMTs are more senior and experienced EMTs and also have additional training in establishing IV cannulation, and in some areas limited access to lifesaving medications and advanced emergency airway management.

EMT-Level 4: Internationally, EMT-Paramedic represents the highest level pre-hospital care professionals. Currently EMT-Paramedics, or Level-4 EMTs are not being trained in Sri Lanka.

New Falck Ambulance

System of prenatal protection of fetus, health protection of newborn, health protection of preschool and school-age children

Prenatal careMidwives provide Prenatal care to women at home visits and in health clinics. These visits include blood pressure screening, measurement of weight and education related to nutritional needs during pregnancy. The midwife registers all pregnant women, and most are registered in first trimester of pregnancy. Nearly every pregnant woman (98.5%) receives antenatal care

Registration of BirthEvery birth should be registered with the government to obtain a birth certificate which act as the main legal document for a citizen in Sri Lanka. The name of the child (which is given by the parent), details of the mother and the father will be entered in the birth certificate. The birth certificate will be required to obtain the National Identity Card, Passport and many more legal activities. An application form should be obtained from Divisional Secretariat and proceed with the registration.

Educational Institutions comprise a. institutions for pre-school children b. primary school c. secondary school

The tasks of female consultation (as per SLCOG):

• Giving the outpatient treatment-and-prophylactic care to women during pregnancy and after delivery;

• Decrease of maternal and prenatal death rates, spontaneous abortion;• Carrying out of physical and psychological prophylactic preparations of the pregnant

women for delivery;• Giving the outpatient care at gynecologic diseases;• Examination of the work conditions for working women;• Organization of health educational work with women;• Giving social and legal aid to women according to the legislation of protection of

motherhood and the childhood.• Prevention of complications of pregnancy, delivery, postnatal period, gynecologic

diseases;• Giving the obstetric-and-gynecologic aid using the modern diagnostics and treatment;• Advisory activity on questions of contraception and prophylaxis of abortions

Pediatric institution activity:

• Fetal and infant mortalityPerinatal mortality consists of fetal and infant deaths occurring between 28 weeks΄ gestation and 1 week of postnatal (till 6 days, 23 hours and 59 minutes), with fetal or infant weight more than 500 g. The perinatal mortality rate is calculated per 1000 cases of live birth and still birth.• Neonatal mortality consists of deaths of live born infants within 28 days of age.

Lady Ridgeway Hospital, Colombo is a premier tertiary children’s care hospital. It is now considered to be the largest children’s hospital in the world. It has specialized units in Cardiology and Cardiothoracic surgery, Orthopedic, Rheumatology and Rehabilitation, Dermatology, Ophthalmology, Psychiatry, Neonatology, Intensive Care, Orthodontics, Maxillo-Facial Surgery, Plastic Surgery, Burns and ENT Surgery.

The Durdans Hospital, Colombo also handles a considerable number of pediatric cases in wide areas of specialties.

References

www.who.orgwww.en.wikipedia.orgwww.mundi-index.netwww.epid.gov.lk- Sri lanka epidemiological unitwww.health.gov.lk/en - Sri lanka ministry of healthwww.tradingeconomics.com/sri-lankahttp://www.imf.org/external/country/LKA/index.html*Sri lanka’s economy, a perspective

Thank you for your attention