3.

1 HEALTH

HEALTH

3.1.1 Background
As in other parts of the country, both public and private sectors provide health care to the people in Northern Province. However, public sector plays the major role in providing health care for the people in this Province. The private sector also provides health care to a lesser extent. The Department of Health Services of Central Government and provincial council cover the entire range of preventive, curative, rehabilitative and promotive health care services in the Province. The private sector provides mainly the curative care through outpatient services. This includes few private hospitals with indoor facilities, full-time general practitioners, government doctors who are engaged in part-time private practice outside their duty hours and other private facilities like laboratories and pharmacies. Recently, few of non-government organizations came forward to assist the government to strengthen preventive care services. Nearly 98% of inpatient care is provided by the government institutions. Preventive, promotive and rehabilitative care is also provided through public sector. Western (allopathic), Ayurvedic, Unani, Siddha, and Homeopathy systems of medicine are practiced in Northern Province. Of these, Indigenous medicine is the main sector catering for the need of the vast majority of the people. In the Northern Province, the Department of Health Services is mainly concerned about western medicine. The Department of Indigenous Medicine also provides health care for a significant number of people in the province. Northern Province is equipped with an extensive network of health care institutions. Primary and secondary health care institutions in the curative sector as well as preventive and rehabilitative care institutions are mainly managed by the Provincial Health Department and tertiary care health institution (Teaching Hospital, Jaffna) is managed by the line ministry. The Ministry exercises guidance, policy direction, management, and co-ordinates planning, implementation and monitoring of the activities of the RDHS Divisions. It is responsible for the overall Provincial Policy and implements programmes identified under the Presidential Task Force(PTF) Recommendations, Master Plan of the Ministry of Health, Colombo and the Five Year Provincial Investment Programme. The Ministry also works to achieve the Millennium Development Goals by year 2015. In 2009, 280,000 IDPs were residing in welfare Villages in Vavuniya district. Government had decided to resettle 100,000 peoples before 31st October 2009. Out of 100,000 populations 52,000 of them were resettled comprising 11 D .S. divisions in Jaffna district and rest of 48,000 populations resettled in other four districts. The Provincial Health Authorities prepared a Plan for Additional HSDP 2009/2010 funded by World Bank according the Need Assessment conducted in district wise and priority has been given for the restoration of health services to the institutions in early recovery areas in Northern Province under Health Sector Development Project (HSDP). Based on the needs assessment report, many major development activities demanded for health service restorations in the early

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HEALTH recovery areas were carried out through government funds while gaps were filled by PTF approved UN agencies & INGOs.

Provincial Health Administration

Previously, the entire health system of Sri Lanka was functioned under a Cabinet minister of the central government. However, with the implementation of Provincial Council Act in 1989, the health services were devolved, resulting in the Ministry of Health at the national level and separate Ministries of Health in the nine provinces. The Central Ministry of Health plays a major role in development of national health policies and guidelines, training of medical and Para- medical staff, management of teaching hospitals and specialized medical institutions and bulk purchase of medical supplies. The Provincial Health Ministry is totally responsible for management and effective implementation of health services within the province, development of policies and guideline for the Province and also human resource management within the Province. In the Northern Province, the Department of Provincial Health Services is under the Ministry of Health & Indigenous Medicine. Since there is no elected body to the Northern Provincial Council (NPC), the management of the health sector is being done by the Secretary and PDHS in line with Ministry of Health, Colombo. The Provincial Director is the head of the Provincial Department of Health Services (PDHS). There are 5 Regional Directors of Health Services (RDHS) for each district. Each RDHS area is geographically similar to the administrative units of district secretariats. The Medical officers of Health (MOH) are mainly responsible for the preventive care of the respective divisional secretary areas and the Medical Superintendents (MSs) & Medical Officers-in-Charge (MoICs)of the hospitals are responsible for curative care of the respective hospitals. The administration of Health Services of the Northern Province is decentralized in to Five Regions under the Regional Directors of Health Services in all five districts, which are responsible for the provision of health services to the respective districts. The health institutions in Northern Province comprising of hospitals with specialist services at District General Hospital, Base Hospital(BH), Divisional Hospital(DH) and Primary Medical Care Units(PMCU) as curative care institutions and MOH Offices, Gramodhaya Health Centers(GHCs), Anti Malaria Campaigns and School Dental Clinics as preventive care institutions. The Ayurvedha Sector is functioning with only Curative Care Institutions in Northern Province. These institutions provide Patient Care and Preventive Care Services to promote the Health Status of the population. Beside this, One Teaching Hospital is functioning in Jaffna district under Line Ministry. There are 08 offices existing for General Administration including Ministry office, Provincial Department for each Health & Indigenous Medicine and Five Regional Directorate of Health Services. 161 Preventive Care Institutions and 91 Curative Care Institutions are available (besides these 5 Chest clinics, one Leprosy unit & 4 STD clinics functioning with the major hospitals). There are 83 Ayurvedic Medical Institutions functioning in Northern Province. Out of 83, 04 District Ayurvedha Hospitals, 02 Rural Ayurvedic Hospital & 13 Central Ayurvedic 119

HEA ALTH Disp pensaries are functioning under the Dept. of In e g e ndigenous M Medicine and sixty four (64) Free ( Ayurvedic Dispensaries are f functioning u under the Local authorities. In 20 010, more at ttention is provided for t maintenance of IDP Health Care Centers by providing the p basic patient ca and pre are eventive care inputs for these insti e r itutions. Th General Hospital, he Vavu uniya and Ba Hospital, Cheddikula in Vavuniya district p ase am provided emergency care for the e disp placed people. The development ac ctivities take place esp en pecially in re esettlement areas to sync chronize with the resettlement progr h ramme. Still there is a ne ecessity to st trengthen th health he insti itutions at va arious levels and an urge need to revamp the preventive h s ent health servic in the ces Nort thern Provin nce.

ailability of Curat y tive Care Instituti e ions in Northern Province e Ava

45 40 35 30 25 20 15 10 5 0 1 Vav vuniya 8 1 9 1 Mannar 1 6 22 4 7 1 Kilino ochchi 1 3 4 1 2 2 Jaffn na 16

Mullaithivu M

District General Ho t ospital Divisional Hospital

Base Hospital (Type A) B l Primary Medi Care Un ical nit

Base Ho ospital (Type B) e

In a addition to the above, teaching Ho ospital is fu unctioning in Jaffna dist n trict under the Line Ministry. The s special clinics for Chest (01 for each district) an STD (01 f each dist h nd for trict) are func ctioning unde General H er Hospitals / Ba Hospitals administere by NPC. ase s ed

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HEA ALTH

Ava ailability of Preve y entive Ca Instit are tutions in Norther Provin n rn nce
10 60 50 4 40 1 30 41 20 5 10 0 avuniya Va Mannar Kilinochc chi Mullai ithivu Jaffna J 10 16 2 1 4 1 4 13 1 1 31 11 3 1 1

Gramodha Health C aya Centre

MO Office OH

Antimalaria C A Campaign

School Dent Clinic tal

Ther are 28 MO Offices and 111 GHC, which are responsible f the preve re OH , r for entive and pr romotive aspe of Healt care for the people especially for mothers an children. Besides the there ects th r nd ese are specialized Campaigns for the control of Ma alaria, Lepro osy, Rabies, Respiratory disease y trol ually transmi itted disease (STDs). es cont and sexu

3. .1.2 A Achiev vemen / Perfor nts P rmanc 200 ce 09 Mid 201 11

Healthcare in the No orthern P Province after Ma 2009 e ay
As a result of the conflict, many health in e nstitutions in wanni area had been b n as badly affecte Some ed. were closed as people and hospital sta left the place for th safety. H d aff heir Health staff from all egory shown reluctant to work in the province. As a result th o e A here was a shortage of almost all a cate cate egories of he ealth staff in ncluding spe ecialists for the secondary and tertia care inst t ary titutions, Fam Health Workers an Public Health Midw mily nd wives. Althou ugh governm ment health service h prov visions and infrastructur exist, th delivery system lacks adequate f res he s s facilities in terms of t equipment and personnels. This becom even more critical on the pre mes m eventive side, which kes n e vices to the resident population diffic r cult. mak provision of adequate health serv

Pro ovision o Health Facilities to IDPs in Welfa Villag of s are ges

The total numbe of Interna Displaced Persons (IDPs) remained unchange nearly at 280,000 er ally d ed 9. housed in schools and ot ther public s sites had bee transferre to the en ed as at 10.07.2009 The IDPs h fare villages. The numbe of IDPs ho . er oused in Vavuniya, Jaffna and Trincomalee had stabilized a s welf as n further ID were rep no DPs ported comi into the district. The cumulative total stand at 280 ing e e ds

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HEALTH 000, consisting of 85, 748 families in Vavuniya. The majority of them 247 912 are housed in a total of thirteen welfare zones and other sites in Cheddikulam administrative division. The government had developed a 180-day plan (UthuruWasanthaya) for resettlement and Development at conflict-affected areas in the North. In line with the above, the Provincial Ministry of Health, NP had developed a draft plan with the collaboration of Ministry of Health(MoH),Colombo for Resettlement & Development and initiated assessment of the need for necessary & urgent health infrastructure. In ward patient care to IDPs was provided at GH-Vavuniya, BH-Cheddikulam, DHPoovarasankulam and District AyurvedicHospital,Pampaimadu, GH-Mannar, TH-Jaffna and PHPadaviya. The number of IDP in ward patients treated at the above hospitas had decreased significantly in that period. The Pooverasankulam hospital continued to treatpatients infected with communicable disease like chickenpox, measles, hepatitis, etc. PampaimaduAyurvedic hospital took care of unaccompanied elderly, postnatal mothers with their newborn and postsurgical patients who need long-term care/ rehabilitation. This was a good example for the collaborative action between NGOs and the government in emergencies. WHO, UNICEF, IOM, MSF-Holland, MTI, SLRC, Handicap International, Help Aged, Sarvodaya are the main agencies providing assistance in these hospitals

Public health services in IDP zones had been established by the respective units of the Ministry of Health & IM, NP with the support of health partners. These include Antenatal care, Child welfare, Family Planning, Nutrition rehabilitation, Hygiene promotion, Training health volunteers, disease surveillance etc. Additional medical teams were drawn from other districts on roster basis to serve in the IDP health care unit of the welfare villages. A new immunization guideline had been released by the MoH, where all the children between the age of six months and one year are given an additional dose of measles vaccine. Children between 1-3 years of age are given a dose of MR vaccine. All males and females between the age of 13 and 21 years who had not received the adult Td vaccine had been given a single dose of a Td. High-risk groups in the IDP camps (such as food-handlers, health workers and workers working closely with patients) were given VI polysaccharide typhoid vaccine. The Ministry of Health had appointed more than 50 new post-intern doctors on a permanent basis to work in IDP sites. These doctors were housed in the semi-permanent quarters provided by Ministry of Health & IM, NP in Cheddikulam. MOH had also taken action to appoint specialists

122

HEALTH doctors to IDP sites permanently in order to develop the health service as a routine system. Provision of health services to new IDP sites and to the resettlement sites was a challenge for the Ministry of Health. As part of the 180 day resettlement & development plan of the government (UthuruWasanthaya), the Ministry of Health & IM, NP had also come up with a plan to mirror their health plans for the next 180 days. In this, the MoH&IM, NP needs for the reconstruction and rehabilitation of health facilities articulated, as well as the need for the provision of medical equipment.

3.1.3 Fund Received 2009 - 2011

Commitments of the Uthuru Wasanthaya Programme during the Year 2009, 2010 & 2011 Capital Allocation in Mn
S/N 01 02 03 04 05 06 07 Jaffna Vavuniya Mannar Kilinochchi Mullaithivu PDHS Office Selected areas in NP Total District 2009 398.139 436.731 292.277 138.374 111.087 1,376.608 2010 450.072 319.490 257.915 260.717 251.250 26.625 1,566.069 2011 338.830 155.090 196.570 521.610 472.890 118.350 1803.340 Total 1,187.041 911.311 746.762 920.701 835.227 26.625 118.350 4,746.017

Capital Expenditure in Mn
S/N 01 02 03 04 05 06 07 Jaffna Vavuniya Mannar Kilinochchi Mullaithivu PDHS Office Selected areas in NP Total District 2009 316.695 399.032 250.701 72.948 40.824 1,080.20 1,476.812 2010 377.245 315.904 251.642 256.059 249.789 26.173 56.031 2,613.043 2011 27.420 2.915 11.119 13.812 0.765 Total 721.360 717.851 513.462 342.819 291.378 26.173

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HEA ALTH

Cap pital Allo ocation & Expenditure 200 2011 June 09 1

1200 1187.041 1187 041 911.311 920.701 835.227 342.819 291.378

800

717.851

746.762 513.462

600

400

721.36

1000

26.625

200

Allocation A

Expenditure E

26.173 26 173

118.35

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HEA ALTH

Fina ancial C Commit tment in 2009 n

450 0 400 0 350 0

Amount in Mn.

300 0 250 0 200 0 150 0 100 0 50 0 0

Allocation n Expenditu ure

Vavuni iya 436.73 31 399.03 32

Ma annar 293 3.821 250 0.701

Ki ilinochchi 138.374 1 72.948

Mullaithivu 111.088 40.843

Jaffna 398.139 316.695

Fina ancial C Commit tment in 2010

500 450 400 350

Amount in Mn

300 250 200 150 100 50 0

Vavuniya Mannar 257.915 251.6415 Kilinochchi 260.717 256.0588 Mullaithivu 251.25 249.789 Jaffna 450.0721 377.2448 PDHS Office 26.6245 26.1737

Allocation Expenditur re

319.4905 315.2448

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HEALTH

Physical Commitment in 2009

No of works committed No of works completed

125 115 94 77 97

52 27 31 20 Vavuniya Mannar Kilinochchi 10 Mullaithivu Jaffna

Physical Commitment in 2010

No of works committed 75 70 57 54 51 54 53 44 62 56 No of works completed

Vavuniya

Mannar

Kilinochchi

Mullaithivu

Jaffna

Physical Resources Development

For the development of health sector in Northern Province, different types of sources of funds for capital expenditure were utilized during the year 2009.The major contributions for these were from Provincial Specific Development Grants (PSDG) and World Bank. The other sources included are National Plan of Action for children, Criteria Based Grants, UNICEF and UNFPA projects. Within the year 2009, the Government re-constructed a number of hospitals which were beyond renovation condition or out dated hospital designs.

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HEALTH

Human Resources Development

431 new staffs were appointed in 2009 including 151 Medical Officers, 05 Consultant Physician, 01 Consultant Paediatrician, 18 Pharmacists, 68 Nursing Officers, 01 Radiographer, 09 PHIs, 19 Midwives, 29 HMAs, 03 MAs, 04 Bio Medical Technician, 10 Spray Machine Operators, 69 Sanitary Labourers and 44 Ordinary Labourers for the Health Sector, Northern Province. The Ministry of Health, Northern Province recruited three hundred candidates with G.C.E. (O/L) qualifications for Basic training of PHM with cabinet approval. The inauguration of this training programme was held on 07/09/2009 at Regional Training Center, Jaffna.. Hundred and Fifty students have been trained in Regional Training Center, Jaffna Another Hundred and Fifty students in Nurses Training School, Vavuniya. Finally 222 PHM students completed their course and deployed from 16th June 2011. 53 dispensers completed their training successfully and deployed from 1st of June 2011. Basic Training for the newly recruited 50 PHII is being conducted at RTC Jaffna. 283 Nursing Officers completed their training and action has been taken to recruit another 250 Nursing Officers with the qualification of GCE(A/L) any stream with the approval of Ministry of Health, Colombo only for Northern Province. Recently 42 nos. Health Management Assistant have been appointed to the administration units in NP. 38 SMOs have been appointed recently.

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HEALTH

Jaffna District

Base Hospital, Point Pedro

Jaffna District is situated in the Northern part of Sri Lanka and is 410 Km away from Colombo. The extent of the district is 1,025.6 sq.km (including inland water sources). It comprises the major part of the peninsula together with small Islands on the Western side. It is surrounded by the Indian Ocean on the Northern and Western side. On the east it is bounded by Bay of Bengal and on the south by Jaffna lagoon and Kilinochchi District. When considering health facilities in Jaffna District, Teaching Hospital, Jaffna is the only tertiary care institution which comes under the administration of Central Ministry of Health. All other curative institutions come under the administration of Regional Director of Health Services, Jaffna. These institutions are forming a network in three levels, such as:

S/N
01 02 03

Category of Institutions
Base Hospital (Type A & B) Divisional Hospital Primary Medical Care Unit

Nos.
04 22 16

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HEALTH In addition to the above hospitals, Cancer Unit, Tellippalai and Chest Clinic, Jaffna s functioning under the administration of Regional Director of Health Services. In the preventive sector under each MOH there are clinic centers which provide mainly Maternal and Child Health care services. In addition to the Western system of medicine, Ayurvedic systems also functioning in Jaffna District under supervision of Regional Director of Health Services. Under Ayurvedic system there are 01 District Ayurvedic Hospital, 02 Rural Ayurvedic Hospitals and 09 Ayurvedic Central Dispensaries and 01 District Manufacturing Unit. In addition, there are 40 Free Ayurvedic Dispensaries under Local Governments. Regional Director of Health Services is in charge for all promotive, preventive, curative & Rehabilitative health activities in the district. Under him Heads of Institutions namely Medical Superintendent, District Medical Officers, Medical Officers in charge and Medical Officer of Health are functioning. Regional Medical Officer, Anti Malaria Campaign, Regional Epidemiologist and Medical Officer/ Maternal & Child Health, Medical Officer, Planning are also functioning under RDHS to assist him in respective fields.

Infrastructure Development renovation / repairs)

(Construction/

Reconstruction/

During the year 2009, a new administrative block with OPD unit at Base Hospital Chavakachcheri, was constructed under NECORD project at a cost of 32 Mn. Furthermore a water tank with water supply connection was provided to this hospital under the same project at a cost of 9.5 Mn. At Base Hospital Point Pedro there was a two storied consultant qtrs. & a drug store constructed under the same project at a cost of 47 Mn. At Divisional Hospital Valvettithurai, a drug store has been constructed and female ward, male ward, OPD unit and ward blocks have been renovated. 01 no of Doctors quarters also has been constructed at a total cost of 28 Mn. There was a drug store constructed at BH Chavakachcheri at a cost of 11 Mn. A Divisional Hospital, a Primary Medical Care Unit and a Gramodhaya Health Centre constructed at Karaveddy, Illawalai & Athiyadi at a total cost of 28 Mn. A new maternity ward constructed at DH Manipay at a cost of 14.5 Mn. 01 no of MO quarters constructed at DH Karainagar at a cost of 8.5 Mn. Beside this, 10 nos. of Divisional Hospitals, 02 nos. of Base Hospitals and 02 nos. of Primary Medical Care Units had been reconstructed at a cost of 10 Mn. Emergency Treatment Unit (ETUs) had been improved in 03 nos. of Base Hospitals & 02 nos. of Divisional Hospitals at a cost of 1.6 Mn. Emergency renovation of hospital building had been done at 3 hospitals at a cost of 1.7 Mn. Intercom facilities had been provided to 3 hospitals at a cost of 2.2 Mn. During the year 2010, in Jaffna district, Base Hospital Tellipalai has been reconstructed at a cost of 30 Mn including Repair of DMO quarters, medical ward, maternity ward, paediatric ward, obstetric unit, Psychiatric unit, kitchen, ambulance garage, store, electricity system, reconstruction of OPD building and corridor, four examination rooms, OPD dispensary, patient waiting area, drug store, dressing room, injection room, ETU, DMO office, Doctors, Nurses and minor staff rest room, 09 nos of staff quarters for MOs, dental surgeon & other staff, boundary wall with gate and a well.

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HEALTH 5 nos. Maternity ward have been newly constructed in Divisional Hospitals Kodikamam, Velanai, Karaveddy, Vaddukoddai, Kondavil at the total cost of 70 Mn. Base Hospital Point Pedro has been refurbished and furnished at a cost of 20 Mn. In Divisional Hospital Atchuvely, the existing OPD block was extended by a side wing block at a cost of 12 Mn. In Base Hospital Chavakachcheri, Medical ward, surgical ward & MO qtrs, 48 beds Paediatric unit are constructed with the allocation of 130 Mn. Within the allocation 62 Mn has been already spent & the 75 % of the building works already completed. Furthermore Bicycle park, Ambulance garage & Vehicle park have been newly constructed at the cost of 6.0 Mn. 02 nos. MOH Offices in Kayts&Uduvil has been newly constructed at the cost of 30 Mn. In Pannai, constructed & equipped a new BME unit with the expenditure of 14 Mn. Doctors quarters in Divisional Hospital Valvettithurai renovated at the cost of 15 Mn and the Divisional Hospital Ampan is under repair with allocation of 16 Mn. In Base Hospital Chavakachcheri, Medical ward, surgical ward & MO quarters are being reconstructed at the cost of 160 Mn including the provision of 30 Mn worth medical equipment. Under the NECORD Project Repairs of Water supply of Sewerage System is ready to commence at the cost of 23Mn.

Opening of Admin Block @ BH Chava.

Opening of GHC Aathiyadi

BH Point Pedro Consultant Qtrs. Opening

Opening of PMCU Illawalai

Opening of Divisional Hospital Karaveddy

Provision of Ambulance boat to DH Nainathivu

Drug Store at DH Valvettithurai

Refurbishment of DH Valvettithurai

Strengthening of RDHS Office

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HEA ALTH

Opening of PM Urumpirai MCU

Drug Store at BH Point Pedro g

Drug Store at BH Chavak e kachcheri

Maternity Ward at DH Manipay M y

Semi-pe ermanent ward at BH Chava. d

Wards r renovation at DH VVT D

Rep pairs to Psychia atric Ward at BH Tellip palai

Repair to Paediatric Ward at BH rs c Tellipalai i

Repairs to Covered way at BH y Tellipalai

Re e-construction o Kitchen at BH of H Chav va.

Const truction of OPD block at DH i Atchuveli

Improveme of Hospital building at ent b B Point Pedro BH

Con nstruction of BM Unit at Pann ME nai

Construction of Maternity ward at DH Kodikam mam

Constructio of Maternity ward at on y DH Kondavil

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HEA ALTH

Con nstruction of M Maternity ward a at PMCU Il llavalai

Constru uction of Mater rnity Ward at DH Vaddukod ddai

Re-construct of MOH Of tion ffice Uduvil

Pro ocurement
In th year 2009 NECORD h provided a computed radiotherapy to upgrad the existing X-Ray he 9, has d de mac chine at a c cost of 11.5 Mn. 02 no of stand by generators had be 5 os. d een provided to DH Kara ainagar& DH Vaddukoddai. District M Management Unit(RDHS) had been st t trengthened at a cost of 1 Mn. Rs. 2 Mn worth dental cha had been provided t School De 1.8 2.5 airs to ental Clinic. Rs. 2 Mn worth MCH eq quipment was provided to MCH Clinics. MoH Colombo supplied a patient d C H, nsport/ambulance boat to Nainathivu Hospital at a cost of 3.8 Mn u 8 tran

In t the year 20 010, Rs. 11 Mn worth medical equipment s 1 h e supplied to Jaffna dist trict BHChav vakachcheri, & BH-Point Pedro viz..D , t Dental equip pment, Bio chemistry ana alyzer. Besid these des lab-reagents, te esting kits w with strips & equipmen instrumen for dog sterilization dental nt, nts n, instr ruments, HB meter with strips, Infa meter, glucometer, f B h ant folding scree weighing scale & en, g eme ergency tray also supplie to selecte hospitals & MOH offic A stand by 20 KV ge ed ed ces. enerators supp plied to Divisional Hospi Karainag Office fu ital gar. urniture & eq quipment w worth of Rs.8 8.0million was procured a supplied to RDHS O and d Office and selected MO offices. O new am s OH One mbulance st isional Hosp pital Maruthankerny and & a mobil dental d le bought at a cos of Rs.5.0 mn for Divi icle Rs. was d fice, Jaffna. vehi costing R 10.0 mn w supplied to RDHS off

Pro ovision of Mobil Dental Vehicl le le

Provi ision of Dental Chair to BH C Pointpedro o

Implementi 5S System at RDHS ing m Office

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HEA ALTH

Imp plementing 5S System at RDH HS Offi ice

Prov vision of Ambula ance to DH Maruthanke erny

Handing Over of Bicycles to PHMM t

Provision of Offi Equipment P fice

Provision of X-Ray equi ipment to BH Po Pedro oint

pacity Bu uilding Cap

The following t e training pro ograms were conducted in 2009 in Jaffna district. e d n
Training on the impo g ortance of ad dolescent nu utrition for ad dolescent Sc chools Girls A campa on the p aign prevention o breast milk substitutes of k Training on implem g ment the Nu utrition Pack kage (INP) in ncluding infa and you child ant ung feeding practices for trainers (TO IYCF r OT) g ed e n aration for co ommunity le edgers Training on improve knowledge of nutrition food prepa Training programme for teacher & adolesc g e rs cent out of s school on improve know wledge on HIV/AID prevention and health DS n Training Programme for volunte g e eers out of school on im s mprove know wledge HIV/A AIDS and other se exually transm mitted infect tions (STI), re eproductive health Training programme for teachers to reactiv g e vates school health clubs & coordina s ation the SH activ vities Training programme for low BMI mothers g e Training programme on Emergency Obstetric Care (EmO including labour room mgt g e OC) m

Training programme to improve knowledge of husbands Pregnant & lactating mothers g e s, m In 2010, More t than 10 nos. training prg . grammes we conducted in Jaffna district. Tra ere aining for PHM to have enhanced kno Ms owledge and skills on ma d anagement o acute maln of nutrition. Tra aining on adolescent, pre e-pregnant and maternal nutriti ion. Workshop for A Behavior Change mmunication (BCC) plan o nutrition is developed implement and mon on d, ted nitored at the district Com leve with the p el, participation of primary h healthcare workers and c w community leaders. Cam mpaigning on b breast feeding during w world breast feeding we eek, training for mother on breast feeding g rs t tech hniques, train on Dieta modification food supplementati & perinatal education for low ning ary ion BME students in Grade 10 in selected schools were also conducted in Jaffna region. E n n a

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HEA ALTH

Va avuni Di iya istric ct

District General Hospital, Vavuniya t

The administrat tion of Health Services of the Vavu uniya Distric is carried out by RDH office ct HS Vavu uniya. In Va avuniya the institutiona network links 64 He al ealth Institu utions comprising of Hospitals with s specialist ser rvices as Dis strict Genera Hospital, District Base Hospital, Divisional al e D ry hest nd c tions and Hospital, Primar Medical Care Units, Ch clinic an STD clinic as curative care institut Gramodhaya Health Cen ntres and Anti Malaria Campaigns as prevent A tive care MOH Offices, G itutions. The Ayurvedha Sector is functioning through 3 Curative Care Institu e g utions in insti Vavu uniya. These institutions provide Curative Care and Preventi Care Serv e s a ive vices to prom mote the Health Status of the populat f tion. re or Administratio Four Prev on, ventive care Institutions (besides Ther are One Institution fo General A this 03 numbers of school d s dental clinics functioning under each MOH divisio ons), Eleven Curative Care Institutions (besides this 1Chest clin Vavuniya 1STD clini functioning at General hospital e s nic a& ic l Vavu uniya). 3 Ayu urvedic Medical Institutio function in Vavun District. Out of 3 one District ons ning niya e Ayurvedha Hosp pital, & 2 Ay yurvedic Disp pensaries are functioning under the Dept. of Ind e digenous Med dicine all are providing fr health se ree ervices.

re os. Offices and 4 Nos. of PH areas, re 41 HM esponsible fo the preven or ntive and Ther are 04 No of MOH O preliminary aspe of Health care for th people, es ects he specially for mothers and children. d

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HEALTH

Infrastructure Development (Construction / Reconstruction / renovation / repairs)

In 2009, 02 Semi permanent wards were constructed at General Hospital, Vavuniya at a cost of Rs. 8.96 Mn and another 02 Semi Permanent wards (01 for each male & female) were constructed at Base Hospital, Cheddikulam at a cost of 9.26 Mn for the purpose of providing patient care to the Internally Displaced People. 01 Medical Officers quarters and Nurses quarters refurbished at Base Hospital, Cheddikulam for Rs.1.74 Mn to accommodate the MOs and NOs who were from out of the districts to serve IDPs. The Pre Mature Baby Unit was extended to establish mother baby friendly unit at General Hospital to a total cost of Rs. 3.787 Mn and Drainage System also installed by Irrigation department, the above major works were implemented under the Provincial funds. In addition to the above hostel for Nurses Training School was constructed to a cost of Rs. 5.00 Mn and Rs. 0.378 Mn worth of Three Wheeler also provided for the training purposes to strengthen the district management capacity and Mobile clinics were conducted in IDP camps to a cost of Rs. 1.895 Mn. The following activities were implemented by the project funds where, the funds flow through the Provincial Council. As such a maternity ward &paediatric ward were extended at General Hospital to a cost of Rs. 13.57 Mn and a paediatric ward was constructed t Base Hospital, Cheddikulam at a cost of Rs. 4.70 Mn. In addition to these the workshop for Artificial Prosthesis was constructed at General Hospital, Vavuniya to a cost of Rs. 8.00 Mn for the entire Northern Province. Under the assistance of Ministry of Health, 01 isolation unit established at a total cost of Rs. 2.04 Mn; 01 chest clinic constructed at a total cost of Rs. 10.00 Mn and 01 MOs & NOs quarters were constructed to a cost of Rs. 102.00 Mn and Surgical Theatre, laboratory, blood bank, dental clinic constructed with extension of maternity, paediatric wards at BH Cheddikulam at a total cost of Rs. 80.00 Mn. In 2010, In Vavuniyadisitrict 06 nos. health institution has been reconstructed / renovated in the resettlement area mainly in Vavuniya North. Rs. 35 Mn spent to rebuild the existing damaged hospitals in the above areas. In the other part of Vavuniya district all health institutions have been fully refurbished with the financial expenditure of Rs. 324 Mn. Especially DGH Vavuniya and BH Cheddikulam were upgraded with the maximum necessary facilities to cater the IDP patients health care needs. In General Hospital Vavuniya, constructed and equipped Pathology and BME section, at a cost of 18 million. 6 unit RE & MOMCH qtrs. has been constructed in the same premises to sought out the accommodation problems in preventive site for those who are working in Vavuniya Hospitals at a cost of 20 million. New administration block and Lecture Hall has been constructed at Nurses Training School, Vavuniya at a cost of 18 million. Divisional Hospital Nedunkerny has been fully reconstructed under the programme of UthuruWasanthaya at a cost of 18 Mn. Repair of Pheriparal unit, Male ward, Maternity ward, Kitchen, Mortuary, Ambulance garage, MO qtrs., Midwife qtrs., Generator room, Clinic center PHI qtrs., Boundary wall & fencing were

135

HEA ALTH also done unde the recon er nstruction o this hospi of ital. Another hospital in Vauniya North DS n N sion adjoinin to the A road, Div ng A9 visional Hosp pital Puliyan nkulam, has been recon nstructed divis inclu uding grade 3 qtrs. at a cost of 9 Mn. The above two h a hospitals (DH Nedunker rny& DH Puliy yankulam) are in the Vav vuniya North DS division which are the major hospitals in this area to h cate the returnees health n er needs in this area. urbishment works were carried out in Genera Hospital V e al Vavuniya inc cluding Exte ension of Refu cove ered way & pipe medica gas system water sup al m, pply and Electrical conne ection for MO & NO M Qtrs Semi perm s., manent Surg gical ward, re e-constructio of MS qt on trs., complet tion of Isolat tion unit, Improvement o infrastruc of cture facilitie such as Maternity ward, Drain es nage system wards m, boundary wall a fencing improvemen at a cost of 31 million. Beside this In General Hospital and nt o s, Vavu uniya, Const tructed and equipped Orthopedic Th heatre Comp at a cos of 25 Mn with the plex st assis stance of Mo Colombo. oH Base Ho thermore ospital Cheddikulam, C , Division nal Hospitals maduwa, Furt Mam Uluk kulam&Pavatkulam have been fully refurbished under the UthuruWasa e anthaya pro ogramme at a cost of 20 m million. In BH cheddikulam New TB ward constru H m, w ucted with th assistance of MoH he e ombo, and a Surgical wa also cons ard structed. In the RDHS offices premises, new conference Colo hall constructed at a cost of 12 Mn.

Semi-perm manent ward at DGH Vavuniya

Impro ovement of Dra ainage System

MO quarters & NO quarters at DGH Vavun s s niya

136

HEA ALTH

Premature Bab Unit Mothe Baby friendly Unit / at Gene HospitalVav by er y eral vuniya

Construction of 6 units RE & M C f MOMCH Qtrs. at GH

athology & BM section at GH Vavuniya ME H Construction of Pa

Construction of Administration B Block at NTS Va avuniya

Improvement of Conference Hall at RDHS Office, e O Vavuniya

f spital Nedunker rny Renovation of Divisional Hos

Renovation o Divisional Ho of ospital Puliyank kulam

137

HEA ALTH

Renovation of Divisional Hos f spital Mamaduw wa

Renovation of Divisional H n Hospital Ulukul lam

Repairs of MO qtrs. at DH Pavatkulam f H

Re-constructio of X-Ray room at BH Chedd on dikulam

Pro ocurement
In 2 2009, Rs.7.439 Mn wort of Medica Equipmen as AB Sca th al nt anner, OT fix lamp an X-Ray xed nd Prot tection item was procu m ured to Gen neral Hospit Base Ho tal, ospital/Ched ddikulam an other nd peri ipheries. CEMONC Equ uipment and US Scann was provided to Ge ner eneral Hosp pital to a cost of Rs 9.07 Mn. 01 bus was provid to NTS to a total cos of Rs.4.30 Mn for the training t ded t st 0 of n nurses and 0 Mobile Cl 01 linic bus wa provided to Vavuniya region at a cost of Rs. 9.07 Mn as a to co onduct mob clinics to the needy areas. bile o rth l t N eter, ECG Recorder, R Rs. 25 Mn wor medical equipment such as Nebulizer, Pulse Oxyme admill, Den ntal chair, S Syringe pum Infusion pump, Ec mp, n cho Machin Mini aut clave, ne, to Trea card diac bed, Ve entilator, Mu ultipara mo onitor, Transport Incub bator supplied to GH Vavuniya, V BH Cheddikula am, DH Ne edunkerny&Puliyankula am. In addi ition, Rs 10 Mn wort CSSD th equipment supplied to GH Vavuniya. Rs 5 Mn wo H orth hospita furniture equipment such as al t d een, Bed Side Locker 4 drawers filing ca r, abinet, Hos spital beds to DH Bed Side Scre Ned dunkerny&P Puliyankulam 3 nos. ambulances & 1 no sin m. ngle cab supplied to Vavuniya V dist trict hospita & selected MOH offic In additio 02 stand generat als ce. on, dby tors also sup pplied to DH Nedunkerny y&Puliyanku ulam.

138

HEA ALTH

Ext tension of Pipe Medical Gas Sy ystem at GH Va avuniya

Nebulize er

Pulse Oxymet ter

ECG Recor rder

Tread Mill

Dental Ch hair

Cap pacity Building

Sign nificant no of Training pr rogrammes were conducted under the various source of fu und. i.e : Eme ergency Obst tetric Care ( (EmOC), incl luding labou room man ur nagement an infection control, nd Continuous Positive Airway Pressure (C y CPAP) techniques, Training on EPI p programme to MOs, Os, PHIs, SPHNs, PHNs, NOs, Pharmaci & Dispen , ist nsers. Traini program ing mmes for RMO SPHIs, P supe ervising staff on Monitoring and sup f pervision in a devolved h health system Training on EmOC m. o and neonatal ca to NOs.T are Training on lactation management to NOs & M Midwives.Tra aining on vention of co ommunicable diseases to health staff Training on infection control to health staff e o f. n prev were also condu ucted during the year 201 under the UthuruWa 10 e asanthaya P Programme.

139

HEALTH

Training to PHMM

Training to IDPs on Environmental Sanitation

Training on Gender Based Violence

Training on food handling

140

HEA ALTH

Manna Dis M ar strict

District General Hospital, Mannar

Geo ographically, the bulk of Mannar Dist trict lies in th Mainland of Sri Lanka with the Districts of he a Kilin nochchi and Vavuniya on its northe and east ern tern bounda aries and its southern boundary s b abut tting Anurad dhapura d district on the eastern side and W Wilpattu National Park (P Puttalam distr rict) on the w western side The Gulf o Mannar and Palk Strait form the w e. of western bou undary of this part of the district, w e while the en of Mannar itself wit a three mile long causeway nd th c conn necting the island with th mainland. he en acilities in M Mannar Distr rict, General Hospital, M Mannar is th major he Whe considering health fa cura ative care institution in the dist trict. All th curative institutions come un he s nder the adm ministration o Regional D of Director of He ealth Service Mannar. es,

S/N N
01 02 03 04

Catego of Insti ory itutions

District General Hos spital Division Hospital ( nal (Type B) Division Hospital ( nal (Type C) Primary Medical Care Unit y

Nos.
01 1 03 3 05 5 07 7

In ad ddition to th above hos he spitals, STD C Clinic and Ch Clinic, M hest Mannar are fu unctioning under the u adm ministration o Regional D of Director of Health Service In the pre es. eventive sec under ea MOH ctor ach ther are clinic c re centres whic provide mainly Matern and Child Health care services. ch nal d e

141

HEALTH In addition to the Western system of medicine, Indigenous Medical system is also functioning in Mannar District under supervision of Regional Director of Health Services. Under Indigenous Medical system there is one Central Ayurvedhic Dispensary functioning at Thalvupadu under supervision of Regional Director of Health Services. In addition, there are 04 Free Ayurvedic Dispensaries under Local Governments. Regional Director of Health Services is in charge of all promotive, Preventive, Curative & Rehabilitative health activities in the district. Under him/her Heads of Institutions namely Medical Superintendent, District Medical Officers, Medical Officers in charge and Medical Officer of Health are functioning. Regional Medical Officer, Anti Malaria Campaign, Regional Epidemiologist and Medical Officer/ Maternal & Child Health, Medical Officer, Planning are also functioning under RDHS to assist him in respective fields.

Infrastructure Development (Construction/ Reconstruction/ renovation/ repairs)

In 2009, In Mannar district, the three storied surgical ward complex phase I was constructed for Rs.27.40 Mn and it was continued to 2010 and 03 storied wards complex was completed to a total cost of Rs. 25.97 Mn. An ICU at General Hospital was strengthened at a total cost of Rs. 3.30 Mn. 01 Primary Medical Care Unit was constructed at Thiruketheeswaram at a total cost of Rs. 14.20 Mn. Further 05 temporary shelters were constructed with toilets and bath tabs to General Hospital to a total cost of Rs.4.47 Mn to accommodate the casualties of IDPs. Maternity ward at Divisional Hospital, Pesalai was refurbished at Rs. 3.876 Mn. 01 Maternity ward was constructed to DH Chilawathurai to a total cost of Rs. 6.90 Mn and 02 Gramodhaya Health Centres were constructed at a Rs. 5.50 Mn. The above activities were implemented through provincial and project funds in 2009. Rs. 5.598 Mn worth of Medical Equipment & Furniture was procured for the purpose of ICU, Medical Wards, Maternity ward and Obstetric Wards to General Hospital and other peripheries. In addition to this Rs. 9.80 Mn worth of Eye Equipment and Rs. 22.00 Mn worth of EmOC Equipment were provided to General Hospital. Under the assistance of Ministry of Health, 02 nos. of semi-permanent rehabilitation wards and 01 semi-permanent ward were constructed at General Hospital at a total cost of Rs.30.50 Mn. Rs.12.00 Mn worth of G1 Endoscope was provided to General hospital. In 2010, In Mannar District, General Hospital Mannar is the major secondary care health institution, which is covering the whole 4 DS divisions in Mannar district. In General Hospital Mannar, Operation Theatre & Surgical ward complex (two storeyed) has been constructed at a cost of 80 Mn. This building construction was commenced in 2009 and has been completed in December 2010. Beside this 30 rooms Nurses chummery quarters has been constructed to accommodate the Nursing Officers who are coming from faraway areas. Newly construction of Blood Bank, refurbishment of Surgical wards, Medical wards and covered way in GH Mannar also carried out under this programme.

142

HEA ALTH Whe we consid the reset en der ttlement are hospitals, Divisional Ho ea ospital Adam mpan was completely dam maged due th battle. Aft the reset he ter ttlement com mmenced in this area, th hospital has been his h fully reconstruct including the Repairs to Maternit ward, OPD Block, MO Qtrs., Midw Qtrs., y ted g s ty D wife Kitch block, A hen Ambulance g garage, Mort tuary, genera ator room, M Mortuary blo Medical ward & ock, Cove ered way at a cost of 38 M t Mn. Further rmore Divis sional Hosp pitals Vidat thalthivu, Periyapandivirichan, Chilaw wathurai, M Murunkan and PMCU Vellankulam and 8 nos. of a m modhaya Health Cente have be ers een also renovated under the U Uthuru Wasa anthaya Gram prog gramme.

Re-constructio of Divisional Hospital, Adam on mpan, before & after reconstru uction

Re-co onstruction of P Primary Medica Care Unit, Vellankulam, befo & after reco al ore onstruction

ruction Re-construction of Divisional H R Hospital, Vidatha althivu before & after reconstr

143

HEA ALTH

Re-c construction of Divisional Hosp pital, Periyapan ndivirichan befo & after reconstruction ore

Midw qtrs. at DH Vankalai wife

MO qtrs. at MOH Murunkan OH H

Pro ocurement
Mor than 15 Mn allocate to provid necessar medical e re ed de ry equipment & hospital furniture f equipment to the resettlem ment area hospitals especially to DH Adampan& DH Chilaw H & wathurai. s, pumps, Elec ctric suckers Hospitals beds, cardi beds, IV stands, s, iac V Infant warmers Infusion p beds side screen, medicine tr rolleysetc. Beside this, 5 nos. amb bulances also provided to enable o the patient trans sport.

Provision of Bio Chemistry Ana P alyzer to GH Ma annar

Provision of Obstetric be to GH Mann eds nar

144

HEA ALTH

Bedside Scree ens

BP Apprat tus

Cap pacity Building

Mor than 5 nos training pr re s. rgrammes we conducte in Jaffna d ere ed district. Train on awar ning reness of com mmunicable diseases, N Nutrition, br reast feedin Awarene program ng, ess mmes for HIV/AIDS, H advo ocacy meeting for gend based vio der olence, Deve elopment Pr rotocols for Timely Refe erral and Tran nsfer of mo others within the distri ict, Training on Neonat Life sup tal pport and paediatric p eme ergency for m medical offic cers and nurses, Trainin programm for AH1N and Deng were ng me N1 gue also conducted i Mannar re in egion.

5 S Implementa ation

Training on 5 S System

Training to PH HMM

Vaccinati ion

145

HEA ALTH

Kilinoc chchi Dist i trict

District General Hospital, Kil linochchi

Kilin nochchi District is situat ted in the Northern pa of the Island. It covers a land area of art approximately 1 1237 sq. KM. The district is divided in to 4 administrative divisions, cons t i sisting of GN sing ages.The ave erage density of populati is 124 pe sq. km y ion er 95 G divisions and compris 327 villa acco ording to the statistical information 2007. Now the resett n w tlement in K Kilinochchi is almost com mpleted and o over 30,000 families com mprising a litt over 115,000 members were rese tle ettled. Whe considerin health fac en ng cilities in Kilin nochchi District, General Hospital Kilinochchi is the major l cura ative care institution in the dist trict. All th curative institutions come un he s nder the adm ministration o Regional D of Director of He ealth Service Kilinochch es, hi.

S/N N
01 1 02 2 03 3 04 4 05 5

Category of Institution C f ns
District General Hos spital Base Ho ospital (Type B) e Division Hospital ( nal (Type B) Division Hospital ( nal (Type C) Primary Medical Care Unit y

Nos.
01 01 01 06 04

Pres sently, all th health in he nstitutions in Kilinochchi are functio n oning excep PMCU Iranaithivu, pt whic is in the Poonakary DS Division In additio to the a ch e y n. on above hospitals, Chest Clinic at Kilin nochchi is fun nctioning under the adm ministration of Regional D o Director of Health Service In the es. prev ventive secto there are 16 Gramodhaya Healt Centers in the 4 MOH areas, und each or, e th n der MOH there are c clinic centers which prov mainly Maternal and Child Healt care servic s vide M d th ces.

146

HEALTH Besides this the Western system of medicine, Indigenous Medical system is also functioning in Kilinochchi District under supervision of Regional Director of Health Services. Under Indigenous Medical system there is one Ayurvedhic Hospital functioning at Kilinochchi old hospital (near the RDHS building) under supervision of Regional Director of Health Services. As well, there are 07 FreeAyurvedhic Dispensaries under Local Governments. Out of 07 FADs only 04 FADs is presently functioning. Regional Director of Health Services is in charge of all promotive, Preventive, Curative & Rehabilitative health activities in the district. Under him/her Heads of Institutions namely Medical Superintendent, District Medical Officers, Medical Officers in charge and Medical Officer of Health are functioning. Regional Medical Officer, Anti Malaria Campaign and Medical Officer/ Maternal & Child Health, Medical Officer/ Planning are also functioning under RDHS to assist him in respective fields.

Infrastructure Development (Construction/ Reconstruction/ renovation/ repairs)

District General Hospital, Kilinochchi was the major hospital in the entire district provided tremendous services to the poor civilians in Wanni region especially during the period of conflict. In GH Kilinochchi so many renovation works have been carried out since the resettlement was commenced. UNICEF has provided funds through the MoH Colombo for the renovations of the Kilinochchi General hospital in war battered Northern Sri Lanka. UNICEF has contributed funds to Ministry of Health & IM, NP through MoH, Colombo to help re-establish emergency obstetric and paediatric care at Kilinochchi General Hospital. UNICEF has funded the refurbishment and equipping of the operating theatre, labour room, maternity and paediatric wards to improve the emergency care of pregnant women, mothers and young children. The newly refurbished and equipped facility officially opened by the Hon. Basil Rajapaksa (M.P), Minister for Economic Development, Chairman Presidential Task Force and Adviser to the HE President on May 27 and is fully operational now. This unit was refurbished at a cost of Rs.13.8 Mn. and Rs. 12.0 Mn worth of medical equipment for the obstetric theatre also provided. In addition Surgical Theatre, 10 nos. Medical Officers quarters, nursing officers quarters, Kitchen also reconstructed. In addition, Under the NECORD II SL project the priority was given to the DGH Kilinochchi. Ground and 1st floor of the block 1,2,3 are being reconstructed at the cost of 34 Mn. Central Air Condition System is being installed at the cost of 14 Mn. Works for the completion of medical officer qtrs. is being also carried out under this project. Furthermore Base Hospital Mulangavil, Divisional Hospitals Akkarayankulam, Uruthirapuram, Veravil, Tharmapuram&Vaddakachchi, Primary Medical Care Units Vannerikulam&Kandawalai, MOH Office Kilinochchi, 8 nos. Gramodhaya Health Centers have been fully reconstructed under the UthuruWasanthaya programme with the allocation of 100 Mn. Phase II work of the RDHS Building complex, has been also carried out under this programme and hoping to complete before August 2011.

147

HEA ALTH Besi this under the UNIC assistanc now the action has been taken to re-const ide CEF ce, e n truct the PoonakaryMOH office at the cost of 23 M e Mn

OPD & Mater rnity ward at DH Akkarayanku H ulam before & a after reconstruc ction

Renovation & repairs to O block & MO qtrs. at PMCU Vannerikulam before & afte reconstruction OPD U m er

novation & repa to OPD bloc at DH Uruthi airs ck irapuram befor & after recon re nstruction Ren

148

HEA ALTH

Renov vation & repairs to Maternity w s ward at DH Uru uthirapuram bef fore & after rec construction

Renovation & repairs to MOH Office Kilinoc chchi before & a after reconstruc ction

Renovation & repairs to R n RMSD Kilinochch before & afte reconstructio hi er on

Refurbis shment of Obst tetric Care Unit at GH Kilinochc chi

Repairs to Maternity Wa at DH o ard U Uruthirapuram

149

HEA ALTH

Maternity w ward at DH Akkaraya ankulam

Re-const truction of PMC Kandawalai CU

Surgical Theatre at DGH Kilinochchi K

RDHS Qtrs. Repairs to R

GHC G Iranaimathanagar

HC m GH Unionkulam

Pro ocurement
In th latter part of 2009, Rs he t s.21.00 Mn w worth of Med dical Equipm ment and Furn niture were provided to a health ins all stitutions an Rs.4.40 M worth of Medical Eq nd Mn f quipment pr rovided only to Base y Hospital, Mulankavil and 01 Mobile Medical Bus als provided at a total co of Rs. 3.2 Mn. In 1 so ost 24 0, edical equipm ment such as Laparosco a ope, Ventilat tor, Nebulize Pulse er, 2010 Rs. 35 Mn worth me Oxymeter, ECG Recorder, Tr readmill, Dental chair, Syringe pump Infusion pump, Echo Machine, p, M Mini auto clave, cardiac bed Ventilator, Multipara monitor, Tra , d, , m ansport Incub bator supplie to GH ed nochchi, and other majo health ins or stitutions. Rs 5 Mn worth hospital furniture eq s quipment Kilin such as Bed Sid Screen, B Side Locker, four drawers filing cabinet, H h de Bed d Hospital bed to GH ds Kilin nochchi& DH Akkarayank H kulam. 5 nos. ambulanc & 2 no s ces single cab, 1 no mobile spraying unit was supplie to Kilinoch district hospitals & selected MO office. In addition, 02 standby ed hchi OH 2 gene erators also supplied to D Veravil and PMCU Va DH annerikulam ure es n his as o Futu initiative also have been taken place in th regards, NECORD ha agreed to provide Rs.4 48Mn medica equipment to DGH in K al t Kilinochchi and a drug lorry also. to Rs. orth medical equipment under the I t Indian Assist tance for We are hoping t receive R 50 Mn wo the DGH Kilinoch hchi

150

HEA ALTH

Provision o Single Cab to MOH Offices of o

Provi ision of Ambula ance (04 nos.)

Pro ovision of Lapar roscope

Pr rovision of Infus Pump sion

Provisio of Transport Incubator on t

Provi ision of Ultra So ound Scanner

Pr rovision of CTG Machine

151

HEA ALTH

Cap pacity Building

Due to shortage of health s e e staff, there w were less tra aining programmes cond ducted in Kilinochchi region. Training on Safe Mo otherhood Programmew were conduct by Colleg of Gyn. Sri Lanka. ted ge S thermore Support given t provide 20 RHAs with basic trainin and to appoint them to vacant to ng t Furt area as an interim measu in order to avoid distruption se as ure ervices until PHM recru uited. 75 Prim mary health care work kers in 4 M MOH areas have enha anced know wledge and skill on man nagement of acute malnu utrition (50 h health staff trained on NRP in Kilinochchi) t

Safe motherh hood programm conducted co me ollege of Gyn & Obs. In Kilinoc chchi

152

HEALTH

Mullaithivu District

District General Hospital, Mullaithivu

The Mullaitivu district consists of 127 GramaSeva Divisions coming under MaritimePattu, Puthukudiyiruppu, Oddusuddan, Thunukkai and Manthai East Divisional Secretariat Divisions. An estimated population of 220,311 lived in the district as at December 31, 2007. According to the latest statistics 69127 people belonging to the 23130 families have been resettled in the Thunukkai, Manthai East, Oddusuddan,Puthukkudiyiruppu and Maritimepattu Divisional Secretariat Divisions. Mallavi and Naddankandal Divisional Hospitals, Mankulam Base hospital Mullaitivu District General and Thunukkai PMCU hospital are now in full swing to cater to the health needs of the resettled families. More than 100 to 350 patients are being treated on daily basis at these hospitals. General Hospital, Mullaithivu was the major hospital in the entire district provided tremendous service to the poor civilians in Wanni region especially during the period of heavy end conflict. According to the available data, this hospital had managed average 325 deliveries per month and 25 - 30 emergency cesareans per month. Furthermore in the OPD patients per day are 400 on average. It was functioned with the bed strength of 200 beds in 09 wards and the inward patients are 200 per day. Around 69127 people have been resettled in Mullaitivu district up to 6th May 2010 and it is expected that another set of people to be resettled from today onwards. The District General Hospital in Mullaitivu is functioning at present to provide medical facilities to the resettled population.

153

HEALTH When considering health facilities in Mullaithivu District, General Hospital Mullaithivu is the major curative care institution in the district. All the curative institutions come under the administration of Regional Director of Health Services, Mullaithivu. S/N 01 02 03 04 05 Category of Institutions District General Hospital Base Hospital (Type B) Divisional Hospital (Type B) Divisional Hospital (Type C) Primary Medical Care Unit Nos. 01 01 01 04 08

Presently, all the health institutions in Mullaithivu are functioning except DH Moonkilaru PMCUs Puthukudiyiruppu, Ampalavanpokkanai, Kokilai, Kumulamunai

Infrastructure Development (Construction / Reconstruction / renovation / repairs)

District General Hospital Mullaithivu has been reconstructing including OPD block under the NECORD assistance with the allocation of 30 Mn. Furthermore Maternity ward &labour room also have been reconstructed. Divisional Hospital Mallavi fully re-constructed including ETU, Operation Theatre, Male & Female ward, OPD Covered way, 02 nos. MO qtrs., Canteen, RMO qtrs. & NO Qtrs., OPD block, Midwife qtrs., Maternity ward, Ambulance garage, Kitchen, Drug store and Mortuary with the nearly expenditure of 30 Mn. Base Hospital Mankulam is belonging to A9 road also considered to repair under this project. OPD block with administration unit and 24 beds male & female ward, MS qtrs., Minor staff qtrs. also reconstructed at BH Mankulam. Furthermore Divisional Hospitals Naddankandal, Oddusuddan, MOH Office Mallavi, 06 nos. Gramodhaya Health Centers were also renovated under this project. PMCU Mulliyawalai&Iyankankulam have been fully reconstructed at the cost of 15 Mn. Beside this, a new building for the RDHS office is constructed in Maritimepattu DS Division and the RDHS qtrs. is also constructed in the same premises. Now, the action has been taken to reconstruct the Divisional Hospital Almapil as the resettlement is commenced in this area. Under the NECORD Project action has been already taken to construct a 30 rooms nurses chummery quarters and now the tender also awarded for this work. Beside this under the UNICEF assistance, 05 nos. of Gramodhaya Health Centers at Mamoolai, Kumulamunai, Thaneerittu, Vattapalai, Alampil are being re-constructed and the Complex for Maternity ward &Paediatric ward at DGH Mullaithivu also started in DGH Mullaithivu at the cost of 50 Mn. Furthermore now the action has been taken to re-construct the Maternity ward &Paediatric ward at DH Mallavi at the cost of 30 Mn

154

HEA ALTH

Re-construction of OPD block at B c f Base Hospital Mankulam befor & after recon M re nstruction

a , ippu before & a after reconstruc ction Gramodhaya Health Centre, Karipattamuri

155

HEA ALTH

Pro ocurement
Kilin nochchi&Mullaithivu dis strict were also treated as the same as the are no medical d ere equipment, hospital furnitu equipment was avail ure lable since t battle was concluded. In the the latte part of 20 Rs.9.70 M worth of Medical Eq er 009 Mn f quipment and Furniture were provid to all ded heal institutio lth onsin the re esettlement areas in Mu ullaithivu. M More than 3 35Mn worth medical equipment inclu uding Mobil Ultra Sou le und Scanner Laparosco r, ope, Ventilat tor, Nebulize Pulse er, Oxymeter, ECG Recorder, Tr readmill, Dental chair, Syringe pump Infusion pump, Echo Machine, p, M , d, , m ansport Incub bator supplie to GH ed Mini auto clave, cardiac bed Ventilator, Multipara monitor, Tra Mullaithivu and DH Mallavi. Over 10 M worth hospital furnitu equipme such as Bed Side Mn ure ent Scre een, Bed Sid Locker, four drawers filing cabinet, Hospita beds to G Mullaithivu& DH de s al GH Mallavi. 6 nos. a ambulances & 3 no single cab, 1 no mobile spray ying unit and 1 no mobile dental d vehi supplied to Mullaithivui district hospitals & selected MO office. In addition, 02 standby icle d s OH 2 gene erators also supplied to D Mallavi a PMCU Th DH and hunukkai. Futu initiative also have been taken place in th regards, NECORD ha agreed to provide ure es n his as o Rs.4 Mn medic equipmen to DGH in Mullaithivu including He 40 cal nt ematological Analyzer (F Part) Five & CP Machine PAP e. to Rs. orth medical equipment under the I t Indian Assist tance for We are hoping t receive R 40 Mn wo the DGH Mullait thivu.

156

HEA ALTH

157

HEA ALTH

Cap pacity Building

Due to shortage of health staff in Kili e inochchi&Mu ullaithivudist tritecs, there were less training prog grammes co onducted in Mullaithivu region. A joint trainin programme with Kilinochchi u ng distr rict, Training on Safe Mo g otherhood Programme were conduc w cted by Colle of Gyn. Sri Lanka. ege S Furt thermore Support given t provide 20 RHAs with basic trainin and to appoint them to vacant to ng t area as an interim measu in order to avoid distruption se as ure ervices until PHM recru uited. 75 Prim mary health care work kers in 4 M MOH areas have enha anced know wledge and skill on man nagement of acute malnu utrition (50 h health staff trained on NRP in Mullait t thivu)

Ach hievements Basic Health In ndicators

158

HEALTH

3.1.4 Future plans for balance period 0f 2011 and 2012

In enhancing further support to Sri Lanka, the Peoples Republic of China has signed a memorandum to grant Rs 7,410 million to develop all State hospitals in the Northern and Eastern Provinces. These funds will be utilized to construct new building complexes and rehabilitate the existing complexes in the North and East. In North, the hospitals in this province will be given modern medical equipment, ICUs, OPDs, Theatres, Emergency Care Units, medical laboratories and all the other facilities available in other State hospitals under this fund. Teaching Hospital-Jaffna, District General Hospitals Vavuniya, Mannar, Kilinochchi and Base Hospitals - Point Pedro, Tellipalai, Kayts have been identified in Northern Province for the building construction including supply of medical equipment. Beside this Base Hospital Chavakachcheri& District General Hospital Mullaithivu have been selected only for the supply of medical equipment. According to the decisions taken at the Project Committee Meeting of this project approximately 4,000 Mn SLR has been allocated including for the Teaching Hospital, Jaffna. The project proposal submitted by the Country Coordinating Mechanism (CCM), Sri Lanka has been accepted by the GFATM for funding and envisages the restoration of health care delivery services and preventive services targeting the control of HIV/AIDS, Tuberculosis and Malaria in the Northern Province. This is a five year project and it commenced in May 2011. In the first year of this project, 5 nos of OPD block, 3 nos. of MOH office, 05 nos. of MOH quarters, 04 nos. of Regional Malaria Office, 01 no of chest ward, basic laboratories in 15 hospitals have been identified to reconstruct/refurbish in the year 2011. In 2011, the priority has been given to Kilincochi&Mullaithivu district as there was/is an urgent need in the recent resettlement areas (Puthukudiyiruppu, Alampil, Kokilai). OPD block at Divisional Hospitals Puthukudiyirrupu, Kokilai, MOH Offices at Mullaithivu, Oddusuddan, MOH qtrs. at MOH Mullaithivu, Oddusuddan, Mallavi, RMO/AMC office at Mankulam have been identified to reconstruct/renovate in Mullaithivu district in this year. OPD block at Divisional Hospitals Poonakary&Pallai, MOH Office Kandawalai, MOH qtrs. Kandawalai, RMO/AMC office Kilinochchi have been identified. This will be implemented as follows (Amounts are in US$).

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Summary budget by cost category

Year 1

Year 2

Year 3

Year 4

Year 5

Total 5 years

Human Resources Technical & Management Assistance Training Health Products and Health Equipment Pharmaceutical Products (Medicines) Procurement and Supply Management Costs (PSM) Infrastructure and Other Equipment Communication Materials Monitoring and Evaluation (M&E) Living Support to Clients/Target Population Planning and Administration Overheads Other TOTAL

205,200 0 219,970 0 0 396,750 3,155,030 0 20,400 0 121,600 76,620 0 4,195,570

715,500 0 813,205 0 0 270,000 5,737,043 0 5,400 0 126,400 105,240 0 7,772,788

896,400 0 59,780 0 0 199,500 3,171,832 0 5,400 0 126,400 185,450 0 4,644,762

896,400 0 67,820 0 0 0 41,420 0 5,400 0 126,400 185,450 0 1,322,890

896,400 0 43,700 0 0 0 13,670 0 5,400 0 126,400 185,450 0 1,271,020

3,609,900 0 1,204,475 0 0 866,250 12,118,995 0 42,000 0 627,200 738,210 0 19,207,030

3.1.5 Constraints
Shortage of Health Personnel in all categories.
In Northern Province, there is severe shortage of Health Personnel specially Consultants, Medical Officers, Para Medical and other category of staffs. After de-merger of the Northern and Eastern Provincial Councils the cadre for Health Sector, Northern Province was approved by Management Service Department in 2008. The approved cadre in 2002 reduced in 2008 to the then in position. 160

HEALTH At present, more health staffs are appointed and most of the staffs are posted to the institutions especially Consultants, Nursing officers and Para Medical staffs. Cadre requirement was sent to Management Services Department and the approval is not yet given.

Shortage of Specialists (Consultants)

At present 27 Consultants are available in Northern Provincial Hospital including 16 consultants were appointed temporarily. The Cadre for the entire Northern Province for Specialists is 51 before the de-merger of Provincial Councils and reduced to 7 at present. Province has almost 90% of vacancy for the specialists.

Shortage of Medical Officers in Northern Province.

There is acute shortage (more than 50%) of Medical Officers especially in whole districts in Northern Province. In 2010, 237 Medical Officers were at Provincial Hospitals for the total cadre of 399. In all institutions the Medical Officers have been transferred within a short period without replacement. It is very urgent to appoint Medical Officers especially for peripheries within the total approved cadre of the Northern Province.

Shortage of Paramedical Staffs in Northern Province.

At present only 604 Para Medical Category of staffs are available in place of approved cadre of 653 in 2009.

Appointment & Transfer of Medical Specialists, Medical Officers & Paramedical Staff
Appointments & transfers of Medical Officers, Dental Surgeons, Nursing Officers and Para Medical staffs are made directly by the Line Ministry to the respective Health Institutions of the Northern Province without consulting the Provincial Authority. Appointment, transfer, promotion and disciplinary action of Medical officers and Dental Surgeons are done by Line Ministry. The provincial authorities only empowered to hold preliminary inquiries and payment of salary in other benefits such OT, Holiday Pay and loans etc. The authority to transfer officers within the province according to the needs and existence of service and disciplinary authority (as per E-code) to be devolved to the provincial council. And also unwillingness of Medical & Para Medical personnel to serve in resettled areas is affecting the medical services to the population.

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HEALTH 1. Insufficient allocation from Provincial Treasury for payment of OT, Holiday payment, advanced to Public Servants and for Salary Revision. 2. Insufficient allocation for drugs, dressing and instruments by the Central Treasury. 3. Non availability of special investigation facilities in the secondary care Institution in Northern Province. (E.g. CT Scan, MRI & Echo Cardiogram and biochemical test such as Lipid Profile, Serum and Urinary Creatinine tests). 4. Laboratory facilities are not sufficient in some institutions. 5. Accommodation facilities are limited for visiting staffs from other provinces and also quarters for the staffs working in early recovery areas are not available at present. Staffs are facing severe hardship to work in these areas. 6. Medical and Paramedical staff reluctant to work in Early Recovery Areas due to lack of facilities as transport and communication. 7. Emerging and re-emerging the following diseases. o Dengue o o o Mental Health HIV / AIDS Tuberculosis

In the year 2010, dengue outbreak occurred in Jaffna district during January after the dengue outbreak in Vavuniya district in 2009. Control measures were taken up with the assistance of Local Government Department. It was controlled to the normal after the several cleaning campaigns and other control measures implemented by Health Department. In 2010, 35 deaths occurred in Northern districts due to dengue, out of these 28 deaths in Jaffna districts.

Inadequate Training to staff in Modern Techniques.

To improve and maintain the Health of people, the preventive services staffs are very essential. The present Training Programme for most of these categories taken for training each year is inadequate.

Scholarships
The quota of Scholarships for Northern Province for the Health Personnel is not adequate. Foreign Scholarships for Medical Officers and other Health Personnel presently available to the Ministry are not sufficient to meet the training needs of the Medical Officers and other Health Personnel.

Improper Clinical Waste Disposal Methods.

In some institutions, Clinical disposal methods are not available. It will cause environmental hazards to the people.

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3.2 INDIGENOUS MEDICINE

INDIGENOUS MEDICINE

3.2.1 Background
The sector of IM plays an important role in health care provision of Northern provincial population. There are twenty three curative centers functioning in Northern Province under DepartmentofIM.Amongthem,RuralHospitalsandDistricthospitalsprovideindoorcareand special treatment in Vavuniya, Mannar, Kilinochchi and Jaffna. Further, five herbal drug manufacturing units provided locally produced medicine and six herbal gardens located in Jaffna,KilinochchiandVavuniyadistrictscultivatemedicinalplants.About507,761patientswere treatedin2010incurativecenters. The department is working towards formulating a framework to reorganize the local governmentdispensarieswithDepartmentoflocalGovernment.MainobjectiveofDepartment of IM is To develop the Indigenous Medicine of NP to attain systemic qualities in order to achieveNationalandGlobalrecognition.

3.2.2 Achievements
2009:
InfrastructureDevelopment:
a) StageI&IIRAH,Pandatharippu b) QuartersforMedicalOfficers ConstructionofDMUAchuvelyCompleted Herbalgarden,Achuvely

Initiatedrehabilitationprogrammesatacostof1.3Mn CapacityBuilding:
a) WorkshopconductedforallAMOsonResearchMethodology b) TrainingprogrammeonHerbalDrugStandardization

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2010:
LargeScaleCultivationofMedicinalPlants HerbalGardenatNavakiri,Jaffna
This Herbal garden was established at a cost of 03Mn at Navakiri. 350 saplings were planted under the 11 lakhs plants at a minute scheme of His Excellency the President Mahinda RajapakseonbehalfofNationalTreePlantingCeremony.Itsdenotablethatallthe350saplings are medicinal plants. Hon.Minister Mr.Duglous Devananda, Hon.Governor Mr.G.A.Sandrasiri, Higher officials of Northern Provincial Council, District Heads of Departments, Ayurveda Protectionsociety,Publicandfarmersofthatarea,studentsandstaffofLankaSiddhaAyurvedic MedicalCommunityandstudentswerepresentedontheoccasion.

EstablishmentofHumanResourceDevelopmentCentre

164

INDIGENOUS MEDICINE Human Resource Development Centre was established at a cost of 28.5Mn rupees at ChunnakamfromCBG.ThestudyprogrammeofLankaAyurvedicMedicalCollegewasinitiated atthisbuildingbytheHon.Governor,NorthernProvinceandSecretary,MinistryofIndigenous Medicine. Higher officials from Nawinne, Northern Provincial Council, District Heads of Departments,AyurvedaProtectionsociety,Publicandfarmersofthatarea,studentsandstaffof LankaSiddhaAyurvedicMedicalCommunityandstudentswerepresented.

RestorationofIMcareinMullaithivuAyurvedicMobileUnit
TheAyurvedicMobileunitisestablishedatacostofRs5MtoserveMullaithivuDistrict.Itwas handedovertoPDIMNPbyHon.Governor,NorthernProvince. This Ayurvedic Mobile Unit serves the people of five Divisional Secretariat Divisions of Mullaithivu District. About 3000 patients of Mallavi, Oddusuttan, Muththaiyankaddu, Kataithuraippatru, Othiyamalai, Vannankulam, Semmalai, Alampil, Selvapuram & Selvanagar areawereservedbythismobilemedicalunitin2010fromAugust.

Restoration of IM care in Mannar District Ayurvedic Hospital of District AyurvedicHospital,Vankalai

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INDIGENOUS MEDICINE It was ceremonially opened on 5th August 2010. Rev.Fr.Jeyapalan, Provincial Director of IndigenousMedicine,RDHS,DivisionalSecretary,GramaNiladhari,MedicalOfficersandpeople ofthatareawerepresentedatthetime.About25000patientsweretreatedbythishospitalin theyear2010. TheIMcareinMannarwasrestoredinresettledareas.Thisisininitiatedthroughestablishment ofDistrictHospitalandfollowedbyorganizingMobileclinicstoMadu,Musaliandotherarea.

RuralAyurvedaHospital,Pandatharippu
ItisthefirstRuralAyurvedicHospitalwasconstructedatacostof16.86MninPandatharippu.It isservingforthepeopleofSandilippaiDSDivisionwithindoorfacilitiesandspecialclinics.The functionofthishospitalstartedfromDecember2010.

RestorationofIMcareinKilinochchiDistrictAyurvedicHospital
TheDistrictAyurvedicHospitalisestablishedtoserveresettledpeopleinKilinochi.Ithasserved about25,000patientsin2010.Rs800,000worthmedicinesweresuppliedforthishospital. 166

INDIGENOUS MEDICINE

DhayataKirullaExhibition2010

TheDepartmentofIndigenousMedicinehasparticipatedforDhayatakirullaof2010inPallegalle. IthasdisplayedAyurvedicandSiddhaProductsincludingMedicines,Nutritionalsupplements andCosmetics.ItalsodisplayedManualspublishedbySiddhaPhysiciansinNorthernProvince.

AppointmentsofAyurvedicCommunityMedicalAssistants20no.swere appointed. EstablishmentofSchoolHerbalGardens(31)

2011:
1. ParticipatedonDhayataKirullaExhibition2011 2. NavakiriHerbalGardenestablished.

EnRepProject
1. KalmadunagarHerbalGardenRs10Mn 2. MullaithivuHerbalGardenRs10Mn

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3.1.3 Fund Received 2009 - 2011

BudgetaryAllocation S/No Year Allocation TotalExpenditure
01 02 03

2009 2010 2011

65,359,050 33,000,000 28,000,000

58,448,258 32,920,000 11,200

3.2.4 Future Plans

Fullyequippedbasehospitalforeach05districts. FiveMobileMedicalUnitsoneforeachdistrict. Largescaleherbalgardensmorethan05acres. EstablishmentofdivisionalHerbalGardenthroughfarmers. DevelopDrugManufacturingUnittofulfillthedrugneeds. Printingtraditionalformulaeasabook. ReprintingDigitizationofmanuals. Researchesonfrequentlyuseddrugs. Popularizetheindigenousmedicalknowledgeamongpeopletocarryoutindaytoday activities. 10. Promotelocaleconomybypromotingcommercialaspectofherbs. 11. Insituconservationofmedicinalplants. 1. 2. 3. 4. 5. 6. 7. 8. 9.

3.2.5 Constraints and strategies followed to overcome

S/ No

Constraints
Limitedresourcemobilization Lackingopportunitiesforcapacitybuilding ofAyurvedicMedicalOfficers,resultingin poorefficiencyinserviceprovision Postgraduatestudies. Lackoffundforfurtherdevelopmentofthe sector. Lackinginstitutionalarrangementfor recruitmentandtrainingofParamedicaland otherStaffofIM. InadequateresourcesinServiceprovision Laboratoryfacilities. Lackofcadreprovisionforskilledstaffand technicalstaffinMedicaladministration.

Strategiesfollowedtoovercome
1. Redeploymentofavailablecadre 2. Workwithotherorganization Eg:Dept.ofAgriculture 1. Triedtoidentifytheopportunitiesto communicatewithinternational agencies. 1. MoreinvolvementwithINGOs/NGOs 2. Communityparticipation 1. Encountertheabilityofavailable stafftoprovideparamedicalservice 1. WorkwiththeHealthdepartmentas stakeholder 1. Arrangementsstarted(FR71)

3 4

5 6

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