Request by Sri Lanka to focus on migrant workers’ health
It is at Sri Lanka’s request that the Regional Committee Meeting will turn an urgent spotlight on migration and health.
Pointing out that this week Sri Lanka hosted a conference among labour- sending countries (the Colombo Process) to discuss key issues, Dr. Palitha Mahipala, Director-General of Health Services said the authorities were able to get the health of migrant-workers onto that agenda as well.
Sri Lanka has done much in this sphere, he said, pointing out that systems are in place to check the health fitness of migrant workers before they leave the country, look after the health of the families left behind by the migrant workers and also check the migrant workers for non-communicable diseases (NCDs) on their return.
Moving onto the numerous ‘positives’ in Sri Lanka’s health sector which place it ahead of many other countries in the region and sometimes on par with the developed world, he, however, conceded that there are several major challenges that need to be met head-on and overcome.
Referring to both the demographic and epidemiological ‘transitions’ in the country which need to be addressed, he said that the elderly population is increasing, with 12.5% of the population being over 60 currently, which will reach 25% by 2040, in addition to disease patterns also changing. The need is for more services to be provided for the elderly as well as strengthening both the preventive and treatment aspects for NCDs. The other areas of serious concern, meanwhile, are the transition in nutritional patterns, from a healthy diet of vegetables and fruit to an unhealthy diet including junk food brought about by lifestyle changes.
The “still unfinished” agenda of communicable diseases (CDs) is also being focused on by the Health Ministry as there is a ‘double burden’ of NCDs and CDs, it is learnt.
Dr. Mahipala though is quick to assure that with the robust primary healthcare (PHC) system in place since 1926 in Sri Lanka, steps are being taken to integrate the modern challenge of NCDs into it. “We have 842 healthy lifestyle centres already and nearly 900 well-woman clinics across the country,” he said, adding that delegates to the Regional Committee Meeting will visit some of them in the Central Province. Not only offering diet suggestions and exercise advice, these centres are also equipped to dispense 16 essential drugs for NCDs.
It is with a touch of pride that the DG points out that while other countries are thinking of having focal points to deal with NCDs, Sri Lanka appointed an NCD Focal Point sometime ago and now has a dedicated Director at the Health Ministry to deal with NCDs.
He details some population-wide approaches to ensure the health of the nation which include tobacco interventions such as an 80% pictorial warning and the recently-introduced Alcohol Policy. Announcing that there are Cabinet papers in the pipeline to introduce plain packaging for the balance 20% of the packet of cigarettes and a further increase in taxation, Dr. Mahipala said that “only Australia has this and if we can push it through we’ll be the 2nd country in the world ” to act with regard to plain packaging.
Sri Lanka is also the first in the region to introduce the ‘traffic light system’ in labelling indicating the sugar content in fizzy drinks.
Underscoring that Sri Lanka has made its mark in the global health arena, he said that “we have many things to show off” to others in the region which include the elimination of polio in 1993 and also neonatal tetanus in 1994. While the country has eliminated lymphatic filariasis with the WHO issuing the certification just last month, the same milestone may be achieved in measles too very soon. “Hopefully the malaria elimination certification will be awarded to Sri Lanka during the Regional Committee Meeting,” smiles Dr. Mahipala.
Sri Lanka is a low-cost model with a good public health system, he says, adding that when taking global health indicators, “we are the best” in SEAR. This is for a country which has allocated about 2% of its Gross Domestic Product (GDP) for health, with moves in the next two years to increase it to 3%, when compared to the United States of America which earmarks 17% and Japan 11.3% of its GDP for health. “We have much to highlight to the region.”
It is vital to think globally and act locally, reiterated the WHO Representative to Sri Lanka, Dr. Jacob Kumaresan, pointing out that there has been a paradigm shift in the landscape of health, with more people working on health than ever before.
We need to make collective decisions and then transfer and implement them locally, according to him. Citing the example of polio, he reiterates that infection, be it bacteria, viruses or anything else, is just a plane-ride away. This is why vigilance is needed not just in one country but across the world.
Paying tribute to Sri Lanka, Dr. Kumaresan says that the country can be a ‘lighthouse’ to the world, showing the way, but Sri Lanka cannot be complacent about its achievements.
“Can the same infrastructure in place in the country be used for behavioural changes? That’s the big question. Should they be re-modelled for the future,” he asked, with a gentle reminder that in public health, the last w mile is the most difficult to run. By 2030, the country needs to ensure that no one has been left behind in the arena of health.