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Health care status and needs of Jaffna By: Dr. S. Sivansuthan


Jaffna is the worst affected area in the ethnic conflict.


Shortage of staff – JTH (1200 beds) 600 53%

48%

400 300 200

47%

46% 29%

16%

100 Ord. Lab

Atten.

Supp. Staff

Nurses

Mos

0 Consult.

No. of staff

500

2007 2006 Needed


2007 Needed

100 80 60

77%

40

0

RMP

0%

MOO

20

9%

Consult.

No. of staff

Shortage of Doctors – Jaffna(38 hospitals)


Patient care JTH

Other hospitals (38)

In Pts

72%

28%

Deliveries

70%

30%

Out Pts

74%

26%

.


Poor public awareness & knowledge

UP 1.2

129

120 100

91

80

105

68 55

60

42

37

40

27

20 2

3

11 7

54

23 22

47 50

Province

Number of cases reported

7.3

Not reported

140

30 32

13

0 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 Year of reporting

NCP

2

SGP

2.7 5.2

SP NWP

7.5

CP

7.8

N&E

8.2 58

WP 0

10

20

30

40

50

Percentage

Number of reported HIV / AIDS cases 1987 – 2006 in Srilanka

HIV / AIDS Cases by Province

60


Other challenges • Lack of lab facilities & shortage of equipments • Shortage of medicines


Short term strategies • Providing good health care service with minimum staff • Training of staff • Improving hospital facilities • Motivating the doctors & staff to stay in jaffna


Upgrading clinical laboratory services Current Situation • • • •

Substandard lab facilities Tests are largely performed manually Shortage of trained technical personnel Certain tests can not be done. Eg:- coagulation profile, hormonal assay, tumor markers, auto immune screen, troponin, lipid profile …..

What is needed?


Upgrading clinical laboratory services • What is needed?

•Fully-automated analyzers  all the tests can be done with minimum staff Total Estimate - SL Rs. 13.96 million Contribution from Ministry of Health – SL Rs. 8.7 million Balance needed – SL Rs. 5.26 million = US$ 52,600/-


Estimated cost for fullyautomated analyzers • Fully Automated 5 Part Haematology Analyzer- 2 million Reagent cost per one year – 1.8 million Coulter Mixer - 40,000/= • Coagulation Analyzer (2 channel) – 450,000/= • Centrifuge & Analytical Balance - 240,000/= • Spectrophotometer - 180,000/= • Glass Distiller – 250,000/= • Osmolarity Meter – 300,000/= Total cost - SL Rs. 5.26 million = US$ 52,600/Biochemistry Analyzer and Immunology & Serology Analyzer worth of 8.7 million will be provided by Ministry of Health next year


Benefits of Upgrading the Laboratory Services • Accurate result • Avoidance of unnecessary transfers • Prevention of delay in initiating treatment • Covering up the shortage of man power and improvement/development of the Histopathology section


Telemedicine • Telepathology • Experts anywhere in the world can interpret or advice • Radiology • Neurosurgical opinion

Lease line Installation fee – 25,000 Rental - 30,000 / month 385,000 / year

= 3850 US$


Teaching activities • Weekly clinical meetings for doctors • Postgraduate classes – weekly • Intensive care training for moo • Twice a month seminars & training for nurses


Cost for Nurses education & training Stationeries & Handouts 2x12x45x25 = 27,000/Publications – 25,000/Refreshment - 2x12x45x65 = 70,200/Annual cost - Rs. 122,200/- = US$ 1222/-


Cost for Regular weekly clinical meetings & doctors education Handouts & Stationeries – 115,000 Refreshment -225,000/= Annual Cost – SL Rs 340,000/= ( 3400 US$ )


Documentaries, audio visual cds

2005

•2007 – Mosquito control


Establishment of Health Education Unit Equipment Needed & Estimated Cost • Video camera - 450,000/• Computer with capture card facilities – 250,000/• DV player - 40,000/• Digital Copier - 350,000/• Digital camera - 55,000/-

Total Cost

SL Rs. 1,145,000/- = US$ 11,450/-


CPR • No cardiac defibrillators in medical Wds • lot of critically ill patients are managed • No cardiology ward • Limited beds in ICU [ 6 beds ] • No high dependency units

.

650,000 X 8 = 5.2 million SL Rs ( 52,000 US$ )


Special fund for drugs & its distribution • Shortage of drugs • Difficulty in distribution • Inappropriate usage of drugs

1 million SL Rs = 10,000 US$ Plastic envelops for distribution of medicines to clinic patients Cost – 30,000x3x12 = SL Rs.1.08 million . . ( USS$ 10,800/-)


Cardiology high dependency unit Estimated cost • • • • • • • • • •

Cardiac bed Mattress Defibrillator Cardiac Monitor ECG Recorder Pulse Oxymeter Syringe pump – Sphygmomanometer Sucker -

10 x 80,000/- = 800,000/10 x 5,000/- = 50,000/1 x 650,000/- = 650,000/2 x 600,000/- = 1,200,000/1 x 150,000/- = 150,000/2 x 140,000/- = 280,000/10 x140,000/- = 1,400,000/= 4 x 7,500/- = 30,000/2 x 40,000/- = 80,000/-

Total Cost SL Rs. 4.64 million ( US$ 46,400/-)


Establishment of indoor play room for pediatric unit • Estimated cost – 75,000 SL Rs . (750 US$)



Clinical aspects in medicine