PREVENTIVE HEALTH CARE SERVICES

With the demographic transition, epidemiological transition occurs. Therefore the burden of disease changes from communicable diseases to non- communicable diseases. Rapid urbanization and changes in lifestyle contribute to the increase exposure to risk factors for NCDs. Physical inactivity, unhealthy dietary pattern, tobacco consumption and alcohol are the major lifestyle related risk factors and diabetes, hypertension, dyslipidemia and obesity are the major intermediate risk factors for four major NCDs, namely Cardio Vascular Diseases (CVD), Chronic Respiratory Diseases (CRD), Diabetes and Cancers. Both Ratnapura and Kegalle districts are having MO/NCD (focal point), a medical officer appointed for implementation, monitoring and evaluation of the activities regarding NCDs at health sector as well as coordinate with the non-health government sector and non-governmental interesting authorities in the field.

Healthy Lifestyle Centers (HLCs) were established to cater the demand of increasing burden of NCDs. Any person, preferably 35 – 65 years of age and is previously undiagnosed for NCDs is an eligible candidate for screening facilities provided by HLCs. Health promotion and health education for risk factor prevention, screening for intermediate risk factors, basic treatment, referral and follow- up are the services that are supplied by the HLCs. Provincial Directorate is working on providing HLC services in all primary health care institutions in the Sabaragamuwa province which is one of the services in Essential Services Package (ESP).

With the demographic transition, epidemiological transition occurs. Therefore the burden of disease changes from communicable diseases to non- communicable diseases. Rapid urbanization and changes in lifestyle contribute to the increase exposure to risk factors for NCDs. Physical inactivity, unhealthy dietary pattern, tobacco consumption and alcohol are the major lifestyle related risk factors and diabetes, hypertension, dyslipidemia and obesity are the major intermediate risk factors for four major NCDs, namely Cardio Vascular Diseases (CVD), Chronic Respiratory Diseases (CRD), Diabetes and Cancers. Both Ratnapura and Kegalle districts are having MO/NCD (focal point), a medical officer appointed for implementation, monitoring and evaluation of the activities regarding NCDs at health sector as well as coordinate with the non-health government sector and non-governmental interesting authorities in the field.

Healthy Lifestyle Centers (HLCs) were established to cater the demand of increasing burden of NCDs. Any person, preferably 35 – 65 years of age and is previously undiagnosed for NCDs is an eligible candidate for screening facilities provided by HLCs. Health promotion and health education for risk factor prevention, screening for intermediate risk factors, basic treatment, referral and follow- up are the services that are supplied by the HLCs. Provincial Directorate is working on providing HLC services in all primary health care institutions in the Sabaragamuwa province which is one of the services in Essential Services Package (ESP).

Mental health is not merely the absence of mental illness but is a state of well-being in which an individual realizes his or her own ability, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. Mental health encompasses emotional, psychological and social well-being, influencing cognition, perception and behavior. It likewise determines how an individual handles stress, interpersonal relationship and decision making.

Sri Lanka is a country that suffered by 3 armed internal conflicts (North east conflicts and 71/72 and 88/89 civil conflicts) during the past half century which increased the trends of having high prevalence of mental disorders. High prevalence of drug abuse also contributed to it. In year 2020 disturbance of normal life due to COVID 19 aggravated the problem.

The Directorate of mental health administrates and coordinates the mental health services nationally. District MO/Mental health (Focal point) coordinates district activities with other relevant health and non- health groups. Consultant psychiatrist is the main health care professional responsible for the mental health services. Both psychiatrist and MO/Mental health (Focal Point) will jointly coordinate and arrange the services regarding mental health.

Family Health Bureau (FHB) had been established under the vision of “A Sri Lankan nation that has optimized the quality of life and health potential of all women, children and their families” and it is the focal point for Maternal and Child Health (MCH) in Sri Lanka.

Provincial Directorate of Health Services shares the responsibilities of FHB in planning, coordinating, monitoring and evaluating the Reproductive, Maternal, Child, Adolescent and Youth Health [RMNCAYH] programme in the province and functionalizes them at grass root level.

Medical Officer/Maternal and Child Health (MO/ MCH) is the district focal point that provides technical guidance to the MOH staff under the supervision of FHB as well as provincial and district CCPs and the administrative authority of RDHS.

The post-partum period, specially the first 42 days after delivery is crucial for both the mother and the new born. PHM should visit and give domiciliary care for the post-partum mother. There is a 89% coverage of at least one visit during the first 10 days in 2019 and there is a gradual increase in the services in the year 2020 up to 94.1%.

TFocusing on nutrition and health care in the ‘golden 1000 day window’ of a child will help to ensure that the child can live a healthy and productive life. Investing in better health and nutrition in the first thousand days; neonatal, infant and early childhood will help families and communities to break the cycle of poverty. Provincial plans of neonatal, infant and under five-year children care is based on latest epidemiology, evidence and global and country learning and the support of Family Health Bureau – Sri Lanka.

Family planning is any procedure that assists any person to have a desired number of children at an appropriate age with proper spacing between children and prevent any unwanted pregnancies. The family planning activities are carried out within the province in keeping with the National Family Planning Programme conducted by the Family Health Bureau. The main objectives of the programme include ensuring the availability and accessibility to quality modern family planning services including emergency family planning services and addressing the unmet need for contraception to reduce unwanted pregnancies, abortions and teenage pregnancies.

Sir Edward Jenner first demonstrated that vaccination provides protection against Smallpox in 1798. Since then vaccines have continued to reduce the burden of many bacterial and viral diseases. In year 1978 National Progrmme of Immunization in Sri Lanka was aligned with WHO Expanded Programme of Immunization (EPI) and the programme is coordinated nationally by the Epidemiology Unit of the Ministry of Health. The main objectives of the progrmme is to eradicate Polio, to eliminate Neonatal Tetanus, to prevent Congenital Rubella Syndrome and to reduce mortality, morbidity and prevent outbreak associated with vaccine preventable diseases such as Tetanus, Diphtheria, Whooping cough, Polio myelitis, Tuberculosis, Measles, Rubella and Japanese encephalitis and Hepatitis. Provincial immunization programme was aligned with the same global and national objectives, technically guided by provincial and district consultant community physicians, coordinated by a district focal point appointed to Ratnapura and Kegall district; Regional epidemiologists. Provincial team is working for the achievement of a target of 100% age specific vaccination coverage.

Family planning is any procedure that assists any person to have a desired number of children at an appropriate age with proper spacing between children and prevent any unwanted pregnancies. The family planning activities are carried out within the province in keeping with the National Family Planning Programme conducted by the Family Health Bureau. The main objectives of the programme include ensuring the availability and accessibility to quality modern family planning services including emergency family planning services and addressing the unmet need for contraception to reduce unwanted pregnancies, abortions and teenage pregnancies.

Leptospirosis is a lethal infectious disease caused by bacteria and it is the second most prevailing disease in the province. It is a zoonotic disease that can be transmitted through rodents, pigs, dogs and some other wild animals. This disease can occur when people are exposed to water that is contaminated with urine from infected animals. Since the Sabaragamuwa province is affected by heavy rainfall and flooding and a considerable amount of people engage with jobs associated with mud and water such as gem mining and paddy cultivation they are highly susceptible for leptospirosis. There is an increasing trend in the Leptospirosis outbreaks mainly in the Ratnapura district.

Leishmaniasis can be considered as an emerging disease entity in the province, mainly in the Embilipitiya area in the Ratnapura district. There are 3 main forms of leishmaniasis – visceral (also known as kala-azar, which is and the most serious form of the disease), cutaneous (the most common), and mucocutaneous. Leishmaniasis is caused by protozoan parasites which are transmitted by the bite of infected female phlebotomine sandflies. Distribution of the phlebotomine sand flies depends on geographical differences, abundance of vertebrate hosts, habitat availability and environmental factors such as rainfall and temperature. Leishmaniasis was made a notifiable disease in Sri Lanka in 2008, and therefore, reporting of all persons with leishmaniasis to the relevant Medical Officer of Health (MOH) is a legal requirement.

The Ministry of Health and the Ministry of Education act together for successful implementation of the School Health Programme according to the World Health Organization criteria. The goal of the School Health Programme is to “Ensure that children are healthy, capable of promoting their own health and health of the family and community; and are able to optimally benefit from educational opportunities provided.” Formulating health promoting school policies, developing competencies for the promotion of their own health, creating safe and healthy school environment, establishing school and community relationships to promote health and delivering health services such as School Medical Inspection and school dental services are the main strategic areas of the School Health Programme.

The National progamme conducted by directorate of environmental health, occupational health and food safety, Ministry of Health, is implemented by Public Health Inspectors (PHII) at Grass Root level. The programme is coordinated by provincial and district PHII by each level. The progrmme ensures access to safe drinking water, safe food for consumption, availability of sanitary latrine and make sure the work places are safe and healthy.

Organization of oral healthcare delivery system in the Sabaragamuwa province includes curative oral healthcare services as well as preventive and control oral healthcare services. Curative oral healthcare services consist of both general oral healthcare and specialized oral healthcare. General oral healthcare is provided through the clinics located in Adolescent Dental Clinics (ADCs), Community Dental Clinics (CDCs), Primary Medical Care Units (PMCUs), Divisional Hospitals, Base Hospitals, District General Hospitals, Provincial General Hospital and Teaching Hospital. Specialized oral healthcare is provided through specialized oral health units in hospitals as Oral and Maxillofacial Surgery (OMFS) Units, Restorative Dentistry Units, Orthodontic Units, Preventive Oral Health Units and Oral Health Units in Public Health Institutions.

The School Dental Service which caters for school children is primarily managed by School Dental Therapists (SDT) under the direct technical supervision of Regional Dental Surgeon and direct administrative supervision of Medical Officer of Health. SDT provides preventive oral healthcare for children aged between 3-13 years. Their target group for treatment is children in grade 1, grade 4 and grade 7 classes in schools where there are more than 200 students and in schools with less than 200 school children all the children below 13 years. The current norm is to have one School Dental Clinic (SDC) per one Medical Officer of Health (MOH) division and 2000 school children as the target population per SDT.