The Health System Enhancement Project (HSEP)
The Health System Enhancement Project (HSEP) is an Asian Development Bank financed Health Project in Sri Lanka started in December 2018. The project targets all the nine Districts in four provinces of Central, North Central, Sabaragamuwa, and Uva with a special focus on the geographically, socially, and economically deprived populations. The expected project impact is to contribute to the Government development objective of ensuring a healthier nation with a more comprehensive PHC system. The project outcome is to improve efficiency, equity, and responsiveness of the PHC system. The beneficiary population of the project is approximately 7 million which is 33% of the Sri Lankan population (21 million), while the target population within the four provinces, is estimated to be approximately 2.4 million.
The project outputs are,
PHC is enhanced in Central, North Central, Sabaragamuwa, and Uva provinces;
Health information system and disease surveillance capacity are strengthened; and Policy development, capacity building, and project management are supported.
Scope of the project.
The Health System Enhancement Project is delivered through a project investment modality and is expected to be effective from 1st December 2018 and will complete on 30th November 2023. The proposed project will improve efficiency, equity, and responsiveness of the primary health care (PHC) system based on the concept of providing universal access and continuum of care to quality essential health services. The project pursues an equity perspective in planning and delivering of essential primary health services. It expects to further inform and operationalize government PHC reform initiatives to,
Reduce bypassing of PHC facilities by providing more comprehensive services, including the care for NCDs,
Develop a referral system. Functionally integrating preventive and curative services.
The project will target underserved communities’ access to PHC, and will address selected gaps in core public health surveillance in line with the international health regulations (IHR)
Primary Health Care System Strengthening Project (PSSP))
The Primary Health Care System Strengthening Project (PSSP) is a health development project funded by the World Bank and currently ongoing in Sri Lanka, with a particular focus on the Sabaragamuwa province. The aim of the project is to improve the overall health status of the population in the area through a range of initiatives designed to strengthen the primary healthcare system and enhance the quality and accessibility of healthcare services. The project is being implemented through a multi- pronged approach, with various initiatives being carried out to address different aspects of healthcare service delivery. Some of the key elements of the project are as follows:
People-centered health service: The project is designed to deliver health services to all people in specific geographic areas through population empanelment. This means that the population of a given Grama Niladari Division (GN division) would be assigned to the closest Primary Medical Care Institution (PMCI) based on the distance. The empanelment of a population to PMCIs is carried out within a district (Ratnapura or Kegalle District), and all levels of institutions within a district other than specialized institutions will be utilized for empanelment. In 2019-2020, eight PMCIs in Ratnapura district: Keeragala, Kiriella, Theppanawa, Alupola, Erathna, Udawalawa, Kuruwita and Kalthota and, seven PMCIs: Beligala, Rambukkana, Deraniyagala, Dewalegama, Undugoda, Hemmathagama and Pindeniya in Kegalle district were empaneled successfully.
Development of Primary Medical Care Institutions (PMCIs): The project aims to develop PMCIs to provide quality healthcare services to the population. This includes improving infrastructure facilities, and equipping PMCI laboratories to carry out basic investigations including hematology, microbiology, biochemistry, and histopathology. The project also includes the deployment of point of care equipment and the establishment of mobile laboratories.
Provisions for Non-Communicable Diseases (NCD) prevention: The project aims to develop and implement measures to prevent and manage NCDs, which are a major cause of illness and death in the area. This includes the provision of NCD care drugs as one-month supply blister packs, developing user- friendly protocols and guidelines for NCD screening and management, and increasing screening for NCDs.
Development of laboratory networking systems in PMCIs: To improve the quality and accessibility of laboratory services, the project aims to establish laboratory networking systems in PMCIs. This includes establishing sample collecting centers to forward samples to apex hospitals, deploying point of care equipment to PMCIs Endana, Keeragala, Dodampe and Weragama in Ratnapura district and Basnagala and Amanawala in Kegalle district. Developing of level two laboratories in Divisional Hospitals for analysis of samples collected from PMCIs. Community engagement mechanisms and increased accountability for the health sector: The project aims to develop community engagement mechanisms and to increase accountability for the health sector. This includes establishing a Grievance Redress Mechanism (GRM) called as “Suwasawana” with a special hotline provision (1907), to respond to public feedback on health services.
Public-private partnership environment: The project aims to enable a public-private partnership environment through the promotion of patient- friendly services (NCD screening) in cooperation with the private sector, whenever possible, based on need. Gender-sensitive services: The project aims to establish operational appointment systems and proactive outreach services to address the gender gap in utilization of NCD care services. Personal Medical Records System: The project aims to develop a personal health records system to facilitate coordinated patient care. Patients who are registered to a particular PMCI are eligible to receive a Personal Medical Record.
Overall,thePrimaryHealthCareSystemStrengthening Project in Sri Lanka, with a focus on Sabaragamuwa province, aims to improve the accessibility and quality of healthcare services through a range of measures, including the development of primary medical care institutions, the implementation of NCD prevention and management programs, the establishment of laboratory networking systems, and the promotion of community engagement and public-private partnerships.