4. Physical and human resources ................................................................ 78 Chapter summary

4. Physical and human resources

Chapter summary

The state curative facilities in the allopathic system are organized into a tiered structure, each providing a defined level of care. They range from the National Hospital of Sri Lanka and teaching hospitals with super specialties; provincial, district, general and base hospitals with selected specialties; to divisional hospitals (outpatient care and inward care) manned by nonspecialist doctors and primary medical care units offering only outpatient care. Some 628 hospitals provide inpatient care facilities and have a combined total bed strength of 83 275 with an average of 3.9 beds per 1000 population. The public health services are mostly provided by the state sector through a network of some 354 MOH units, which run 3825 branch clinics spread across the country.

Sri Lanka completed a Service Availability and Readiness Assessment (SARA) survey in 2017 among a sample of 755 facilities, including curative and preventive service delivery points, the relevant findings from which have been summarized in this chapter.

Investment proposals are identified through the respective national and provincial budgets. Institutions that come under the line ministry are seen to get a major share of funding for physical resources. In the private sector, investment for ambulatory care clinics (general practitioner [GP] practices) is borne by the practitioners themselves. Investment for the establishment of private hospitals is done mostly through Board of Investment (BOI)-approved projects by entrepreneurs.

The past decade has witnessed the development and deployment of many institution-based electronic HISs in Sri Lanka. There are successful and scaled-up models (i.e. electronic Indoor Morbidity and Mortality Reporting [e-IMMR], Health Information Management System [HIMS], Hospital Health Information Management System [HHIMS], Reproductive Health Management Information System [RHIMS] and District Nutrition Management System [DNMS]), which have been implemented with varying levels of maturity, while the rest are limited to pilot implementation and have failed to scale up to the national level. Major concerns identified are lack of clear policies guiding

health information management, compartmentalization of the information governance mechanism, inadequate coordination among existing information systems, limited data-sharing, moderate use of information for decisionmaking and insufficient automation leading to a relatively modest quality of health information. The National Policy on Health Information (2016) seeks to rectify this situation.

The Ministry of Health (MoH)11 employs approximately 140 205 persons (both in the line ministry and provincial health ministries) belonging to 327 different categories. The health workforce has gradually increased during the period 2005–2015. However, this increase has not been uniform across staff categories and an appropriate skill mix is yet to be identified. Further, along with the evolving reforms in health care, service delivery cadres need to be revised. Private sector health-care delivery is expanding but estimates of the workforce are not available.

Recruitment and training of MOs has been regular through the university system. However, in other staff categories, such as nursing, professions supplementary to medicine (PSM) and paramedical categories, it needs be streamlined. Initiation and expansion of graduate programmes in state universities for nursing and some PSM staff categories have been a significant achievement in the development of human resources (HR) for health. Doctors have evident career development opportunities, but more attention needs to be paid to career development pathways for other staff categories.

Data on the professional mobility of health workers is limited. Monitoring mechanisms need to be strengthened on dual practice, professional mobility and private sector health workforce.

At present, key HR management functions of the MoH, HR planning, recruitment services, training and development, services administration such as administration of salary structures, service minutes, transfers, discipline, performance appraisals, etc. are performed by various divisions of the MoH. The Human Resource Coordination Division was established in 2017 to improve coordination among these units.

11 The Ministry of Health (MoH) of Sri Lanka has undergone numerous name changes over the past 20 years. In the text of this document, we use “Ministry of Health (MoH)”, which is the current iteration. However, when referencing ministry publications, we use the name that was used by the

Ministry at the time of publication.