5.4 Inpatient care

The increase in the elderly population and NCDs have added to the burden on the existing health-care system, which has been slow to respond to these changes. The proposed reorganization of the PHC would ensure that it would act as a gatekeeper towards accessing secondary- and tertiary-care services. Accordingly, specialized services would be made available through a referral pathway from the PHC system. These changes in the referral system would be facilitated through the use of IT solutions. However, it should be recognized that the success of PHC reforms would depend on a sea change in population and provider perceptions and behaviour.

5.3.2 Specialized ambulatory care (day care/day hospitals/day clinics/ surgical centres) The MoH promotes the provision of day-care services in all hospitals with a view to providing comprehensive patient care without unnecessary delays and as a means of reducing admissions, hospital-acquired infections and the cost of patient management.

Currently, selected hospitals provide day-care services such as day surgeries, radiological and other investigations, family planning procedures, rehabilitation, haemodialysis services, physiotherapy, occupational therapy and speech therapy. Although day-care services are functioning within the system, their performance data are not captured separately in the HIS. In addition to these services, the state has introduced the concept of preliminary care units in many of its secondary- and tertiary-care hospitals, so that all patients needing acute care are first treated at these PCUs and then reviewed by the respective consultants. Only those who need inward care are admitted for further management. This too has significantly reduced the number of admissions and has been identified as an initiative that reduces the inward workload and congestion and improves the quality of inward care.

5.4 Inpatient care

Among countries in the Asian region, Sri Lanka is a country with a high hospital bed penetration (4 per 1000 population) (World Bank, 2020). Inpatient care is provided by both public and private hospitals with state sector institutions providing the bulk of the services. The health facility survey of 2016 identified 628 public hospitals (Table 5.1), accounting for 73% of hospitals and 93% of the bed strength in the country (Department of Census and Statistics, 2016). Levels of care have been categorized, facilities for each level of care have been identified and institutions are being developed in a phased manner.

The same survey identified 141 private institutions located mostly in Colombo and other large cities.14 Inpatient care by the private sector contributes around 5% to the total patient care (Ministry of Health, Nutrition and Indigenous Medicine, 2017b). Subspecialization is noted within private hospitals in Colombo in areas with a high demand, such as neurosurgery, cardiac surgery, maternal and newborn care and cancer treatment. Inpatient care in the private sector is provided mainly by a few key players who hold nearly 50% of the private sector bed capacity.

Table 5.1 Summary of the different services by level of care and management authority

Curative, rehabilitative & palliative care Preventive care

Tertiary care Teaching hospitals 16 Directorates under Public Provincial general 3 Health Services I hospitals Directorates under Public District general Health Services II hospitals Directorates under Environment & Occupational Health Directorates under noncommunicable diseases (NCDs)

19

Subtotal 38

Secondary care

Base hospital – Type A 24 Base hospital – Type B 50

Subtotal 74

Primary care Division hospitals – Type A 50 354 Medical Officer of Health (MOH) units covering entire country On average 40 000–80 000 population/MOH area

Divisional hospitals – Type B Divisional hospitals – Type C Primary medical care unit (PMCU) with maternity beds

Subtotal

134 296

11

491

Other hospitals Including rehabilitation hospitals, Cancer Institute Maharagama and others

Total

25

628

Source: Department of Census and Statistics, 2016

14 This is based on the Health Facility Survey (2016) and is an update of the 2011 figure of 125 stated in Chapter 4. National

Provincial