5.8 Rehabilitation

The NMQAL tests samples of medicinal drugs for quality control before they are registered by the NMRA and also has a role in post-marketing surveillance of these medicinal drugs through random assessments.

5.7.3 Blood and blood products The National Blood Transfusion Service (NBTS) is a fully state-owned special campaign for maintaining blood transfusion services across the country. The NBTS has a service history spanning more than 55 years. There are 99 functioning blood banks within the state hospitals at the level of BHs and above, and two stand-alone blood centres (the National Blood Centre and the Southern Regional Blood Centre) affiliated to 19 cluster centres, based on the geographical distribution. Each cluster centre is headed by a consultant transfusion physician who provides clinical and technical guidance. The service provides quality-assured blood and blood components and relevant laboratory testing for the entire state sector hospitals and for most of the private sector hospitals. Sri Lanka collects 100% of the blood from voluntary donors. All donated blood is tested for HIV, hepatitis B and C, and syphilis (National Blood Transfusion Services, 2016). The human leukocyte antigen (HLA) laboratory of the NBTS is the only place in Sri Lanka where cross-matching for organ transplantation is carried out. Other functions of the NBTS include manufacturing laboratory reagents and reagent red cells, promoting appropriate clinical use of blood and blood components through hospital transfusion committees, conducting training programmes for postgraduate trainees on transfusion medicine and haematology, and promoting transfusion medical research.

5.8 Rehabilitation

Although the true extent of disability in Sri Lanka is unknown, WHO estimates that 15% of the population has some form of disability. Currently, both inpatient and outpatient rehabilitation care are available in secondary- and tertiary-care institutions in the government sector and in the larger private hospitals. In addition, special rehabilitation hospitals at Ragama, Digana and Laliambe provide dedicated rehabilitative care to around 4500 patients every year (Ministry of Health, Nutrition and Indigenous Medicine, 2016b). These services are under consultant rheumatologists and their supportive technical teams comprise general physiotherapists, speech therapists and occupational therapists. Lack of knowledge among the general population about what can be achieved through rehabilitation has led to a degree of acceptance of disability. This, together with insufficient services, both institutional and community based, problems of accessibility and cost remain as barriers to rehabilitation.

The two key ministries working in the area of disability are the Ministry of Social Services and the MoH. The Ministry of Social Services is the nodal agency for programmes for persons with disabilities. A separate secretariat has been set up in the Ministry of Social Services with a directorate providing support for assistive devices, livelihood and monetary support. A significant achievement was the launch of the World Disability Report, which highlights the different barriers that people with disabilities face – attitudinal, physical and financial. This was followed by the formulation of a National Action Plan on Disability (World Health Organization, 2014b). A National Steering Committee for the Care of People with Disabilities is chaired by the Secretary Health. The Secretary of this Committee is the consultant community physician attached to the Directorate of Youth, Elderly and Persons with Disabilities (YED).

At the level of the MoH, the Director YED is responsible for providing technical guidance, including policy and guidelines for rehabilitation. The Directorate also supports rehabilitation facilities that function under the MoH. These include rehabilitation hospitals and other hospitals with rehabilitation departments and facilities. At the provincial level, the PDHS is responsible for providing disability and rehabilitation services in the facilities managed by the province.

Four types of health institutions provide rehabilitation services in Sri Lanka. They are: (i) rehabilitation hospitals under consultants in rheumatology and medical rehabilitation; (ii) all tertiary-level GHs and some DGHs and BHs, many of whom have consultant rheumatologists; (iii) some DGHs and BHs that provide limited rehabilitation services and physiotherapy; and (iv) hospitals with no rehabilitation services, with patients being referred to higher levels or for community-based rehabilitation.

Together with the MoH, the Ministry of Social Services implements community-based rehabilitation programmes. These aim to promote rehabilitation of persons with disabilities in order to enable them to enjoy their rights, carry out their responsibilities and create opportunities through social development programmes to integrate them into society. The Ministry attempts to promote early identification and intervention and educate the community to encourage home-based care rather than institution-based care, and thereby improve the quality of life of persons with disabilities by promoting and protecting their rights.