The World Health Organization (WHO) marked its 70th anniversary on World Health Day that fell on April 7. This signified a special occasion for Sri Lankans, since WHO chose Sri Lanka as the location to commemorate its birth. An excerpt from an interview with Minister of Health, Nutrition and Indigenous Medicine, Dr. Rajitha Senaratne on the significance of the event and progress of the health sector follows below.
Q. What was special about World Health Day being held in Sri Lanka?
A. World Health Day is the first global event held in Sri Lanka, in its entire history. It is the day inaugurated by World Health Organization (WHO), to commemorate health. Every year, this celebration was held at the WHO headquarters in Geneva, this is the first time they deviated. Director General, WHO, Dr. Tedros Adhnom decided to hold this year’s commemoration in Sri Lanka, at the executive committee meeting held in January. He said, there is no better place to hold the commemoration. At the press conference here, Dr. Adhnom further said, Sri Lanka has the best health services available in the entire world.
Q. In what context can the WHO theme, ‘Better health for everyone everywhere’, be applied to Sri Lanka?
A. Everyone everywhere is the universal health coverage, in other words, free health. This is why WHO appreciates our health system. However, although we say there was a free health service in the country, there were certain limitations to this. One example was the limitation of the funds for cancer treatment, to Rs. 1.5 million. Cancer drugs cost about Rs. 280,000 daily, which meant a patient was limited to about five or six vials. After this, the patient would pass away. This was their fate. However, I extended their lifetime by somehow reducing the price of the drug from Rs 280,000 to Rs. 144,000, which is approximately half the price. In comparison with the previous Government which spent Rs. 1.3 million, I am spending Rs. 4.8 billion on them. If I didn’t reduce the price, I would have spent around Rs. 9.5 billion.
Secondly, heart patients had to buy stents from outside spending Rs. 2.5 to 3.5 lakhs. Now, we supply the stents free of charge. The statistics of the Colombo Cardiology Unit indicates that only 50 to 60 patients have inserted stents, prior to the distribution of free stents, but now, 450 to 500 patients insert stents.
Likewise, the newly invented drug for myocardial infarction (heart attack), Tenecteplase, is imported and supplied to hospitals nationwide. This is the next alternative if there are no facilities for inserting a stent. Prior to giving Tenecteplase and stents free of charge, e.g. if six patients were brought to a cardiologist, five died. Now, only one patient would die.
Similarly, we are giving cataract lenses free of charge for 1.2 million people suffering from vision problems, per year. Further, the price reduction of 48 essential drugs by about 100 to 300 per cent, as well as price reductions on cataract lens and stent prices, ensures even those getting treatments at the private sector have to spend less money. The allocation of more money for health by the Government is the main feature of universal health care.
Q. How has various international bodies evaluated our health system?
A. The March 2018 volume of the British Medical Journal (BMJ) editorial has written, “we should applaud the decision of the Sri Lanka Ministry of Health, taken after the survey, to provide cardiac stents to hospitals with PCI facilities and to include troponin testing as a routine examination in state sector hospitals. Also laudable is the recent introduction of state operated ambulance services in some parts of Sri Lanka, which would lead to the reduction of the total ischaemic time, with further reduction of STEMI in- hospital mortality.”
Also, World Bank, in its 2017 report says, the best pro- poor health policy is available in Sri Lanka. Further, UNICEF says our natural birth rate is equal to the world’s richest two nations, USA and Kuwait. This is why the British Guardian says, USA as a rich nation must repent on how a middle level island nation is equivalent to USA on this front.
Q. How is the current situation on dengue prevalence in the country?
A. Dengue is now under control and death rate has gone down drastically. You cannot eradicate dengue in a year or two. Even USA is now experiencing dengue in many of its states. Malaysia, which has a better economy than us, indicates a higher patient and death rate due to dengue.
Q. Although Sri Lanka is Malaria free at the moment, climate experts say it can return by 2050, due to prevalent droughts and floods. Are there any long term programs to prevent the situation?
A. Yes, we are still on the alert for Malaria. Though we are now Malaria free, we are still continuing this program. Also, we have a separate program now for Prevention of Malaria.. Prior to this, the reasons for the return of Malaria were not climatic, but migratory. We have alerted all the divisions from the airport downwards on this migratory factor. There was a new species of Malaria in the North that has come from Southern India, which we managed to control.
This year, we expect to eradicate mother to child HIV. Mother to child HIV has now come down, controlled by the HIV program. Likewise, we are hoping, rubella and measles too will be eradicated before 2020. Therefore, out of communicable diseases we have only two problems, HIV and dengue.
Q.Is the Health Ministry considering regulating the health sector at any point?
A. We have already brought in regulations for the time a doctor examines a patient, and the consultation fee. Accordingly, a doctor has to examine a patient for 10 minutes and the maximum retail price per consultation is Rs. 2,000. I have also set up guidelines where the doctor has to wait for a minimum of one hour after performing a surgery. It is important to handle post operation complications. I have received complaints where a doctor performs a surgery and soon after goes to another hospital. But, during this time, the patient can experience complications.
We are also trying to bring in more regulations, with a maximum retail price for all the health procedures in private hospitals. We have currently selected 53 such procedures to be price controlled. In every procedure, the private sector has agreed to bring down the price, but the issue is with doctors’ fees. I have already discussed this with the Government Medical Officers’ Association (GMOA), they are not happy. I have to discuss with the Association of Medical Specialists( AMS) in controlling their fees. 95 percent of the doctors practising in the private sector are doctors from the Government service. They are paid Government salaries, allowances, duty free car permits and so many other facilities. This is their second employment. So, it is possible to impose limitations.
Q. When carrying out In Vitro Fertilization (IVF), commonly known as test tube babies, who has the powers to oversee the number of embryos produced and their fate?
A. Private hospital authority has all the powers to intervene and inspect the places carrying out IVF. With them, I have used my investigation teams to visit those hospitals and inspect the procedures, etc. Whenever there is a complaint, I send my teams to investigate.
Pic: Thilak Perera