brand logo

Stakeholder collaboration essential to provide optimal healthcare to urban and estate sectors

22 Jul 2021

  • Health expert says LG bodies should partner with primary healthcare teams 
BY Ruwan Laknath Jayakody  All the relevant stakeholders, including the Local Government authorities in charge of certain aspects of both the urban and estate/plantation sectors, should develop collaborative partnerships with primary healthcare teams in order to provide optimal healthcare services to address the unique health issues and challenges affecting such sectors and their underprivileged populations.  This recommendation was made in a story on “Estate and urban sectors in Sri Lanka: vulnerabilities requiring focused attention” which was authored by E. Wickramasinghe (attached to the Health Ministry’s Estate and Urban Health Unit) and published in the Journal of the College of Community Physicians of Sri Lanka’s 27th Volume’s First Issue on 9 July 2021.  As per population statistics, it is noted that the around 21.4 million people living in Sri Lanka can be categorised as living in three sectors, namely, estate, rural and urban. However, as noted in the Census and Statistics Department’s Demographic and Health Survey of 2016, the indices related to health, and the outcomes and challenges pertaining to health, which are faced by under-settled urban dwellers and estate workers differ distinctly from those concerning the rest of the population.  In this regard, Wickramasinghe noted that the Health Ministry’s Estate and Urban Health Unit had been established during the late 1990s for the purpose of giving attention and making focused interventions concerning the need to uplift the health status of such vulnerable groups.  With regard to the estate sector, in the “Update on the health status of the plantation community in Sri Lanka” by N. Periyasami, it is noted that the sector includes all plantations that are 20 acres or more in extent, mostly tea plantations, stretched across five Provinces, and with 10 or more resident labourers from among the roughly 1.1 million population living in such areas where the majority are Tamils of Indian origin.  Regardless of such, the health vulnerabilities of the people living in these areas have continued for several decades, with under-nutrition being a major health issue which has however shown a slow decreasing trend according to the Census and Statistics Department's Demographic and Health Survey of 2016.  As explained by Wickramasinghe, the provision of healthcare services in the estate sector evolved in stages. The first was during when the British colonial power ruled the country where the practice was for the planters to themselves look after the health related concerns of estate workers. The second was when the nationalisation of estates took place and thus the healthcare of estate sector labourers became a national responsibility. The third was when the privatisation of estates took place, thus bringing the management of the provision of healthcare services in estates under the estates managements, which was administered through Estate Medical Assistants, with the State or the Health Ministry on the other hand, supplying the necessary medication. However, Wickramasinghe points out that it was during this third stage of the process pertaining to the evolution of the healthcare services provided to the estate sector which involved privatisation and the involvement of estate managements that in the decades since, health-related indicators of the estate population had taken a turn for the worse. The fourth and current stage involves the process of the integration of the health services in the plantations into and being amalgamated with the national level health system.  Furthermore, Periyasami explains that over the course of this period of change, the curative healthcare services provided for estate workers too has fluctuated owing to the numerous challenges faced by such, with the major obstacles being the involvement of multiple stakeholders with varied and varying interests, coupled with minimal coordination among such stakeholders.  That said, Wickramasinghe mentions that since 2007, the preventive healthcare services for estate sector workers had been taken over by the Provincial health authorities.  Nonetheless, Periyasami further explains that estate dwellers continue to face major health related issues such as malnutrition, low birth weight, anaemia, substance misuse disorders and tuberculosis (TB).  Elsewhere, M. Weerasinghe and D. Fernando observe in “Access to care in a plural health system: concerns for policy reforms” that the urban sector covering 65 Local Government authority areas (24 Municipal Councils and 41 Urban Councils) is where an estimated four million of the population (18.4% of the total) live. In this urban sector too, the United Nations (UN) Habitat’s “Report on the state of Sri Lankan cities 2018” observes that owing to the rapid, unplanned urbanisation, urban cities have expanded to accommodate those migrating in search of work, and arriving for purposes of education, business and marriage, in turn creating conditions of overcrowding, congestion in transportation and the resultant traffic, a high demand for a limited number of resources, and the increase in the need for healthcare services. As a result, as both the Census and Statistics Department’s “Sri Lanka Demographic and Health Survey 2016” and the study on “Urban living and obesity: is it independent of its population and lifestyle characteristics?” by C. Arambepola, S. Allender, R. Ekanayaka and D. Fernando notes, this situation has led to a high prevalence of diarrhoeal diseases, respiratory diseases (TB), vector-borne diseases (dengue fever), substance abuse disorder, road traffic accidents, being overweight and obesity, and other related risk factors for chronic non-communicable diseases, among both children and adults.  Wickramasinghe explained that as a measure of upgrading the living standards of urban low income groups, the Urban Development Authority (UDA) had together with certain other primary stakeholders, planned to relocate 68,000 families in unauthorised and impoverished dwellings in urban settlement flat complexes by 2030 as according to them such would pave the way for people who were living in horizontal under-settlements such as slums and shanties to settle in vertical flats, thereby resolving issues pertaining to shelter, sanitation and safe water requirements. However, Wickramasinghe points out that these along with large scale developmental projects in cities, has resulted in environmental pollution, especially air pollution, and fractured social and communal relations and support networks, whilst exacerbating problems such as communal violence, drug-related problems, and being overweight and obesity.  Therefore, these matters are, Wickramasinghe emphasised in conclusion, crucial issues that require targeted interventions.


More News..