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7/15/2019 1 REDUCING MATERNAL MORTALITY IN SRI LANKA 2 Outline Country profile Organization of the health sector Maternal mortality data Maternal mortality reviews New interventions
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REDUCING MATERNAL MORTALITY
IN SRI LANKA
2
Outline
Country profile
Organization of the health sector
Maternal mortality data
Maternal mortality reviews
New interventions
7/15/2019
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3
Sri Lanka
An island with land area of approx 65,610 sq km and a population of 21 million.
9 provinces
28 health regions
350 health divisions (MOH areas)
Free health service since 1930s
Free education since 1944
Primary education (6-14 years) coverage 93.7%
Per capita GDP US $ 4065 (2017)
Health expenditure 1.3% of GDP and 7% of total government budget (AHB 2010)
Current Health/demographic Indicators
Crude birth rate 15.2/1000 Pop
Maternal mortality ratio 33/100,000 LB
Infant mortality rate 8.8/1000 LB
Growth rate 0.7%
TFR* 2.2
CPR* 64.6%
Unmet need* 7.5% (*DHS 2016)
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SRI LANKA
Population
20.3 million (2012)
5.5 million (27%)
Women in the reproductive
age group (15-49yrs)
3.0 million (15%)
‘Married’ Women
Secretary of Health
Director General of Health Services
Deputy Director Generals• Public Health Services I &II• Medical Services• Planning• Administration• Finance• Lab Services
Epidemiologist Director MCHDirector HEB
EpidemiologicalUnit
Family HealthBureau
Health EducationBureau
ORGANIZATIONAL STRUCTURE (Central Level)
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Preventive Health System in Sri Lanka
25 AdministrativeDistricts
350 Health divisions
(MOH AREAS )
FURTHER DIVIDED IN TO
6690 PHM AREAS
9 provinces
Family Health Bureau
Provincial Director of Health Services
Regional Director of Health Services
Medical Officer of Health areas
PHNS SPHMPHI PHM
Other staff
Curative health institutions
Medical officer Maternal & Child Health
Preventive Care
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Curative sector
Line Ministry Provincial Ministries
Teaching Hospitals District General Hospitals
Provincial General
Hospitals
Base Hospitals
District General Hospitals Divisional Hospitals
PMCUs
SG/FPU/FHB
Newborn Baby
Well-baby clinic
School Medical
Inspection
Marriage
Pre pregnancy Screening,
Assessment
& Counselling
Pregnancy Antenatal care
Obstetric Morbidity
Delivery
Maternal Death
Newborn
Screening
Pre- employment Screening
Intrapartum Management
Post Partum Care – Hospital / Field
Family Planning
GP/OPD – Peripheral Hospital
Cardiology / VP Referral
Life course
Approach
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Sri Lanka
Maternal Mortality Ratio 1911 – 1995
2327.4 2331.1
2493.6
2329.9
2044.8
1767.1
2136.0
1916.5
2679.6
2164.9
1824.0
1334.7
1055.7
826.2
654.6
370.8302.5
239.3
145.4136.1 102.4
75.8
64.557.860.258.3
50.6
37.238.634.7 26.925.420.823.6
23.5
0.0
500.0
1000.0
1500.0
2000.0
2500.0
3000.0
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11
19
14
19
17
19
20
19
23
19
26
19
29
19
32
19
35
19
38
19
41
19
44
19
47
19
50
19
53
19
56
19
59
19
62
19
65
19
68
19
71
19
74
19
77
19
80
19
83
19
86
19
89
19
92
19
95
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MMR – Sri Lanka, UK and Sweden
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Sri Lanka
Maternal Mortality Ratio 1911 – 1995
2327.4 2331.1
2493.6
2329.9
2044.8
1767.1
2136.0
1916.5
2679.6
2164.9
1824.0
1334.7
1055.7
826.2
654.6
370.8302.5
239.3
145.4136.1102.4
75.8
64.557.860.258.3
50.6
37.238.634.726.925.420.823.6
23.5
0.0
500.0
1000.0
1500.0
2000.0
2500.0
3000.0
19
11
19
14
19
17
19
20
19
23
19
26
19
29
19
32
19
35
19
38
19
41
19
44
19
47
19
50
19
53
19
56
19
59
19
62
19
65
19
68
19
71
19
74
19
77
19
80
19
83
19
86
19
89
19
92
19
95
Source:
Registrar General’s
Department
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British Colonial Era
• Control of Malaria
• Introduction of modern medicine
• Expansion of healthcare facilities
• Skilled attendance at delivery -
scale-up of midwifery services to
rural areas
• Free Health care
• Introduction of Antibiotics
• Improvement of social status of
women
• Improvement of transport
modalities
• Colonial support to health, education and
transport expansion
• Medical education started in 1870 –
Colombo Medical College
• Midwifery services started in 1920s –
cornerstone of the success
• Civil Death registration from 1860s –
availability of maternal mortality data
Sri Lanka
Maternal Mortality Ratio 1911 – 1995
2327.4 2331.1
2493.6
2329.9
2044.8
1767.1
2136.0
1916.5
2679.6
2164.9
1824.0
1334.7
1055.7
826.2
654.6
370.8302.5
239.3
145.4136.1102.4
75.8
64.557.860.258.3
50.6
37.238.634.726.925.420.823.6
23.5
0.0
500.0
1000.0
1500.0
2000.0
2500.0
3000.0
19
11
19
14
19
17
19
20
19
23
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26
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29
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32
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35
19
38
19
41
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44
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47
19
50
19
53
19
56
19
59
19
62
19
65
19
68
19
71
19
74
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77
19
80
19
83
19
86
19
89
19
92
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95
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Post-independence• Free education in mother
language –Literacy improved
53% (1950) to 93% (1976)
• Blood Transfusion service was
established in 1950. First Proper
Blood Bank in 1960 and it
steadily improved to a world
class service
• Social development initiatives;
food subsidies and
supplementation, subsidized
public transport and maternity
benefits
MMR reduced from 826.2 (1948) to 93.6
(1976)
• Increasing hospital deliveries
• Health human resource development
• Improved obstetric care
• Better public health delivery system
• Initiation of Family Planning services
• Continuous political support
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1976 onwards..• Further increase in institutional
deliveries
• Organized Family Planning
services
• Steady increase of MBBS
qualified Doctors (In 1982 - 450
per year and 2017 - 1250 per
year)
• Post Graduate Institute of
Medicine (1981) – availability of
locally qualified specialists since
1985.
• Modernized care
• Increased EmoC facilities
• Increasing health budget
• Improved road network –Three
Wheelers in rural areas /
Ambulance services
Newborn Baby
Well-baby clinic
School Medical
Inspection
Marriage
Pre pregnancy Screening,
Assessment
& Counselling
Pregnancy Antenatal care
Obstetric Morbidity
Delivery
Maternal Death
Newborn
Screening
Pre- employment Screening
Intrapartum Management
Post Partum Care – Hospital / Field
Family Planning
GP/OPD – Peripheral Hospital
Cardiology /
VP Referral
Life course
Approach
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Availability of Public
Health Midwives and MMR
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Proportion of
Hospital
Deliveries
1970 - 2016
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EmNOC facilities
distribution
country-wide
Blood
Transfusion
Services
• Annual Collection of blood -
423,668 units (2017)
• 100% from Voluntary Blood Donors
• Availability of Transfusion
Specialists
• Blood components
• Massive blood transfusion protocol
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Care for the Pregnant Women
331,000Pregnancies
82% Pregnancy Registration < 12 wks
99% Antenatal care
99.9% Hospital Deliveries
(94% in specialized hospitals)
92% Post-partum domiciliary care
Contraceptive Prevalence Rate (CPR)
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Teenage Pregnancy Rate
Total expenditure on health as a
percentage of GDP.
https://www.indexmundi.com/g/r.aspx?t=0&v=2225&l=en
Health Expenditures
Sri Lanka 3.5%
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Evolution of MDSR process in Sri Lanka
Vision
A country;
• in which there are no preventable deaths of
mothers, foetuses and new-borns
• where every pregnancy is planned and
wanted,
• every birth celebrated, and
• women, babies and children survive, thrive
and reach their full potential
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Targets for Maternal, Newborn and
Perinatal Mortality
Indicator 2020 2025 2030
(SDG)
Maternal
mortality ratio (per 100,000 live births)
25 15 <10
Neonatal
mortality rate (per 1000 live births)
4.2 3.4 <2.2
Still birth rate (per 1000 total births)
4.5 3.5 <2
Moving beyond Maternal deaths
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Number of maternal
near-misses notified (2017)
152
Register of
Eligible women in
Danger
To capture high risk women at community
level, document and provide
targeted care by a multidisciplinary care team
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In-depth exploration of
Maternal Suicides
A collaborative work by;
• Family Health Bureau
• The College of Psychiatrists of Sri Lanka
• Mental Health Directorate
Acknowledgements
Dr.Kapila Jayaratne – NPM, MCMMS Unit/FHB
SLCOG
All the staff – FHB
RDHS / Hospital Administrators
SLCOG CCPs / MOMCH
MOOH / MO PH
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