BY Consultant Family Physician, Dr. S. Kumaran, and Viduni Basnayake
This article describes the experiences of a novel, evidence-based approach that involves patients, and their family members, in delivering health care, providing medical education, and conducting research, at a primary care institution, called a Family Health Care Centre.
The Northern Province, in Sri Lanka, is a war-ravaged region that lags behind the rest of the country, in economic development.
After the COVID-19 pandemic had already squeezed the health services of its limited resources, the current financial crisis has pushed the sector to the brink of collapse. This crisis puts patients at further risk due to power outages, a lack of medicine, and equipment shortages. Another major issue, caused by the economic collapse, is the shortage of human resources. In addition, frequent protests, brought on by political unrest, disrupt the provision of health services.
Primary care is the provision of integrated, accessible healthcare services, by physicians and their support teams, to patients, while developing a sustained relationship with patients, within the family and community. The care is person-centered, team-based, communit-aligned, and designed to achieve better health, and better care, at lower costs. Family Medicine is the focal point of primary care and, unlike other specialties that focus on a specific organ or disease, Family Medicine is a field in which physicians treat most ailments and provide comprehensive healthcare to people of all ages – from newborns to seniors.
In Sri Lanka, the delivery of primary care is no easy task. Inadequate human resources, limited infrastructure (buildings, furniture, labs and equipment), lack of a multidisciplinary approach in team work, inadequate government policies and fund allocation, and the lack of awareness of primary care services, among the general population, are the main obstacles. The delivery of health services is made more challenging by patients who have multiple health issues, complicated psychosocial problems, transportation issues from their homes to healthcare facilities, and a lack of awareness of their medical conditions. The preventive sector is often overlooked in times of crisis, which makes the situation worse.
Research studies play a major role in primary care as the findings can be used for the betterment of public health-related issues. But, such studies have become challenging due to inadequate public participation that affects the data collection, and insufficient funding to carry out research. When the healthcare system is in crisis, clinical medicine will receive more attention than research. Further, most doctors also shift their attention away from research.
Despite the challenges outlined above, Sri Lanka’s one of effective Family Health Care Centre was established in the newly built maternity block of the District Hospital, Kondavil, with the full support of the hospital’s District Medical Officer (DMO) and the Regional Director of Health Services (RDHS), Jaffna. The authors created the basic structural drawings and the final plan was agreed, after several discussions with the authorities of both Provincial Ministries of Health and academics of the Faculty of Medicine, University of Jaffna, in 2012. The centre is an extended arm of the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna.
The centre welcomed young, unemployed family members, who had ceased their formal education after the secondary level. Job titles were created, based on their identified areas of interest. The job training provided, helped in capacity building, as well as social recognition. These trained community members play a variety of roles in the delivery of FHC services as noted below.
Community health assistant in home-based geriatric care:
Home-based geriatric care is one of the services provided by the Family Health Centre, Kondavil, for patients who are unable to visit the hospital for various reasons, such as elderly or bedridden conditions. Young women, introduced by patient forums, were trained to register the chosen elders for home care, locate the homes, schedule monthly visits, indicate drug delivery dates, and maintain the home-visit bag and equipment in a calibrated manner.