Maternal and Child and Family Planning Services in Sri Lanka.
– Reported, May 25, 2013
The Family Health Bureau was made the central organisation of the Ministry of Health responsible for planning, co-ordination, direction monitoring and evaluation of the family health programme. The staff at the Family Health Bureau was strengthened to man five units, namely, Training, Health Education, Plantations, Supplies and Services and Evaluation and Research, initially.
Since the International Conference on Population and Development in Cairo in 1994, the concept of reproductive health (RH) has been introduced, addressing reproductive health issues of the adolescent and post adolescent even before they become mothers and also Womens reproductive health conditions even after menopause. A life cycle approach to family health care has been introduced. Some of the reproductive health issues that have received emphasis in the programme are RH problems in the adolescents, early identification of reproductive organ malignancies, prevention of reproductive tract infections including sexually transmitted diseases and HIV/AIDS, concept of womens empowerment and male involvement in RH activities.
In the implementation of the RH programme, the Family Health Bureau (FHB) play the central role maintaining a close collaboration with the National Cancer Control Programme (NCCP) and the National STD/AIDS Control Programme (NSACP). In this role, the FHB undertakes, in-service training of health personnel in RH; offers technical assistance in programme management and service delivery; conducts relevant health services research to support and strengthen service delivery; and monitors and evaluates programme performance. In addition, the Bureau is responsible for the procurement and distribution of contraceptives, equipment and other supplies needed for family planning and maternal and child health services.
In the delivery of RH services, the Ministry of Health continues to utilize its well-developed health infrastructure consisting of a network of medical institutions (larger, intermediate and smaller peripheral institutions) and Health Units. The latter are responsible for preventive and promotive aspects of health including domiciliary services in MCH and family planning.
The PHM is the front line health worker for providing domiciliary MCH/FP services in the community. Each PHM has a well-defined area consisting of a population ranging from 2000-4000. Through systematic home visits, she provides care to pregnant women, infants and pre-school children and family planning services including counselling and provision of contraceptive pills and condoms to couples in the reproductive age. She also provides necessary education and advice to adolescents on RH where needed and educates women on the importance of screening for reproductive organ malignancies thus motivating them to attend the Well Woman Clinics for necessary check-up. She also assist routinely at the area MCH/FP clinics which are conducted fortnightly, linking the community with the institutional health system. Her activities are supported by a system of record keeping which enables her to plan and monitor her routine activities.
The government of Sri Lanka is committed to provide a comprehensive system of health care to its people. Maternal and Child Health and Family Planning forms an important component of the prevailing health care system and is an integral part of the Primary Health Care service strategy. Maternal health, Child health and Family planning are closely integrated and the following services are provided through the well developed infrastructure of the Ministry of Health, which comprise a wide network of medical institutions and health units.
The Family Health programme covers a wide spectrum of services comprising:
Infant and Child care which provides for
Immunization against six common childhood diseases,
Monitoring growth and development
Psychosocial development of the child
Control of Diarrhoeal Diseases
Acute Respiratory infections
Nutrition of the pregnant mothers and children
Care of the School child
Appropriate maternal care is provided to all pregnant women during antenatal, intranatal and postnatal periods through the health care system.
Antenatal care is provided through a network of MCH clinics conducted in medical institutions and by Public Health personnel in the field. These clinics are usually conducted once a fortnight. In addition domiciliary care is provide by Public health Midwives through routine home visiting. Pregnant women are registered for antenatal care early and a Pregnancy Record is maintained to facilitate proper follow-up. High-risk mothers are identified and special care is provided through out pregnancy and delivery. A system of referral exists for cases that need special care.
As a routine all pregnant women are provided immunization with tetanus toxoid. This together with clean delivery practices has reduced the incidence of neo-natal tetanus dramatically enabling Sri Lanka to achieve elimination levels.
Births in government medical institutions have increased steadily during the past four decades. Easy access to institutional care and regular contact with the PHM appears to have influenced the choice in favour of institutional deliveries. Of the deliveries that take place in government institutions, almost 68% occur in larger hospitals where specialist services are available.
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