Maternal and Child and Family Planning Services in Sri Lanka.
- Reported, May 25, 2013
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 Women’s 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 women’s 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
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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