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By Fathima Riznaz Hafi
Sri Lanka is hosting the 69th session of the World Health Organisation South-East Asia Regional Committee from 5-9 September.
By serving as the host country for the five-day event, Sri Lanka can reap immense benefits for its health sector. This will be the ideal platform where health officials can share their experience in addressing developments in national health issues. Attention can be drawn to the country’s accomplishments in the health sector which includes successfully achieving MDGs. Furthermore, modalities can be worked out to enhance collaboration between health ministers.
The Regional Committee, which consists of 11 member countries – Bangladesh, Bhutan, India, Indonesia, Myanmar, Thailand, Sri Lanka, the Maldives, Korea, Timor-Leste and Nepal, was established in 1948 with a view to respond to health issues in the region.
“Annually ministers of health from the 11 member countries come together to discuss health issues which are vital for the region and decisions are made. It is a crucial meeting where decisions made are regarded with the highest priority. This is the highest governing body of the South East Asian region as far as health is concerned,” said Ministry of Health, Nutrition and Indigenous Medicine Director General of Health Services Dr. Palitha Mahipala.
He was speaking at a media workshop which was held on 31 August to enhance the media’s understanding of the importance of the upcoming meeting.
The workshop organised by WHO included briefing on health topics of national significance and highlights on the main topics that will be discussed at the high-level meeting. Discussions on non-communicable diseases, Anti-Microbial Resistance (AMR) and the vast progress in Sustainable Development Goals will be the key agenda at the meeting.
“This meeting is very important for Sri Lanka. The health system here has evolved over the years and we have done wonderfully well in certain aspects. If you take the immunisation program in Sri Lanka it is recognised internationally as the finest immunisation program in the world, which has 100% coverage. No other country in the world has so much coverage when it comes to immunisation,” he said.
“With the immunisation programs we have we were able to eradicate most of the communicable diseases. Polio has been eliminated in Sri Lanka; no cases of polio have been reported since 1993, no neo natal tetanus cases from 1994, no diphtheria cases from 1994, measles are close to elimination and so are rabies and rubella. We are going for elimination of many diseases which are important for other countries as well and Sri Lanka can highlight this at the meeting.
“We have a few other achievements: We have eliminated filariasis and we got the regional certification from WHO last month. There have been no cases of malaria from October 2010 in Sri Lanka and three years have been completed without any indigenous malaria cases. Therefore we are going to receive the malaria elimination certificate during the meeting, hopefully.
“There are three evaluation teams, coming to evaluate our systems, surveillance, recordings and everything. They were extremely happy that we have a robust system in Sri Lanka. In communicable diseases we have done wonderfully well and have so much to be highlighted in the Regional Committee; it will be very useful for the other countries to learn how he have done it and the ministers of health and delegation who are coming can take that message back. In Sri Lanka we spend low per capita income on health but still the achievement is remarkable. We also focus strongly on areas of MCH (Maternal and Child Health).
“The model we use – the primary healthcare model is a very important model for other countries to follow; recently we had teams coming from Bhutan, Nepal, Bangladesh and Timor-Leste to study our primary healthcare system. WHO introduced the primary healthcare to the world in 1978 but Sri Lanka had started primary healthcare way back in the 1920s. Sri Lanka is a country that talks so much about primary healthcare. Our healthcare system has gone beyond most of the healthcare institutions. We go to the doorstep of the people. We can highlight all this at the Regional Committee.”
“Over the years our economic transition has improved and people are more literate – we call it digital revolution that took place in Sri Lanka and globally and because of that people have more information about diseases. Their demand is high now and the economy has also improved so the health system demands for more and more. However now a new disease has been coming up and that is Non-Communicable Diseases (NCDs) and they are on the rise,” he said.
Non Communicable Diseases
NCDs include heart disease, diabetes, chronic obstructive airway disease and cancer and WHO has predicted that by 2020 the number of deaths due to cancer will be more than the number of deaths due to heart disease.
“Today globally 38 million people die due to NCDs and 422 million cases of diabetes are reported. This is a huge disease burden and in Sri Lanka too we are highly burdened by NCDs. 70% of deaths are due to NCDs. This is the biggest challenge we are facing and to respond to that many policy decisions have been taken by our Cabinet of Ministers of the Government of Sri Lanka,” Dr. Mahipala noted.
“To deal with this, way back in 1994 we had identified that we should have a directorate. When I went through the response by many countries they were still suggesting that there should be a directorate or focal point at the Ministry of Health to respond to NCD – that is where many countries are. But Sri Lanka identified a directorate and appointed a director of NCD way back in 1998 which is a policy decision in the right direction. Today we have an NCD bureau with the deputy director general at the highest level because we need to deal with this disease.”
Healthy Lifestyle Centres
Over the last few years Healthy Lifestyle Centres have been established – these are not for patients. For the first time in the Sri Lankan health system’s history centres have been opened in hospitals for the general public to get themselves screened.
BMI is calculated and blood pressure, blood sugar and cholesterol are checked. If they have a disease they are directed to the relevant treatment and if they are at risk the centre works on that; for example if they smoke they are started on the cessation of smoking; if it is hypertension that is approached accordingly.
The centre tries to improve their lifestyles, by changing their diet pattern, increasing physical activity and urging them to eat healthy, with more vegetables, less salt and less sugar. He warned that Sri Lankans consume excess quantities of sugar and salt. The transition of lifestyles is therefore being introduced in these centres.
Well Women Clinics
906 centres called Well Women Clinics have also been established for the screening of cervical cancer and breast cancer. Apart from that blood glucose, blood pressure and BMI are checked and they are going to introduce cholesterol checks.
A decision has been taken to combine these two together – the healthy lifestyle centres and the healthy women clinic; so roughly there are 2,000 sub-centres, which can screen for NCD. Nowhere in the region is there such a system. Many regional countries need to study this, he says.
During the fourth day the delegations and ministers will be taken to central points and will be shown some of our healthy lifestyle centres so they can see how it is being run and start practising it in their countries. “This is also one of the highlights at the upcoming meeting. We want to expose them to what we are doing. They need to know and they want to know,” he said.
Also to be discussed at the meeting will be tobacco, which he warned, is predicted to kill one billion people in this century. He mentioned the methods that have been used to tackle this problem, such as pictorial warning, and said an increase in taxation to reduce tobacco consumption would be suggested. Similar methods will be recommended for alcohol.
Resistance Anti-Microbial Resistance (AMR) is another topic that will be tackled at the meeting and he added that they have set up a national committee, with round table conferences to tackle many of these issues.
Reiterating that the Sri Lankan system has done a lot he added that this does not mean that we can be complacent as we still have many challenges. “We can learn from other countries as well. This meeting will be a platform for the Ministry of Health, the Government of Sri Lanka and the citizens of this country and the media to highlight our achievements so that other countries can learn and also at the same time we can learn from certain other countries where they are doing well so that globally health systems will be improved and citizens will have a better future,” he said.
Also speaking at the workshop was WHO Country Office Sri Lanka National Consultant on NCDs Professor Nalika Gunawardena, who spoke in greater detail on Non-Communicable Diseases in Sri Lanka. Explaining that NCDs are chronic, non-contagious diseases that are caused by unhealthy lifestyles and account for 70% of the deaths in Sri Lanka, she urged changes to one’s lifestyle in order to prevent the disease.
Unhealthy lifestyles, which include bad eating habits, physical inactivity, tobacco and alcohol use are the contributing factors to the disease while the dangers faced by people who ignore the risks are fatal as they result in heart diseases, high blood pressure, stroke, diabetes, cancer and chronic lung disease such as asthma.
Suggesting lifestyle changes that can make a difference, she said: “Carrying out 150 minutes of moderate activity (brisk walking) per week would suffice to be categorised as physically active. Similarly reducing the salt and sugar intake would make a noteworthy difference in curbing high blood pressure and diabetes. She added that the intake of fruit and vegetable is too low with 73.1% of males and 72% of females consuming less than the recommended five fruit or vegetable servings per day.
Innovative methods in Sri Lanka to address the problem
“There are ample opportunities to make physical exercises an integral part of the daily routine, with public parks and community gymnasiums easily accessible. As an initiative from the Ministry of Sports, free services of sports officers are offered for physical activity sessions,” she said.
She also urged the utilisation of the Healthy Lifestyle Clinics as there is much benefit to be derived from them, adding that 780 clinics were located in hospitals all over the country, with no appointments or referrals needed and NCD screening was free.
“Sri Lanka is the first country in the region to adopt a Framework Convention of Tobacco Control with pictorial warning issued, smoking in public enclosed areas prohibited, advertising, sponsorships and promotions banned and sales to persons under 21 years prohibited.”
Finally she invoked the cooperation of the media to educate the public on risk factor reduction, promote the use of screening services and urged them not to support direct or indirect advertising of risk behaviours (such as celebrities smoking and drinking).
Speaking on public health successes in Sri Lanka was WHO National Professional Officer for Communicable Diseases Dr. Janakan Navaratnasingam.
“Sri Lanka has invested in a robust public health system ensuring free access to health services for the entire population. We have spent less money on health than other countries but achieved far more. Some of the greatest public health success stories come from communicable diseases,” he said.
Noting that most communicable diseases are preventable or treatable, he suggested that we address communicable diseases through ‘control’ (whereby we bring down the disease burden), ‘elimination’ (with interruption of transmission of disease) and ‘eradication’ (termination of all transmission of infection, with zero cases e.g. small pox).
Sri Lanka’s success against communicable disease
“Tremendous success has been reflected by rapidly falling morbidity and mortality. We achieved smallpox eradication in 1972 (it was globally eradicated in 1979), diphtheria eliminated in 1991, polio eradication in 1993, leprosy elimination in 1995, neonatal tetanus elimination in 2009, lymphatic filariasis elimination in 2016, and are now vying for certification for malaria elimination. The country remains free of emerging diseases such as the Ebola Virus Disease, MERS-CoV and Zika,” he said.
High literacy rate especially among females, sanitation, water supply, a wide network of health services e.g. preventive and curative services and a strong immunisation program with very high coverage island-wide were the factors that contributed towards this success, he added.
Finally he urged the public to follow the guidelines below:
It is hoped that with the guidance of health experts from Sri Lanka as well as other member countries, success stories such as ours can be shared and followed, health issues will be dealt with and favourable solutions delivered during the highly anticipated WHO Regional Committee for South East Asia.
Health Ministers of the 11 Member countries of WHO South-East Asia Region are meeting in Colombo, Sri Lanka, from 5-9 September to set health priorities for the region, home to nearly a quarter of the world’s population.
Noncommunicable diseases such as cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, which kill nearly 8.5 million people every year and are the leading cause of deaths in the Region, will be a key agenda at the sixty-ninth WHO Regional Committee meeting, the highest policymaking body of WHO in the Region, being hosted by Sri Lanka.
Accelerating improvements in health in the era of Sustainable Development Goals, with the focus on the most vulnerable, will be another key agenda of the meeting.
Prime Minister Ranil Wickremesinghe, will inaugurate the meeting. WHO Director GeneralDr. Margaret Chan, WHO South-East Asia Regional DirectorDr. PoonamKhetrapal Singh, other WHO experts and senior officials from health ministries of member countries will be participating in the meeting.
With the region having eliminated maternal and neonatal tetanus and individual countries witnessing major wins such as elimination of mother-to-child transmission of HIV and syphilis by Thailand despite an ongoing HIV epidemic; elimination of lymphatic filariasis by Maldives and Sri Lanka; yaws by India; and malaria by Maldives; there will be a greater push for time-bound elimination of diseases.
Tackling Anti-Microbial Resistance (AMR) as a priority with a multi-sectoral approach involving food, agriculture and animal sectors, in addition to the health sector, will be deliberated at the meeting.
Ending preventable maternal and child mortality, addressing the double burden of malnutrition and health of migrant populations will also be discussed and focussed upon at the meeting.
WHO’s recent emergency reforms and further strengthening of core capacities by countries under the International Health Regulations for responding to health emergencies will be other key areas to be discussed and emphasised upon.
The Regional Committee meets annually and is hosted by one of the 11 Member countries of WHO South-East Asia Region.
WHO’s South-East Asia Region comprises the following 11 Member States: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.
