Janaka Perera pegs the must-haves for an organised community health system

Good health is a prerequisite for a nation’s economic and social progress. Despite Sri Lanka achieving a relatively high health score, it continues to experience critical problems in many areas. And this is the primary reason for the need for an improved community healthcare system especially considering the challenges faced by poor and vulnerable communities.

During the time of the island’s ancient agricultural civilisation, people lived close to nature. The native physicians on whom they depended focussed primarily on prevention rather than cure. Virtually every villager was to some extent a physician since they knew about nutritious vegetables and fruits, and the curative power of herbs and spices.

The country was basically rural with no urban areas and townships as is the case today. In such an environment, our forefathers led their lives on the premise that one is largely his or her own doctor, and that the kitchen is the best hospital while food is the best medicine.

That the right food is good medicine was known by many people in the East including India and Sri Lanka long before it was in the West.

There are numerous similarities between Ayurveda dietetics and traditional foods – so much so that many of the latter may be called ‘health foods’ as they could prevent, reverse and even cure illnesses. In contrast, today’s junk foods are slowly but surely leading to sickness and obesity.

Deshabandu Dr. Publis Silva – who is the master chef at Mount Lavinia Hotel – is in his 80s and in good health. He stresses the need for people to become accustomed to traditional healthy food such as red rice, kurakkan and green gram, instead of processed foods and wheat flour products.

King Aggabodhi VII was renowned for his medical research. According to the Chulavamsa, the king “studied the medicinal plants over the entire island of Lanka to ascertain whether they were wholesome or harmful to the sick.”

All that research and knowledge almost ended with the dawn of the modern era, which changed medicine, methods of medical treatment and maintenance of healthcare services, in parallel with socioeconomic and industrial transformation.

Consequently, Sri Lanka and the rest of the world have undergone many changes although not all of them have been beneficial to society. Changing lifestyles and industrialisation have led to aggravated problems that were unheard of in the past. One example is the increasing number of young people who are falling victim to diabetes thanks to bad dietary habits.

Over 70 percent of the nation’s population is by and large rural but many citizens (and poorer segments in urban areas) lack access to proper healthcare under the changed conditions unlike during the precolonial period.

Today, the focus is more on curative medicines rather than preventative measures. The poor and even middle income groups whose main source of healthcare facilities is the public sector are increasingly pushed to the margins especially in the provinces – and into the clutches of the private sector. These people are at the mercy of the medicinal drug mafia.

Fast food consumption and living in polluted environments among other factors have increased health risks. As a result, more financial resources will be required to meet the rising demand for easily accessible and affordable quality healthcare.

Questions have been raised about the island’s healthcare system as a whole – i.e. both the public and private sectors – although the state and businesses have been rapidly building (as well as improving) infrastructure, services and human resources. This is a result of Sri Lanka’s transformation into a middle income country, which has led to both positive and negative outcomes.

As in other developing countries, Sri Lanka faces challenges in providing healthcare services and retaining a workforce to support it in remote rural areas.

Public service midwives have been an important part of Sri Lanka’s primary healthcare system since the early 20th century. Traditionally, these healthcare workers focussed only on midwifery but have now evolved into a professional cadre. They also play a vital role in family health especially in rural settings.

State backed community health worker (CHW) programmes have been introduced in a number of countries as part of their primary healthcare policies. Although CHWs are salaried or receive an honorarium under many of these programmes, they also work as unpaid volunteers in several such endeavours.

A better organised community healthcare system can play a critical role in developing a sustainable healthcare service by educating the public (from school level onwards) on wholesome diets and proper living, civic consciousness, social responsibilities that are vital to communal wellbeing and training in primary healthcare, as well as the enforcement of tighter regulations covering fast food advertising targeted at children.