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Preparatory Survey for the Project for Improvement of Basic Social Services Targeting Emerging Regions

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Democratic Socialist Republic of Sri Lanka Ministry of Health PREPARATORY SURVEY FOR THE PROJECT FOR IMPROVEMENT OF BASIC SOCIAL SERVICES TARGETING EMERGING REGIONS FINAL REPORT JANUARY 2012 JAPAN INTERNATIONAL COOPERATION AGENCY (JICA) GLOBAL LINK MANAGEMENT, INC. INTEM CONSULTING, INC. SAD JR(.) 12-003 The following foreign exchange rates are applied in the study (as of December 2011) USD 1 = 76.8 JPY LKR 1 = 0.7 JPY Location Map Galgamuwa BHB Kaluwachikudy BHB Teldeniya BHB Warakapola BHB SPMC State Pharmaceutical Manufacturing Corporation (SPMC) Front view of SPMC Tablet compression machine Film coating machine Filling, capping and labeling line BH Teldeniya Front view of the Hospital Clinical laboratory BH Galgamuwa Front view of the Hospital X‐ray room Hematology analyzer and biochemistry analyzer Ward BH Kaluwanchikudy Front view of the Hospital PCU/ECU BH Warakapola Front view of the Hospital New x‐ray unit before installation Ultrasound scanner Clinical laboratory Ambulance Ambulance Interior of ambulance Abbreviations AMO Assistant Medical Officer BES Biomedical Engineering Services BH Base Hospital BHA, BHB Base Hospital type A, Base Hospital type B bn Billion BOR Bed Occupancy Rate BP British Pharmacopoeia B/S Balance Sheet BTMU Bank of Tokyo Mitsubishi UFJ C Central Province CBG Criteria Based Grant CBSL Central Bank of Sri Lanka CD Central Dispensary CEB Ceylon Electricity Board CSSD Central Sterile Supply Department CTG Cardiotocography CVD Cardio‐vascular diseases DBH District Base Hospital DG Director General DGH District General Hospital DH District Hospital DM Diabetes mellitus DRA Drug Regulatory Authority E Eastern Province ECG Electrocardiography ECU Emergency Care Unit ENT Ear, Nose and Throat ERD External Resource Development EU European Union FC Finance Commission FCP Foreign Currency Portion GBV Gender‐based violence GDP Gross Domestic Product GFATM Global Fund to fight AIDS, Tuberculosis and Malaria GMP Good Manufacturing Practices GoSL Government of Sri Lanka HIMS Health Information Management System HLC Healthy Lifestyle Centre(s) HMP Health Master Plan HPLC High Performance Liquid Chromatography HRH Human Resources for Health HSDP Health Sector Development Programme ICB International Competitive Bidding ICU Intensive Care Unit IDP Internally‐displaced people IHD Ischemic Heart Disease IMMR Indoor Mortality and Morbidity Return IMR Infant Mortality Rate JFY Japanese Fiscal Year JICA Japan International Cooperation Agency JPY Japanese Yen LCB Local Competitive Bidding LCP Local Currency Portion LM Line Ministry MBBS Bachelor of Medicine & Bachelor of Surgery MCH Maternal and Child Health MDGs Millennium Development Goals MDPU Management Development & Planning Unit MH Maternity Home MICU Medical Intensive Care Unit MLT Medical Laboratory Technologist MMR Maternal Mortality Ratio MO Medical Officer MoFP Ministry of Finance and Planning MoH Ministry of Health MOH Medical Officer of Health, or Medical Office of Health MoH&IM Ministry of Health and Indigenous Medicine MSD Medical Supplies Division MSU Medical Statistics Unit N Northern Province NC North Central Province NCD Non‐Communicable Diseases NCE New Chemical Entity NDQAL National Drug Quality Assurance Laboratory NECORD North East Community Restoration and Development Project NHSL National Hospital of Sri Lanka NPD National Planning Department NPP NCD Prevention Project NW North Western Province Obgy Obstetrics and Gynaecology ODA Official Development Assistance OPD Outpatient Department OT Operation Theatre PBC Premature Baby Care PC Provincial Council PCU Primary Care Unit PDHS Provincial Director of Health Services PGH Provincial General Hospital PGIM Post Graduate Institute for Medicine PH Provincial Hospital PHI Public Health Inspector PHM Public Health Midwife PIU Project Implementation Unit P/L Profit/Loss Statement PMCU Primary Medical Care Units PMU Project Management Unit PQ Prequalification PSDG Provincial Specific Development Grant PSM Professions Supplementary to Medicine PU Peripheral Unit QCBS Quality‐Cost Based Selection RDHS Regional Director of Health Services RFP Request for Proposals RH Rural Hospital RMO Registered Medical Officer ROA Return on Asset ROE Return of Equity Sub Sabaragamuwa Province SAARC South Asian Association for Regional Cooperation SBCU Special Baby Care Unit SEC State Engineering Corporation SICU Surgical Intensive Care Unit SOE Statement of Expenditure Procedure SOEs State Owned Enterprises SPC State Pharmaceutical Corporation of Sri Lanka SPMC State Pharmaceutical Manufacturing Corporation of Sri Lanka STEP Special Term for Economic Partnership TB Tuberculosis TH Teaching Hospital TOD Treasury Operation Department ToR Terms of Reference TQM Total Quality Management UNFPA United Nations Population Funds UNICEF United Nations Children's Fund USD United States Dollars USP United States Pharmacopoeia VP Visiting Physician WB World Bank WHO World Health Organization WRCD Weekly Return on Communicable Diseases Table of Contents Location map Photographs Abbreviations CHAPTER 1 INTRODUCTION ........................................................................................................... 1 1.1 Sri Lanka: Economic Growth and Poverty Reduction................................................................. 1 1.2 Health Outlook of Sri Lanka ....................................................................................................... 2 1.3 Japanese Contributions to Improving Health Service Delivery in Sri Lanka ............................... 4 1.4 Major Donors Contributions to Improving Health Services in Sri Lanka .................................... 6 1.4.1 The World Bank (WB) ......................................................................................................... 7 1.4.2 The World Health Organization (WHO) ............................................................................. 8 1.4.3 United Nations Children’s Fund (UNICEF) .......................................................................... 9 1.4.4 Asian Development Bank (ADB) ......................................................................................... 9 1.5 Dialogue with the Government of Sri Lanka ............................................................................ 11 1.6 Policy Framework and the Rationale for the Project ............................................................... 12 1.6.1 “Mahinda Chintana” ........................................................................................................ 12 1.6.2 Health Master Plan .......................................................................................................... 13 1.6.3 The National Policy & Strategic Framework for Prevention and control of NCD ............ 13 1.6.4 National Medicinal Drug Policy (2005) ............................................................................ 14 1.7 Objectives, Schedule and Methodologies ................................................................................ 14 1.7.1 Survey objectives ............................................................................................................. 14 1.7.2 Survey schedule ............................................................................................................... 14 1.7.3 Survey areas ..................................................................................................................... 15 1.7.4 Survey methodology ........................................................................................................ 15 1.7.5 JICA study team members ............................................................................................... 15 CHAPTER 2 Health Service Delivery System ................................................................................. 16 2.1 Organization of Health Service Delivery .................................................................................. 16 2.1.1 Decentralised health administration ............................................................................... 16 2.1.2 Organisation of government curative care institutions ................................................... 18 2.1.3 Referrals ........................................................................................................................... 19 2.2 Public Health Expenditures ...................................................................................................... 20 2.2.1 National ............................................................................................................................ 20 2.2.2 Provincial .......................................................................................................................... 22 2.3 Human Resources .................................................................................................................... 24 2.3.1 Current availability of Human Resources for Health ....................................................... 24 2.3.2 Regional distribution of health personnel ....................................................................... 25 2.3.3 Deployment of HRH ......................................................................................................... 26 2.3.4 Production of major categories of HRH ........................................................................... 26 2.3.5 HRH policies and strategies .............................................................................................. 27 2.4 Essential Drugs and Common
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