Holistic approach for healthcare system

The remarks by President Anura Kumara Dissanayake that people should stop unnecessary hospital visits have drawn criticism, but also alarm from those for whom regular hospital visits are a must on their monthly calendar. The President’s remarks were made in reference to Government plans to introduce a new primary healthcare-based system under which patients would no longer be able to independently choose which hospital or specialist to visit for every medical condition. Instead, they would first be directed to a primary-care doctor, who would assess their condition and refer them to a higher-level facility when necessary.

The Government plans to establish 1,000 new “Arogya” centres across the country as part of the initiative; these centres will serve as the first point of contact for families seeking medical care. The system would help ensure that patients receive appropriate treatment at the right level of care, while reducing unnecessary visits to major hospitals.

The President must be aware that he would be touching a raw nerve by making such a suggestion. The free healthcare system in the country is a lifeline for millions, and the public at large depend heavily on the services of State-run hospitals for their medical needs. The monthly or once-in-two-or-three-month ‘clinic’ visits are a must for many. In addition to this, the Outpatient Departments (OPDs) in main hospitals are full of patients who come largely to get the necessary medical attention, bypassing the primary medical facilities closer to their homes.

The main reason people prefer to get to a general or base hospital is because they are assured of being seen by a doctor or even a specialist, depending on their conditions. At the available primary health facilities, the basic facilities are lacking, hence forcing people to get to a district hospital.

The President’s proposal may not be popular but is a good move which would benefit the public, as well as ensure that patients with more serious ailments get due attention, if the primary healthcare system can ensure that minor ailments are treated at that level.

But the issue is that, at present, the primary healthcare system is not good enough, and if such a system is to be implemented, the basics will have to be put right first.

In addition to this, the healthcare system faces other challenges. According to some studies done last year, it was found that Sri Lankans consume medicines at above-normal levels, with the health sector procuring pharmaceuticals under 863 generic categories — two-thirds imported and the rest locally manufactured — a volume that could be nearly halved through proper therapeutic guidelines, resulting in significant cost savings.

The reasons for over-prescription of medicine may have to do with the lack of clear prescription guidelines, but patients too seem keen to pop as many pills as possible, even for conditions which can be managed with diet and lifestyle change; but with a healthcare system that does not lay enough emphasis on such an approach, taking medicines seems the easiest way to overcome health issues.

There was a time when many people looked to alternative medicine such as Ayurveda to get treatment for a number of conditions. These are practices that must be encouraged to stop the high dependency on prescription medicine, which is not always the cure for all ailments.

There needs to be a holistic approach to healthcare in the country, and this should come with educating the public on a healthy lifestyle, proper diet, exercise, etc., so that the onset of age-related ailments is pushed back and the dependency on medicines is reduced.

A concerted public awareness campaign will go a long way in this regard, which will also help in reducing hospital visits among the population and lead to a more sustainable healthcare system.