Sri Lanka economic crises health reforms

Health service delivery reforms during and after economic crisis

Sri Lanka is facing its most profound economic and financial crisis since independence. The economic crisis has compounded health system pressures arising from the COVID-19 pandemic, leading to reduced provision of public services, increased unmet need, growing out-of-pocket expenditure, and increased risk of catastrophic health expenditure and impoverishment.

Health system reforms to restore essential service provision will require judicious use of scarce resources. Past economic shocks and recoveries may offer important lessons and opportunities for reform. We conducted a rapid review of grey and empirical literature from four countries – Indonesia, Thailand, Vietnam and Greece – to identify health service delivery reforms implemented to improve health system efficiency and support universal health coverage in the context of economic shocks. This rapid evidence synthesis was commissioned by the World Health Organization (WHO) Sri Lanka office to appraise existing evidence on health system efficiency interventions taken by countries in the context of an economic crisis.

The country case studies highlight a process of reforms over many years, some of which can be directly attributed to crisis events, but the majority were independent of specific crises. Nonetheless, all countries took actions during their respective crises which have had enduring impacts on the resilience of their health systems to future shocks, including the COVID-19 pandemic.

The findings from each case study suggest that a ‘long-haul’ perspective on health reform is needed to build health system resilience – defined as the ability to prepare for, manage (absorb, adapt and transform) and learn from economic shocks.

The full report has been developed with more extensive summaries of the inputs received, available here.

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Policy Papers - 12/04/2023

Rapid evidence review and country case study analysis

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Media release

High blood pressure, also known as hypertension, is a huge global health challenge. Over the last 30 years, the number of people with hypertension has doubled, and around a third of adults aged 30-79 have the condition - 1.28 billion people worldwide. Untreated hypertension can lead to kidney disease, heart disease, and stroke, accounting for 11.3 million deaths in 2021 alone.

New funding to improve lives of young people in India and Fiji by addressing non-communicable disease risk factors

New funding to improve lives of young people in India and Fiji by addressing non-communicable disease risk factors

George Institute researchers have secured funding totalling over three million dollars (Australian) to improve the health and wellbeing of adolescents living in slums in India and school children in Fiji. The funds will be split across two research projects, led by Prof David Peiris and Dr Bindu Patel respectively.

The funding has been awarded by The Global Alliance for Chronic Diseases (GACD), which brings together national and international funding agencies to address non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) and vulnerable populations in high-income countries (HICs). It focuses on implementation research that takes a life course approach to preventing and reducing common NCD risk factors.

Australia’s National Health and Medical Research Council (NHMRC) is one of the funding agencies in the GACD.

Building resilience in urban slums

Prof David Peiris, Director of the Institute’s Better Care Program, and Prof Pallab K. Maulik, Deputy Director in the George Institute India will lead a multidisciplinary research consortium from India and Australia to implement a life-skills program for young people living in Indian urban slums.

The project, named ANUMATI - which means ‘consent or permission to do something’ in Hindi - will involve older adolescents (15-19 years) with or at high risk of depression living in New Delhi and Hyderabad. It will include a 16-week education program delivered by trained facilitators and a peer-led social media program. The project aims to reduce depression symptoms, and other non-communicable disease (NCD) risk factors like smoking, alcohol consumption, and substance abuse and to test whether low-cost social media programs perform as well as in-person education programs.

Prof Peiris says, “With the ANUMATI implementation study, we are widening our focus from health care sector specific interventions to community-based approaches to enhance young people’s resilience. We have seen these approaches work in different parts of the world and hope to apply those learnings to improve the wellbeing of young people living in challenging environments such as slums.”

The four-year project begins in October 2023.

Preventing disease through health promotion in schools

Dr Bindu Patel, Senior Research Fellow in the Health Systems Science team at The George Institute, has secured funding to assess the effectiveness of Health Promoting Schools (HPS), a national government-supported program in Fiji. Launched in 2016 by Ministry of Education, Heritage and Arts (MEHA) and Ministry of Health and Medical Services (MHMS), HPS is a cross-sector program delivered through the school curriculum to improve health and wellbeing by addressing common risk factors for NCDs.

The goal of this research project is to evaluate the impact of the program so far and assess the value in scaling it up in Fiji. It will be conducted in partnership with MEHA, MHMS, and Fiji National University.

Explaining the potential impact of this work, Dr Patel says “Effective and sustainable systems level changes can only be made through multi-sectoral approach to health promotion, and continuous information gathering and feedback to adapt interventions. Our evaluation will inform HPS implementation strategies to optimise health, educational and social outcomes for different groups across the Fijian community.”

The project will start in July 2023 and run over a period of five years.

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Further reading

SMART Mental Health

Triumph over Mental Illness: Suresh’s Journey with SMART Mental Health Initiative

Suresh’s life was filled with pain, suffering, and despair. His world had come crashing down when he lost his first wife to a tragic accident, leaving him alone to deal with his demons into a sea of alcohol and rage. His family became the target of his uncontrollable anger, and he refused any help from anyone, even those who cared for him.

When ASHA workers tried to help him, Suresh walls were impenetrable. He shut himself off from the world, refusing to meet with them, even as they pleaded with him to seek medical attention.

It was only when Indu, a Field Investigator from The George Institute India and Geeta, a Alawalpur PHC Asha worker joined their efforts that he finally relented. But even then, he refused to seek medical help, despite being at a high risk of severe health complications.

“We repeatedly visited his house to convince him to take the screening test just once, and after repeated attempts, we succeeded!” narrates, who is one of the hundreds of ASHA workers who have undergone training to assess depression, anxiety, suicide risk, and screen community members for common mental disorders in rural India under The George Institute India’s flagship initiative - the SMART Mental Health Programme.

Their training helped them pierce Suresh's mental barriers and propelled him to come out of his shell. Dr. Pranjali, (Medical Officer in-charge of PHC) compassion and counseling too were like a ray of hope in darkness. He finally found the strength to seek the help he so desperately needed. With her prescription and advice, he not only received medical treatment but also found a new purpose in life - buffalo milk business.

 

SMART Mental Health Initiative

SMART Mental Health was started to help adults with Common Mental Disorders (CMDs) like depression, anxiety, and suicidal thoughts. The program aims to improve the way these disorders are managed and treated so that more people can get better. They do this by running big campaigns in the community to reduce the stigma around mental health and using a special mobile device tool (SMART Health) to help doctors make better treatment decisions. The program is helping to improve mental health in a community where many people need help.

Designed to use in rural areas with low resources, SMART Mental Health has now successfully trained a total of 460 ASHAs to assess for depression, anxiety, and suicide risk, and screened 170,000 community members residing in rural Haryana and Andhra Pradesh for such CMDs.

Today, Suresh is a different person. Filled with joy and hope, he no longer lashes out at his loved ones and instead treats them with the kindness they deserve - thanks to the love and care of the people who never gave up on him.

However, there are millions who need help in dealing with mental illnesses. Despite 150 million people living with mental disorders, mental health care faces significant challenges. Only 25 out of 100 people receive it, hindered by a lack of professionals, quality care, social stigma, and limited access, especially in rural areas.

“What we have on mental health is some government trainings in some distant centers - which we sometimes attend, sometimes cannot.”, informed Dr.Pranjali.

Despite the scarce time, Dr. Pranjali insisted on saying, "More such initiatives like SMART Mental Health should grow. Its usability is so easy that any health worker can diagnose mental health patients, needless of having a specialisation"

“All’s well if it ends well!”, exclaims Suresh - once a patient of severe anxiety and depression, now an ambassador of the SMART Mental Health initiative, encouraging others to shun stigma and believe in mental health.

31/03/2023
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