Médecins du Monde and HDO release policy review on plantation sector healthcare delivery system

Médecins du Monde (MDM) and the Human Development Organisation (HDO) recently released a desk policy review on the healthcare delivery system in the plantation sector and the needed actions for improvement.

The launch was held at the residence of Ambassador of France in Sri Lanka and the Maldives Jean-Marin Schuh in the presence of National Co-Existence, Dialogue and Official Languages Minister Mano Ganeshan, Health, Nutrition and Indigenous Medicine Deputy Minister Faizal Cassim, civil society and academia. 

 
Sri Lanka maintains its high standards of health services and education with remarkable health and education indicators and is identified as a country comparable with the developed world. A low maternal mortality ratio, low infant mortality rate, high literacy rate and high life expectancy are some of the key achievements. 

While this is well recognized and appreciated, still women and young people in the plantation sector face significant barriers in accessing health services and specifically sexual and reproductive health and rights information and services, which create adverse effects on health and well-being of women and youth, violating some of their basic human rights.

MDM or Doctors of the World in English, is a French medical organisation working since 1980 to improve access to universal healthcare. MDM works in 44 countries across the globe and has been working in Sri Lanka since 2005. 

In 2015, MDM started a M€ 1 project co-funded by Agence Française de Développement (French Agency for Development, AFD). The AFD/MDM-co-sponsored intervention is implemented by the HDO, a local organisation working in the plantation sector in the Central Province of Sri Lanka and MDM is also actively working in the Northern Province. The HDO is a rights-based non-governmental organisation situated in the plantation promoting the rights of the plantation community since 1992.

 
Among other things by its action, the HDO contributed to granting of citizenship by the state of Sri Lanka to 265,000 plantation Tamil people in 2003. The overall objective of the work MDM is doing in Sri Lanka with the HDO is to improve awareness on sexual reproductive health mainly on knowledge about general SRH issues, service accessibility, availability, to reduce morbidity/mortality linked with STI, unwanted/early pregnancies and gender-based violence in the plantations, with a specific focus on women and youth. 

Following this, the HDO commissioned two technical experts to conduct a desk policy review to highlight the current health system in the estate sector, challenges and needed actions for improvement.

Healthcare provision and standards existing in the estate sector is very far distanced from the national healthcare system in Sri Lanka in terms of quality and benchmarks. The estate population is considered a marginalised group in Sri Lanka as they lag behind in areas such as housing, safe drinking water, nutrition, sanitation and education. 

It is a well-known fact that the economic contribution of the estate community is remarkable but their health needs remain unsatisfied compared to the urban and rural segments in the country. Twenty-five percent of population in the plantation live without any sanitary facilities (HHI and ES 2012/2013); 35.9 percent of children under-five (U5) are underweight and the poverty headcount ratio in the estate sector is 10.9 percent vs. 2.1 percent from urban and 7.6 percent from rural areas. 

There is also a higher incidence of home deliveries (2.2 percent) in the estate sector compared to zero percent in urban and 0.5 percent in rural areas (DHS 2006). This has created many socio-economic problems in the estate sector affecting the health of the children, adolescents and women in particular and men. Reproductive health services are reaching the estate population on par with the national population. However, knowledge on sexual and reproductive health and its service provision among the women and youth are low in the estate sector compared to the rural and urban sectors. Lack of regular mechanism to deliver these services in the estate sector and lack of sexuality education in schools that contributes to low level of SRH knowledge specially for unmarried young people, are highlighted in the review. 

The desk policy review identified problematic areas existing in the healthcare delivery system in the estate sector with recommendations to the government and/or the relevant stakeholders directly associated with the health of the estate community. The full integration of the estate health sector into the government system is the main solution identified along with the improvement of education, housing and infrastructure development inside the estates.

Presently, preventive health services of the estate sector are under the provincial health authority but the curative sector is still not completely under the national health system: although the nationalization process of estate hospitals was initiated in the year 1996, there are numerous factors delaying the process 
of nationalization.