Sri Lanka’s low-cost people-centred approach to health challenges
Geethani Priyardarshi was on the bus in her home town in Sri Lanka when she had a chance meeting that may have saved her years of ill health. A fellow passenger, who is a public health midwife, suggested that Geethani, 37, have a check-up to see if she was at risk of developing a noncommunicable disease (NCD).
Luckily for Geethani, she lives close to the Digampitiya Healthy Lifestyle Centre in Kurunegala district, North Western Province, that focuses on detecting, treating and preventing NCDs.
These diseases, which include heart disease, stroke, cancer, diabetes, and respiratory disease, now account for 65% of all deaths in Sri Lanka and are a significant factor in escalating health-care costs. “Within a generation, Sri Lankans have moved from an agrarian culture to a more sedentary urban lifestyle, and yet they are still eating large quantities of white rice, with the expected rise in obesity, diabetes and other lifestyle-related conditions,” says Dr F R Mehta, WHO Representative to Sri Lanka.
Healthy lifestyle centres
“Within a generation, Sri Lankans have moved from an agrarian culture to a more sedentary urban lifestyle, and yet they are still eating large quantities of white rice, with the expected rise in obesity, diabetes and other lifestyle-related conditions,”
Dr F R Mehta, WHO Representative to Sri Lanka
In response, the country has, since 2011, used its extensive network of clinics and hospitals to set up 700 healthy lifestyle centres. Primary care health workers have been retrained to give nutrition and lifestyle counselling, resulting in a more integrated, people-centred and economical approach to health care and promotion. Midwives, for example, use routine home visits as an opportunity to encourage family members to be screened.
The establishment of healthy lifestyle centres drew on lessons from three pilot projects that were supported by WHO, Japan’s International Cooperation Agency (JICA), the World Bank and professional medical colleges. WHO supported training run by the colleges to educate health workers in using the WHO Package of Essential Noncommunicable Disease Interventions to detect, manage and treat NCDs. The Organization also provided funding for island-wide training of medical officers.
It is essential to communicate lifestyle and health messages in ways that people can understand and act on. Dr Mehta says: “Through the community centre approach, families are given information on increasing physical activity and healthy diet, such as switching to smaller quantities of red rice, and are given recipe booklets that use local ingredients and cooking styles. This is an example of what is possible in a country that has effectively achieved Universal Health Coverage.” In Sri Lanka, all citizens have access and a right to affordable quality health care, making the introduction of necessary new approaches feasible.
Health messages to community groups
In Batticaloa, in Eastern Province, medical officers are using already established networks of community groups to inform people about NCDs. After attending a talk on healthy diet, Komathy Amarasingam, 33, from the Women’s Rural Development Society, said she would pass on to women in her community what she learned.
“One key lesson is the importance of getting your Body Mass Index checked and being screened,” she said. “Many women don’t know about the link between obesity and lifestyle. Personally, I am going to do more meditation and physical activity, perhaps cycling.”
The busy waiting room at the Digampitiya centre is a sign that the health message is working. But Anura Jayasinghe, 43, is a rare male face. He brought his wife for screening but he has no plans to be screened himself. Mr Jayasinghe says he feels fine, and anyway, he can’t take time off from work.
His response illustrates a major challenge for Sri Lanka’s NCD screening programme. Men are more at risk of NCDs, due to increased smoking prevalence, low physical activity and fruit and vegetable consumption, and high BMI. But they are less likely to attend screening centres, so check-ups are also taking place at workplaces and in public locations, including banks and railway stations.
More needs to be done in prevention, health promotion and to address inequities in the health system, health experts say, but Sri Lanka has embarked on a timely journey to tackle NCDs.
Such community-based measures are examples of cost-effective and evidence-based interventions recommended by WHO and its "Global action plan for the prevention and control of NCDs 2013-2020".