Abstracts of oral and poster presentations of the 1st South East Asia Regional Group Meeting of the International Epidemiological Association and 24th Annual Academic Session of the College of Community Physicians of Sri Lanka 2019

Ruwan Ferdinando
2019 Journal of the College of Community Physicians of Sri Lanka  
Out-of-pocket-expenditure (OOPE) is rising and currently, remains at 51% (2016) of the current health expenditure of the country. High out-of-pocket expenses for healthcare have been shown to impede seeking healthcare, health status and quality of life. It can drive families towards impoverishment and threaten equity in healthcare. An effectively conducted Root-cause-analysis (RCA) could help to identify determinants of inefficient healthcare performance leading to high OOPE. Aims: To identify
more » ... eterminants of high out-of-pocket expenditure for modifiable and impactful policy options Methods: A root-cause-analysis (RCA) was conducted to obtain a deep insight into high OOPE as it would help policy-makers know the origin of the question through which prioritization of the modifiable causes can be undertaken. Extensive literature search and exploration of available data and statistics i.e. Household Income and Expenditure data (HIES), Global Health Expenditure Database (GHED) and brain storming were utilized to identify the root causes. Later the root-causes were grouped into categories. The identified root causes were then categorized using the "TPN system" (TPN: totally, partially and nonmodifiable). The root-causes that would have the greatest impact once modified were identified, based on evidence, expert opinions from economists, public health specialists, healthcare financing specialists, and model based economic evaluation using available data. This analysis identified the most modifiable, impactful causal factors for "high OOPE amongst patients with NCDs". Thereafter feasibility of the proposed option/s was considered from both political and operational perspectives. Results: Four main categories of underlying root causes that are related to government service provision leading to high OOPE amongst patients with NCDs were identified. When prioritized by TPN, they were as follows: 1. Improving the timely availability of drugs and laboratory services 2. Extending after-hour government laboratory, pharmacy, and clinic services 3. Implementation of Electronic-Health-Record (EHR) for continuity of care. The approximate cost of implementing EHR is Rs. 23 billion and it has a relatively high feasibility as the most cost-effective strategy to reduce 30% OOPE. Conclusion: Out of the key determinants identified Electronic-Health-Record system as the most cost-effective and feasible policy option through which OOPE can be reduced. Background: Although Sri Lanka has a well-established primary health-care system, which screens the vision of school children of grades one, four seven and ten, the burden of refractive errors implies that further provoking into the issue is needed to identify and rectify causative situations. Aims: This study determined the barriers for seeking health care related to refractive errors among children aged 5-15 years attending state schools in the Colombo district. 1 st South East Asia Regional Group Meeting of the International Epidemiological Association FREE PAPER SESSION 1 education sector in supporting the screening and treating of refractive error. The themes that emerged from the medical officers of health were related to reduced quality of the screening and follow up of children with refractive errors, poor parental support, lack of monitoring and evaluation of the screening programme and the necessity for the revision of cadre positions of medical officers and the lack of inservice training programmes for Medical Officers of Health. Conclusions & Recommendations: Barriers identified within the existing system of services related to refractive errors should be rectified by incorporating these changes into the school health programme in order to effectively treat children with refractive errors.
doi:10.4038/jccpsl.v25i3.8229 fatcat:iibkho6xsvdnhatguw36edlyaa