KeyNote Address - International Ergonomic Association Recife, Brazil 2012

Dear Kapila,

I join with all the leadership team of the IEA in congratulating you on achieving this prestigious invitation and delivering the inspiring story. It was a pleasure to be with you in Recife and to witness your presentation with international colleagues. They were so impressed by you and your achievements. It was a wonderful example of the proposed “Future of Ergonomics” challenge how you have engaged so successfully with  political and business stakeholders to take up the leadership to strive for adopting theergonomics interventions.

I just wished there were more in the room to hear thestory. It was a pity that the Program had four excellent keynotes all on at thesame time.

I am personally so proud to be part of your journey Kapila. Who would have thought 6 or 7 years ago when we started corresponding that you wouldbe one of the IEA 2012 Keynote speakers in Brazil with a paper to be publishedin the Journal Ergonomics?

Your personal drive and commitment is a wonderful testament of what makes a successful outcome. I look forward to witness your next achievements. I feel confident that there will be many more to come.

Best Wishes,

David Caple

Former President - IEA

The 18th World Congress on Ergonomics 2012

Designing a Sustainable Future

The 18th World Congress on Ergonomics will be held February 12-16, 2012, in Recife, Brazil.
The congress will be a joint conference with ULAERGO – the Union of Latin-American Ergonomics Societies and ABERGO – the Brazilian Ergonomics Association. ABERGO is the official host of the Congress.
The congress theme of “Designing a Sustainable Future”, expresses a current concern with the design of resources which aim to meet human needs while preserving the environment so that these needs can be met not only in the present but also in the future. As a discipline which is involved in the designing of the interactions among humans and other elements of a system, ergonomics must consider “sustainability” as a key aspect in optimizing resources to improve human well-being and overall system performance. So, one of the major challenges in the field of ergonomics for the 21st Century will be the design and management of systems that satisfy custom demands in terms of the requirements for human compatibility and at the same time consider sustainability.
http://www.iea2012.org/index.htm

Congress Program  http://www.iea2012.org/congressprogram.htm


Keynote Plenary Sessions

In the early evening there will be a choice of various keynote speakers, highlighting actual trends in ergonomics and related fields of expertise.

Each plenary session will last 60 minutes. There will be simultaneous translation from English to Portuguese.

Kapila Jayaratne

Consultant Community Physician,
Family Health Bureau, Ministry of Health, Sri Lanka




Short Bio:
Dr. Kapila Jayaratne is a medical doctor specialized in public health and child health. He holds master's and doctorate degrees in Community Medicine from the University of Colombo, Sri Lanka, and had the post-doctoral training at the University of Melbourne in Australia.
He currently directs the National Program of Maternal and Child Mortality and Morbidity Surveillance in the Family Health Bureau of the Ministry of Health of Sri Lanka. Dr. Jayaratne has authored several studies on ergonomic factors in the school environment and its influence on the health of school children. In these studies, he has looked at the problem of backpacks carried by children. He designed a healthy model of a backpack in accordance with ergonomic standards, which resulted in a national campaign to popularize and adopt this model in Sri Lanka from year 2011, which benefited nearly four million children.
Dr. Jayaratne initiated many knowledge transfer programs on ergonomics for children in both paper and electronic mass media. He also contributed to World Health Organization (WHO)’s Guidelines on Children’s Environmental Health Units.
Dr. Jayaratne is the coordinator of the National Healthy Schoolbag Campaign and also the chair person of the Working Committee on the Development of Standards for Schoolbags of Sri Lanka Standards Institute.


Keynote:
Inculcating the ergonomic culture in developing countries: National Healthy Schoolbag Initiative in Sri Lanka

Sri Lanka is an industrially-developing country boasting of better health indices that are on a par with industrially-developed countries. To optimize the compatibility between the user population and the operating environment, an ergonomic perspective is essential. School constitutes an important environment for the child where ‘productivity’ in terms of attainment of expected educational levels is of prime importance to the child, the family and the country as a whole.


A school-based cross-sectional study was conducted in a district in Sri Lanka to assess the situation with regard to ergonomic factors of the school educational environment and its influence on negative health outcomes among school children. A sample of 1607 school children of Grade 6, 7 and 8 were selected from 55 schools using a stratified multi-stage cluster sampling method.

The study revealed the need for major improvements in several ergonomic parameters within the classrooms. Observations included: the need to improve seating arrangements in relation to location of the blackboard and to make the chair and desk combination to be ergonomically optimal. It was noted that the students carried heavy bags in an unhealthy manner and that schoolbags were not ergonomically modeled.

Children perceived severe general tiredness and reported discomfort linked with carrying their schoolbag. Many children reported musculoskeletal pain with one third, suffering from recurrent pain. Ergonomic mismatches were identified as risk factors of recurrent musculoskeletal pain. A smaller proportion of children were found to have significant lateral deviation of the spine.

Research findings necessitated identification of priority areas and formulation of feasible solutions with the involvement of major stakeholders. Issues related to schoolbag were recognized as major concerns. Solutions were contemplated on: strategies for bag-weight reduction, introduction of a model healthy bag and “bag behaviour change”. Findings were disseminated through local mass media and at international forums to share and update good practice evidence. Advocacy of policy makers, ministers, administrative officers, health program managers and health care professionals of both health and education sectors, played a crucial role. The sharing of the research outcome and recommendations with the Ministry of Education (MoE) stimulated further research by MoE into exploring strategies to lighten the schoolbag. Text books were split into several volumes. The size of exercise books was limited to 80 pages. A healthy schoolbag was modeled by the principal investigator in accordance with ergonomic standards. The Sri Lanka Standards Institute was consulted on physical quality assurance. Bag manufacturers were registered and were educated on the criteria to be met in full in manufacturing a “healthy bag”.
A schoolbag regulatory committee was established to monitor implementation of the national healthy schoolbag campaign. Sample bags from bag manufacturers were evaluated by the regulatory committee and bags that complied with healthy standards were awarded a ‘healthy bag’ logo certified by Ministry of Education. Healthy school bags were introduced at national level at the commencement of the academic year 2011.
Children, parents and teachers were made knowledgeable through mass media, leaflets and at exhibitions on a healthy bag and bag behaviour. Nearly four million school children will be the beneficiaries of this project. In addition to promoting a healthy school environment for the child, this work attempted to inculcate an ergonomic culture in a country where industrial development is likely to take an important place in the development scenario.

Regional Workshop on Integrated Approaches to Prevent and Manage Pneumonia and Diarrhea for achievement of MDG 4 - Dhaka, Bangladesh 27-30 Sep 2011

Background: In the context of MDG4, resource-poor countries can accelerate their progress by implementing a framework for pneumonia and diarrhoea prevention and control which improves access to interventions of proven effectiveness across a continuum of -- addressing risk factors (protection) -- providing vaccination (prevention) --- and integrated case management (treatment) to children when they develop pneumonia or diarrhoea.


Purpose: The intent of the workshop was to catalyze the work of different programmes at country level to achieve maximum impact. The pneumonia and diarrhoea control strategies were used as a vehicle to increase the coverage of interventions within on-going, integrated approaches to child survival such as IMCI and primary health care.

The primary focus was on finding synergies among three interventions: exclusive breastfeeding, vaccination and integrated case management. However, countries are encouraged to include other interventions relevant to their specific situation, e.g. HIV, malaria, water and sanitation, and environment-related interventions.

The Sri Lanka delegation included; Dr. Kapila Jayaratne (National IMCI Manager), Dr, Virgini Mallawarachchi (Epidemiology Unit), Dr. Anoma Jayathilaka (WHO) and Dr. Supriya Warusavithana (WHO).

Situation Analysis of Pneumonia and diarrhoea in Sri Lanka was presented by Dr. Jayaratne and Country Action plan by Dr, Mallawarachchi.

Hon Minister of Health updated on National Healthy Schoolbag Campaign

Recently Hon Minister of Health, Mr. Maithripala Sirisena was updated on the progress of the National Healthy Schoolbag Campaign at Ministry of Health, Suwasiripaya.

Dr. Kapila Jayaratne described Hon minister of healthy features of the ergonomic bag and the implementation process of the campaign hand in hand with Ministry of Education.

Dr. Ravindra Ruberu, Secretary of Ministry of Health and Mr. Mervin Gunasena, Private Secretary to Minister of Health also participated at this occasion.

President's Secretary briefed on National Healthy Schoolbag Campaign

Mr. Lalith Weeratunga, Secretary to President of Sri Lanka, was briefed on the National Healthy Schoolbag Campaign.

Dr. Kapila Jayaratne described him the research work done in this regard and how the outcome of the study was translated in to practice. He explained the progress of the campaign at present and requested secretary to add momentum to this project which would improve the health of nearly 4 million school children in the country.

School bags - health issue

By Edward Arambewala

Daily News online edition: http://www.dailynews.lk/2011/01/10/fea29.asp

An epidemiological research was carried out in a representative district of Sri Lanka with the participation of 1,607 school children on Ergonomic factors in the educational environment and their influence on school-going early adolescents.

This was stated by Family Health Bureau Health Schoolbag project coordinator and Consultant community physician Dr Kapila Jayaratne when speaking to Daily News Health Watch.

Research findings

Many children experienced discomfort due to sub-standard seating arrangements in the classroom. A significant proportion had to turn their necks to see the blackboard. Seating locations were not changed for many children.

There is wide-spread incompatibilities of classroom furniture with anthropometric dimensions of children Majority of children perceived discomfort due to mismatched furniture There were gross deficiencies with regard to carrying school bags. Deficiencies were noted in weight, model, ergonomic features and the carrying behaviour.

Children experienced several negative effects, such as muscular-skeletal pain, attributable to mismatched ergonomic factors Research outcomes further revealed that a majority of children carried bags with unhealthy features and they were too heavy according to international standards. Text books and other writing books accounted for more than two thirds of the school bag weight. Bag behaviour was not healthy. Many children reported negative health consequences. It is evident that a 'big health issue' exists in Sri Lankan schools with regard to carriage of school bags. These findings necessitated formulation of feasible solutions with the involvement of major stakeholders.

We considered it important to translate research findings into action.

We adopted three strategies

• Dissemination of research findings
• Provision of feasible solutions
• Advocacy

Research findings necessitated identification of priority areas and formulation of feasible solutions to improve the current status. Taking into account, several factors including feasibility of implementation and acceptability by the adolescents and their parents, it was considered that issues related to schoolbags should be a priority area for intervention.
Solutions were contemplated on - strategies for bag-weight reduction, introduction of a model healthy bag and bag behaviour changes.

The main conclusions were shared with Education Ministry and other stakeholders. Dissemination of research findings through multitude of mass media sensitized students, teachers, parents, general public and administrators of health and education sectors.
Research outcomes were even shared at international forums to obtain further inputs and update good practice evidence. Solutions were contemplated on; strategies for bag weight reduction, introduction of a model healthy bag and bag behaviour change.
When findings and recommended solutions were shared with the Education Ministry for education authorities themselves to find solutions to heavy schoolbag. Education Publication Department Commissioner W M N J Pushpakumara took the lead role. He initiated another research project to be undertaken to explore strategies to lighten the schoolbag. Text books were split in to several volumes. Only page-80 exercise books were recommended.

Introduction of the model school bag

The need for modelling a healthy schoolbag was imperative. Inputs were obtained from the International Ergonomic Association and from consultations with experts. Healthy bags designed ergonomically in other countries were also studied.
School Health Unit of FHB, for their role, initiated designing a model school bag. Dr Kapila Jayaratne, being a member of the Technical Committee of International Ergonomic Association on Ergonomics for Child Educational Environments (ECEE), consulted several international ergonomic experts on healthy features of a bag.
Several bag models were studied and a sample schoolbag with ergonomic features was manufactured to suit Sri Lankan contexts.

The model bag was evaluated by a team of experts including Paediatricians, Orthopaedic Surgeons, Community Physicians, Psycho-ergonomic consultants and Physiotherapists. It was field-tested at a Colombo suburb school and children, teachers and principals responded on local adaptability.

Our bag

A healthy schoolbag adapted for Sri Lankan children was modelled according to ergonomic standards. This sample bag was locally manufactured based on an ergonomically designed healthy bags approved by the Australian Chiropractic Association.

Once the sample bag was evaluated by experts and children, recommendations were sent to the Education Ministry. Sri Lanka Standards Institute was consulted for physical quality assurance.
Registration of bag manufacturers
Bag manufacturers were registered by the Education Ministry and they were educated on the healthy bag concept.
A successful awareness program for bag manufacturers on healthy schoolbag was held. More than 400 manufacturers from all over Sri Lanka on participated at this meeting. Dr. Kapila Jayaratne, described the research background: focusing on burden of the problem, why the ergonomic features are essential to safeguard health of children and what is expected from local manufacturers. Sri Lanka Standards Institute Chamari Geeganage explained physical quality aspects and the process of developing standards on schoolbag. Mr. Tissa Vitana of Ministry of Education elaborated on registration procedure, evaluation of bags by the National Advisory Committee on Schoolbag, the process of awarding logo of the 'healthy schoolbag' and post-market surveillance system for quality assurance.

The project was pioneered under the supervisory guidance of Prof Dulitha Fernando.

Children’s Environmental Health Units

The World Health Organization has released its latest publication on Children’s Environmental Health Units.

www.who.int/entity/ceh/publications/childrensunit.pdf


Health care providers are well placed to detect, treat, and prevent environmentally-related diseases and health conditions. Few mechanisms and structures are in place to enhance the recognition of environmental influences on human health, serve as repositories and sources of information for those concerned about children’s health and the environment, and promote action towards healthier and safer environments for children of today and adults of the future.

For health professionals to effectively protect children from environmental threats, specialized training is useful. Evidence shows that health providers are generally not provided the training that they need to address the complex environmental health issues with respect to air, water, soil, and products (Pope & Rall, 1995) Diarrhoeal diseases often recur frequently when underlying causes such as contaminated water are not taken into account by the health provider, understood by the community or adequately addressed by governments. The complexity of children’s environmental health (CEH) issues is compounded by the combination of legacy environmental issues, such as water quality and sanitation service delivery, with modern challenges such as transboundary contamination by persistent toxic substances, ozone depletion and hence ultraviolet and ionising radiation, global climate change, and exposure to endocrine-disrupting chemicals). For children in developing countries, the presence of all such risks represent a ‘triple burden of disease’ – a high level of communicable diseases, the increasingly severe burden of non-communicable diseases, and emerging risks from new diseases and additional stressors from the social and physical environment.

Definition of a Children’s Environmental Health Unit
A Children’s Environmental Health Unit (CEHU) is a centre that advances the ongoing training of health care providers, the ongoing education of the public and other sectors concerned about CEH on the protection of children from environmental threats, the management of children with known or suspected exposure to environmental stressors, and the diagnosis, management, and treatment of children with illnesses that are derived from environmental stressors.


Children’s Environmental Health Units educate health care professionals and others about preventing environmental exposures and about diagnosing and treating environmentally-related diseases. Their policy advice to government officials can strengthen governmental responses to environmental health problems. By maintaining databases and collaborating with partners in the health community, they can contribute to the knowledge base on children’s environmental health issues.


The development of this document was funded by the U.S. Environmental Protection Agency under assistance agreement CR 831028 to the World Health Organization.
This publication was coordinated at WHO by Jenny Pronczuk de Garbino, Marie-Noel Bruné, and Ruth Etzel with the assistance of Tania Gavidia from the WHO Collaborating Centre in Perth, Australia.

The following people contributed to this publication:

Martha Berger
Irena Buka
Enrique Cifuentes
Lilian Corra
Fernando Díaz Barriga
Luis Roberto Escoto
Adriana Grebnicoff
Michael Hatcher
Raul Harari
Kapila Jayaratne
Amalia Laborde
Philip Landrigan
Sang-il Lee
Siobhan McNally
Helia Molina
Juan Antonio Ortega-García
Enrique Paris
Jerry Paulson
Leslie Rubin

Standards for schoolbags

Sri Lanka Standards Institute is in the process of developing standards for schoolbags. A working group comprised of healthcare professionals, ergonomists, university academics, representatives from Ministry of Trademm textile engineers and selected bag manufacturers is involved in the process.

Dr. Kapila Jayaratne serves as the chairman of the working group on developing standards for schoolbags.

Once the specifications and standards are finalized, they would be accepted as the legal standards.

Donald Court Visiting Fellowship for Dr. Kapila

Dr. Kapila Jayaratne, Senior Registrar in Community Medicine of Family Health Bureau, Ministry of Healthcare and Nutrition, has been awarded the prestigious Donald Court Visiting Fellowship by the Royal College of Paediatrics and Child Health (RCPCH), United Kingdom.
His extensive field work and research in the field of child health has been taken into consideration in selection for this fellowship which is awarded annually for the medical professionals worldwide involved in community child health.

Under this fellowship, Dr. Jayaratne is to undergo a three week training in childhood disability at Nottingham University Hospital.

In addition, he has been selected to present a scientific paper on 'Musculoskeletal Pain among school-going adolescents - a prevalence study in South Asia' based on his research on Sri Lankan schoolchildren at the Spring Meeting of the Royal College of Paediatrics and Child Health held from April 14 to 17 at the York University.

Daily News Healthwatch Friday, 11 April 2008 -http://www.dailynews.lk/2008/04/11/fea08.asp

Child Friendly Schoolbag introduced to Health Minister

Dr. Kapila Jayaratne of the Community Health Unit and Dr. Preethi Perera, Director, Family Health Bureau demonstrate the newly designed school backpacks to Minister of Health Nimal Siripala de Silva. The new backpack was designed as those currently used by children had come under severe criticism because of its weight and shape which experts say could affect them physically.


http://www.island.lk/2009/10/21/news.html

Ergonomic factors of educational environments

Ergonomics is the scientific study of the people and their work. It helps in improving human performance and finds solutions to health and safety problems. The school is the largest workplace of all. Children are the “workers” there. Matched ergonomic arrangement at the place of work is essential for better human performance.

Musculoskeletal pain, general tiredness, lateral deviation of the spine and poor educational performance have been identified as key negative effects due to mismatched ergonomics in the classroom.

Feasible solutions are available to mitigate ergonomic risks. Many developed countries have contemplated on both micro and macro ergonomic preventive strategies. The classical ergonomic approach is based on the study of human characteristics and environmental parameters. This knowledge needs to be applied in the analysis and redesign of total environment.

Study
A school-based cross-sectional study was conducted in a representative district (Gampaha) to analyse the ergonomic factors of school educational environments and negative health outcomes among school children with the objective of translating findings of research into action with key stakeholders.
A sample of 1607, school children of Grade 6,7 and 8 were selected from 55 schools using stratified multi-stage cluster sampling method.
The study included 52% male and 48% female students from urban (31.7%) and rural (68.3%) schools. They carried books in backpacks (79.6%), shoulder bags (17.9%) and suitcases (2.3%). Mean weight of schoolbag was 3.72 Kg. Mean schoolbag weight/body weight was 11.04% (SD=3.88).
A bag weighing >10% of bodyweight (international cut-off) was carried by 57.9% of children. They were seated with a mean angle of 30.71 degrees (SD=19.67) and 398.04cm (SD=132.09) mean distance to blackboard with 23.3% having to turn their necks >45 degrees to see the centre of the blackboard.
A standard chair with backrest without hand-rests was used by 95.6%.Regular use of backrest was reported by 12%. An individual desk had been provided to 78.3%. Desk surface was horizontal in 84.9%. A foot-rest was present in 82% desks.
Sitting area length of chairs did not match with buttock-popliteal length of child in 87.3%. A mismatch in seat height and popliteal height was observed in 79.8% while legroom height of desk did not comply with popliteal height in 76.3%.
A larger proportion (71.2%) of children reported musculoskeletal pain with 35.9% suffering from recurrent pain while 62.8% locating pain in more than two anatomical points. Presence of mismatched seat depth-buttock-popliteal length gave rise to 1.6 time risk of developing recurrent musculoskeletal pain.
Carriage of backpack over both shoulders protected them from such pain. Seventy two percent of children perceived discomfort due to carriage of schoolbag. No correlationship was found between bag weight and pain. Moderate to severe general tiredness was reported by 62%. Only 32 (2.35%) children found to have significant lateral deviation of the spine. Academic performance or school attendance were not significantly affected.

Research findings necessitated identification of priority areas and formulation of feasible solutions with the involvement of major stakeholders. Issues related to schoolbag were recognized as major concerns. Solutions were contemplated on: strategies for bag-weight reduction, introduction of a model healthy bag and bag behaviour change. Findings were disseminated through local mass media and at international forums to share and update good practice evidence.

Crucial role
Advocacy of policy makers, including Ministers of Health and Education, played a crucial role. Sharing of research outcome and recommendations with Ministry of Education (MoE) stimulated a secondary research by MoE exploring strategies to lighten the schoolbag.
Text books were split into several volumes. Only page-80 exercise books were recommended. A healthy schoolbag was modeled by the principal investigator according to ergonomic standards. Sri Lanka Standards Institution was consulted for physical quality assurance.Bag manufacturers were registered and were educated on healthy bag.

Children, Parents and teachers were made knowledgeable through mass media, leaflets and at exhibitions on healthy bag and bag behaviour.
A schoolbag regulatory committee was established to monitor implementation of national healthy schoolbag campaign.This pioneer public health sector research work led to a successful healthy schoolbag campaign at national level in Sri Lanka.

Read more: http://www.sundayobserver.lk/2010/06/27/spe05.asp

An outbreak of mumps in Dompe

Ceylon Medical Journal



An outbreak of mumps in Dompe
P Palihawadana, ILK Jayaratne, N Wijemunige
http://www.sljol.info/sljol/index.php/CMJ/article/view/1051

doi: 10.4038/cmj.v52i1.1051
Ceylon Medical Journal Vol.52(1) 35-36

Promoting Ergonomics for Children in Educational Environments (ECEE) in Industrially Developing Countries

Please visit: http://www.iea.cc/ECEE/index.html

The International Ergonomics Association (IEA) Ergonomics for Children in Educational Environments (ECEE) Technical Committee (TC) was organised by Cheryl Bennett following a successful symposium at the IEA 2000 Conference in San Diego. Anyone interested in joining the committee is urged to contact the Committee Chair, Karen Jacobs at kjacobs@bu.edu .

Mission
The purpose of the EECE TC is to provide a forum for the international exchange of scientific and technical ergonomics information related to children and educational environments.

The Committee promotes professional and public awareness of ergonomics related to children of all abilities in all aspects of their lives and the application of ergonomics in all educational environments.

Kapila Jayaratne was appointed as the co-chairperson of the International Ergonomics Association’s (IEA) Ergonomics for Children in Educational Environments (ECEE) Technical Committee (TC) in recognition of the work he is doing to advance the health and well being of children.


Read more:

National Healthy Schoolbag campaign in Sri Lanka -http://www.iea.cc/upload/IEA-IDC%20National%20Healthy%20Schoolbag%20campaign%20in%20Sri%20Lanka.pdf

Sri Lanka Medical Association (SLMA) oration 2010

Dr Kapila Jayaratne was awarded the opportunity to present the Sri Lanka Medical Association (SLMA) oration 2010 - Ergonomic Factors in the Educational Environment and their Influence on School-going Early Adolescents.

Dr Jayaratne is the first public health physician who has been honoured with this prestigious oration, the highest recognition for medical research, awarded by the Sri Lanka Medical Association.

The Sri Lanka Medical Association is the oldest professional medical association in Asia and Australasia, with a proud history dating from 1887. Being the national professional medical association in Sri Lanka, the SLMA brings together medical practitioners of all grades and all branches of medicine. The SLMA has expanded its territories to facilitate its members to present their research and to further their professional and academic development.

Read more:

www.slma.lk/static/viewnl.php?Details=8

www.slma.lk/static/viewnl.php?Details=2

Optimizing the roles of health workers to improve MDGs 4 and 5 discussion forum

http://my.ibpinitiative.org/DisplayKnowledge.aspx?c=7b47857a-349e-4eb2-bcba-fe6d95c04fbe&f=44a7373e-dcdc-46dd-b37c-8ea5ba3fb43b&i=32a29121-0f4f-4529-8bf8-0e3521f53eaf

Week 1 Day 1
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Sri Lanka being a low income country is boasting of achievements on maternal and infant mortality rates in par with developed countries. Key factorsbehind this success story and novel strategies focused on further reductionof both mortalities need to be shared at international level.
The crux of this achievement is the public health service delivery systemwhich covers each and every household in the island. Public Health Midwives(PHMs), with basic training on filed health care, cater for 3000 - 5000population or nearly 800 - 1000 households in a designated healthadministrative locality. She is accountable for maternal and child healthcare of the each house hold under her purview. This domiciliary carenetwork has prompted tremendously health status of women and children inthis country. The spectrum of her service ranges from registration ofeligible couples, preconceptional counseling, antenatal care, intrapartumcare at field (if necessary), postpartum care, family planning promotion,neonatal care, promotion of exclusive breast feeding, immunization, earlychildhood care, growth monitoring, school health and adolescent reproductivehealth services in a life course approach.Linked with them are the supervisory staffs, Supervising PHM, Public HealthNursing Sister and Regional Health Care Manager. The supervision includesformal field visits to informal surprise checks. Review of service deliveryis done at local conferences (3-5 PHMs) and monthly conferences (all PHMsin a regional administrative area) where each PHM is supposed to presentprogress of her performances. The system is in-built with appraisals atvarious levels.

Publich Health Information system originates from the daily logs of the PHMdiary cascading in to a national level network which is continuouslymonitored at national level by the Family Health Bureau -the focal point formaternal and child health (MCH) in the country. The review system has beenexpanded from district level to national level with the participation of allthe stakeholders of MCH.

Sri Lanka introduced maternal death audits in 1982 and now it has beenupgraded to a National Maternal Mortality Surveillance System with a networkof maternal death information network and regular national level reviewsystem throughout the country. Sri Lanka has excelled in maternal mortalityreduction with the latest provisional MMR figure of 33.4 per 100000 livebirths for the year 2008. Learning from what went wrong at ground levelhelped fine tuning maternal care service delivery in the entire country.Capacity building of PHM, the grass root health care worker, is modelledbased on findings and recommendations of national maternal mortalityreviews. This is of importance with the increase of proportion of indirectmaternal deaths in Sri Lanka to develop skills of PHM on obstetric medicalconditions and what is expected from them. Early detection and approriatereferral is the theme as practiced universally. Novel strategies -eg. rapidcommunication with clinicians, targeted health education, high risk approachin family planning promotion- will undoubtedly help in further decline inmaternal mortality in Sri Lanka.

Sri Lanka hopes to reduce the catering population for each PHM with furtherexpanding scope of her domicillary care.

Kapila Jayaratne
Sri Lanka


Kapila Jayaratne, Sri Lanka has excelled in maternal mortality reduction of 33.4 per 100000 live births for the year 2008. Learning from what went wrong at ground level helped fine tuning maternal care service delivery in the entire country. Capacity building of PHM, the grass root health care worker, is modeled based on findings and recommendations of national maternal mortality reviews. This is of importance with the increase of proportion of indirect maternal deaths in Sri Lanka to develop skills of PHM on obstetric medical conditions and what is expected from them. Early detection and appropriate referral is the theme as practiced universally. Novel strategies -e.g. Rapid communication with clinicians, targeted health education, high risk approach in family planning promotion- will undoubtedly help in further decline in maternal mortality in Sri Lanka.

Femi Oladapo: Thanks to Kapila for sharing Sri Lanka's success story with the rest of the world. There is no doubt that building a formidable health team at the grassroots level based on evidence from situation analysis would go a long way in reducing the high rates of maternal and newborn mortality in many countries. It has to be acknowledged, though, that not many low income countries have the a strong public health service delivery system as described for Sri Lanka and the same initiative could have different outcomes in another setting. It would be nice if Kapila can provide the forum with more information about the training of these Public Health Midwives so that everyone can appreciate the degree of competence required to achieve a similar feat. Obviously, there is a wide range of services they can render particularly in the area of health promotion. The strength of this kind of health system probably still lies in a good referral system, appropriate supervision, monitoring and evaluation and incentivization of the workforce. The question we need to ask is this, is the success of this health policy intervention dependent on specialized workforce that can provide emergency obstetric care? Or how far could these PHM go to save the life of a woman when the need arises? For example do they perform manual removal of the placenta, give uterotonics or magnesium sulfate for pre-eclampsia?