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Two-week old Ayumi has a free check up at the Castle Street Hospital for Women in Colombo, Sri Lanka.

Quality not quantity in health investment: Proof that $153 per head can boost a nation’s health

15 October 2016

By focusing on prevention rather than cure, countries – and especially least development countries – can get more bang for their buck when investing in national healthcare, advises the Commonwealth Secretariat. Comparisons of the expenditure on health of more than fifty countries, and their respective population’s life expectancy, showed that spending more money on healthcare does not necessarily lead to better public health.

A shining testament to this is Sri Lanka, host of the Commonwealth Medical Association meeting in the capital Colombo this weekend. Sri Lanka’s health expenditure is one of the lowest in the world at 1.8% total GDP, yet their life expectancy is 76 years. In contrast, the USA spends 18% of its GDP and has only a marginally longer life expectancy of 79 years.

Dr Joanna Nurse, head of health at the Secretariat, said at the opening address: “I see a real opportunity here. In Sri Lanka, the Government’s strategic investment in public health has made a fundamental difference. We at the Commonwealth want to take this blueprint and share it with our members, to show how results can be achieved at a realistic and feasible cost.”

Infant mortality in Sri Lanka is eight in every 1000 live births – six times less than the average global rate. Nearly all (97%) women give birth in a hospital or with the support of a skilled birth attendant. Free post-natal care including numerous home visits from a midwife is standard protocol.

At Colombo’s Castle Street Hospital for Women, new mother, Tei, brought her two-week-old baby, Ayumi, in for a check-up.

Tei said: “I have diabetes, and when I was sick and with a fever my husband brought me here and I was admitted, before I went into labour. Ayumi was born three-weeks early, that’s why she is so small. But she is good and healthy now. The doctors and nurses here are excellent, though there are so many patients they are very busy. But all of the care is free, which makes us thankful.”

Embracing digital technologies, Sri Lanka is able to record and monitor patients’ information. Computerised alerts advise healthcare workers of due vaccinations and appointments, plus when new stock needs to be ordered or if the temperature of the medicines fridge varies above or below optimum. Data can be shared instantly with the ministry of health for fast accurate reporting, and instigation of urgent mitigation responses whenever necessary.

Incoming president of the Commonwealth Medical Association, Professor Vajira Dissanayake, said: “We are living in a globalised world where digital health is transforming healthcare and making it possible for more efficient and productive delivery that rationally uses meagre resources.  This can be harnessed especially in the developing world, where there is a large gap between the optimal recommended and actual health workforce on the ground.”

The Commonwealth aims to share the systems of success in Sri Lanka with all of its members to provide policy and implementation guidance. The Commonwealth’s Health Hub is a web-based platform for the exchange of best practices. Health professionals and policy makers can learn, discuss and have access to free resources. 

Dr Nurse continued: “The digitalisation of the system has the potential for huge impact. Imagine if at the first signs of the Ebola outbreak in West Africa, there was a surveillance and reporting system in real time. Or right now, in the response to Hurricane Matthew, if health workers in the Caribbean had the latest information at their fingertips, just think how the losses could be minimalised and how many lives could be saved.”

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