Taking over 59 estate hospitals: Easier said than done?

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Cabinet approval was granted to take over 59 estate hospitals that function under plantation companies, along with the land they have been constructed on under the wing of the Health Ministry, former Health Minister Pavithra Wanniarachchi said in January this year.

Legal barriers 

Wanniarachchi said the Government had gathered the information as an initial step to acquire the land to develop these hospitals. There are legal barriers that prevent it from developing any health institution that was under the purview of the private sector, without taking over the lands. All these health facilities are under the control of plantation companies and there are restrictions to develop them without taking them over, the Minister said at the time.

44 already taken over

The Government in 1994 took over 44 other estate hospitals to develop them with the required infrastructure and human resources. More estate hospitals were taken over by the Government between 1996 to 2007, a majority in 2007. 

Informed medical sources said the 44 estate hospitals taken over by the Health Ministry were only provided with the administrative services required to keep them operational. Doctors, nurses, and minor staff were stationed by the Ministry. But the land that these health institutions were built on is still in the process of being taken over from the plantation companies. 

In 2018, a Cabinet Memorandum was submitted by the Health Ministry to absorb some 450 estate hospitals in five provinces under the purview of the Provincial Councils. They were Kalutara and Colombo in the Western Province, Ratnapura and Kegalle in the Sabaragamuwa Province, Galle and Matara in the Southern Province, and Badulla and Bandarawela in the Uva Province.

Conditional approval

Cabinet granted a “conditional approval” to the memorandum which had been submitted. It also appointed a subcommittee comprising the Secretaries of Ministries. They were Secretaries to the Ministries of Health, Nutrition and Indigenous Medicine (Chairperson), Finance Ministry (Treasury Secretary), Plantation Industries, Land and Parliamentary Reforms, and Hill Country New Villages, Infrastructure and Community Development. The Committee’s primary task was to draft a plan on which hospitals were to be taken over on a priority basis.

59 identified

A total of 59 hospitals were identified according to suitability, two of which could be developed into hospitals, while the remaining 57 into Primary Medical Care Units (PMCUs). Sources said the Committee had submitted its report in 2021. 

They said in February 2022 the priority order had been given, while the Health Ministry had been called on to implement the takeover as a National Plan.  

Present situation

Over three months later, the Regional Director of Health Services, Nuwara Eliya, Dr. Nissanka Wijewardene explained that they were in the process of gathering information regarding land ownership. Information has been sought by the Provincial Health Services from the authorities of the Nuwara Eliya Divisional Secretariat regarding the land ownership.

The land where the hospital is located should be surveyed and sectioned off to it. This means that the number of hectares which belongs to the hospital property should be allocated to it following a legal procedure.  

Outpatient Department (OPD) services and clinic services are being carried out by Estate Hospitals, presently. But when absorbing them to the Health Ministry, consideration should also be paid to the population which they would serve. 59 hospitals have been identified, as they are strategically located and would cater to a sizeable population.

Medical officers and staff would be stationed to attend to OPD and emergency services. Questions as to whether inpatient facilities would also be provided would have to be resolved in due course.  

Health issues and seeking medical attention

Doctors who have worked in District General Hospital Nuwara Eliya said most estate employees sought medical attention once their health issues got aggravated. “As it is, they are very reluctant to come to a hospital for treatment,” sources lamented.

“It was probably due to their employment pattern and the time taken to get to hospital and return meant the loss of wages for a particular number of hours. Therefore, they would rather purchase whatever medicine they could get from a wayside boutique rather than pay attention to their heath,” sources lamented.

A large number of estate employees suffer from health and nutrition issues like anaemia and malnutrition. There are also communicable diseases and other chronic illnesses including tuberculosis (TB) which afflict them. With the economic crisis at present paving the way for mounting food prices, there is bound to be increases in many of the ailments that assail them in the coming months.

There are also incidents that have been reported in the past of under-qualified persons or unqualified persons treating patients at these estate hospitals. The Health Ministry aims at putting a stop to this, as this risks the lives of the country’s estate population.

Economic crisis and medicinal drug shortage

Medical sources observed however that the present process of taking over hospitals would slow down even further with the country’s economic crisis, which has also led to a medicinal drug shortage. As it is, there is difficulty in running state-owned health institutions due to the medicinal drug crisis and the difficulty in settling bills for services provided. The list of burdens facing the state health service is being fuelled by the petrol, diesel, and gas crises that are causing further despair.

Although former Health Minister Pavithra Wanniarachchi said they would look at possibilities of increasing the number of MBBS qualified doctors and health staff and Ambulance services to sustain the acquisitions, the present shortage of doctors and nurses in the state health service would make the situation much more complicated. “It takes about five years to train a doctor and just over three years to train a nurse,” sources said.

There is also the issue of medical staff wanting to work in these places. Without proper facilities, doctors and nurses cannot be stationed to serve in difficult postings due to the transfer issues. Rather, they could be stationed in the nearest large hospital at which they would feel more reassured that there would be another doctor prepared to take over their position once they are transferred out.

But despite some of these pitfalls, one must not forget that our estate population play a vital role in keeping the country’s economy afloat. Therefore, the process of welfare management and ensuring that they too receive quality healthcare services should continue unabated.  

By Dilanthi Jayamanne