ADMINISTRATION REPORT 2009

MINISTRY OF HEALTH & INDIGENOUS MEDICINE, NP.

CONTENTS
PAGES
1. Introduction 01-02

2. Organization 03-08
2.1 Vision, Mission, Objectives & Functions of the Ministry
2.2 Vision, Mission, Objectives & Functions of the PDHS, Office
2.3 Vision, Mission, Objectives & Functions of the PDIM, Office
2.4 Vision, Mission, Objectives & Functions of the RDHS, Office

3. Organizational Arrangements for Various Functions 08-13

3.1 Patient Care Services / Curative Care Services
3.2 Preventive Care Services / Community Health Services
3.3 Planning Unit
3.4 General Administration
3.5 Indigenous Medical Services

4. Resource Status 13-14

4.1 Buildings & Facilities – 2007
4.2 Machineries & Equipments

5. Status of the Health Sector 15-19

5.1 Health Institutions
5.2 Health Statistics

6. Highlights of Performance 19-35

1. Human Resource Development
2. Special Activities performed in the tear 2007
3. Newly Opened Completed buildings for Health Institutions.
4. Vehicles & Equipment procured in 2007

7. Issues Related to Health Services in NP 36-39

8. Finance 39-44
LIST OF CHARTS PAGES
1. Organization Chart of Ministry of Health 08
2. Organization Chart of PDHS Office 09
3. Organization Chart of PDIM Office 09
4. Organization Chart of RDHS Office 10
5. Provision of Capital Expenditure under PSDG in 2009 40
6. Provision of Capital Expenditure under HSDP in 2009 41
7. Provision of Capital Expenditure under Additional
HSDP 2009/2010 42
8. Capital Expenditures under HSDP 2005 -2009 43
9. Capital Expenditure under UNICEF in 2009 44

LIST OF TABLES

1. Cadre Vacancies – Summary 14

2. Health Institutions 15
3. Availability of Curative Care Institution 15
4. Availability of Preventive Care Institution 16
5. Ayurvedha Institutions in 2009 18
6. Health Indicators 18
7. Appointments in 2009 19-20
8. Promotion in the year 2009 20-21
9. Provision of Capital Expenditure under PSDG in 2009 40
10. Provision of Capital Expenditure under HSDP in 2009 41
11. Provision of Capital Expenditure under HSDP 2009/2010 42
12. Capital Expenditures under HSDP 2005 -2009 43
13. Capital Expenditures under UNICEF in 2009 44
14. Progress of Recurrent Expenditure in 2009 44

LIST OF ANNEXURES

1. Staff in Position – Summary as at 31.12.2009- Health 45-47

2. Approved Cadre as at 2008.12.31- Indigenous 48
3. Details of Vehicles in Health Sector, NP 49-51
4. Details of Generators in Health Sector, NP 52-54
5. Capital Expenditure1999-2009 55
 ADMINISTRATION REPORT – 2009

MINISTRY OF HEALTH & INDIGENOUS MEDICINE – NPC

INTRODUCTION

The Ministry of Health & Indigenous Medicine of the North East Province was established in the
year 1989 under the 13th Amendment to the Constitution of the Democratic Socialist Republic of
Sri Lanka. The Ministry exercises guidance, policy direction, management, and co-ordinates
planning, implementation and monitoring of the activities of the Region Director of the Health
Services divisions. It is responsible for the overall Provincial Policy and implements
programmes identified under the Presidential Task Force Recommendations and the Five Year
Provincial Investment Programme.

Following the Supreme Court decision, His Excellency the President to the Republic of Sri Lanka
appointed Hon. Governor Northern and Eastern Provinces separately on 22/12/2006. On the
same day the Hon. Governor appointed Secretaries to both Provinces and instructed to function
separately. The separate administration for both provinces with respect to Health Sector
originated and started functioning in the same office complex. At the same time inseparable
activities for both provinces planned under the 2006 budgetary provision were considered as a
one program till the closure of the financial year that ended on 31st December 2006. Office of
the Ministry of Health and Indigenous Medicine, Provincial Director of Health Services and
Indigenous Medicine started function at Agriculture Building Complex at Varothaya Nagar from
19th March 2007.

The administration of Health Services of the Northern Province is decentralized to Five Regions
under the Regional Directors of Health Services. The institutional network links 344 Health
Institutions comprising Head Offices, Regional offices, Hospitals with specialist services as
District General Hospital, District Base Hospital, Divisional Hospital and Primary Medical Care
Units as curative care institutions and MOH Offices, Gramodhaya Health Centres, Anti Malaria
Campaigns and School Dental Clinics as preventive care institutions. The Ayurvedha Sector is
functioning with only Curative Care Institutions in Northern Province. These institutions provide
Patient Care and Preventive Care Services to promote the Health Status of the population.
Beside this, One Teaching Hospital is functioning in Jaffna district under Line Ministry.

There are 08 Institutions for General Administration, 161 Preventive Care Institutions and 91
Curative Care Institutions (besides these 5 Chest clinics, one Leprosy unit & 4 STD clinics
functioning with the District General hospitals). 101 Ayurvedha Medical Institutions are
functioning in Northern Province. Out of this 101, 02 District Ayurvedha

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Hospital, 02 Rural Ayurvedha Hospital & 13 Nos. of Ayurvedic Dispensaries are functioning
under the Department of Indigenous Medicine and 84 Free Ayurvedic Dispensaries are
functioning under the Local authorities. All are providing free health services to the public.

There are 28 MOH Offices as the MOH office Oddusuddan is newly started function, 111
Gramodhaya Health Centres, 5 Anti Malaria Campaigns and 17 School Dental Clinics are
responsible for the preventive and promotive aspects of Health care for the people, especially
for mothers and children.

The focus of the Health efforts in the Province is the building up of necessary infrastructure &
building capacity of staff for improving the quality of Health Care delivery in the districts so
that health services can be delivered more efficiently at these levels rather than concentrate on
Urban Centres. It is therefore necessary to strengthen the Health Institutions under Provincial
Health Services at various levels in the Northern Province.

In 2009, mass displacement was occurred especially from Kilinochchi, Mullaitivu districts to
Vavuniya district due to the war. The displaced population was placed in 22 IDP centres
established in Vavuniya district. Medical Care was provided through DGH Vavuniya, BH
Cheddikulam and Isolation Unit at DH Poovarasankulam. During May 2009 the total bed
strength for DGH Vavuniya and BH Cheddikulam increased by 491 and 188 respectively. Due to
the overcrowding in the hospitals temporary wards were put up with the help of provincial funds
and other NGO funds for the patient care.

Later resettlement was started during November 2009, development works also started in
parallel. World Bank provided additional funding especially for the development the Early
Recovery Areas. Medical services to the resettled population was provided through Mobile
clinics earlier and later on few hospitals were started function with limited facilities.

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2. ORGANIZATION:
Organization of Health Sector in Northern Province functions through the following Vision
and Mission of the Departments.

2.1. Vision, Mission & Objective of the Health Ministry.

2.1.1 Vision
A Healthier Province contributes to its economics, social, mental, and spiritual
development.

2.1.2 Mission.
To provide efficient and qualitative health services to the people of Northern Province by
formulating policies and strategies in concurrence with National Development Plans
which enable to face the issues and challenges emerging in the provision of services
within the Northern Province.

2.1.3 Objective to be achieved to accomplish to the above Mission.

1. Developing an efficient Administration, Planning and Financial Management system at

Provincial level.
2 Circulate policies among departments and monitoring the implementation.
3. Strengthen the physical infrastructure, medical supplies & equipment and support
services with special emphasis in the under served areas.
4. Coordinate the sectoral activities with the National /Provincial level health institutions.
5. To establish Policies, Guidelines and Standards for the delivery of basic health care
services at regional level.
6. To ensure the employment of all health professionals with the required national standards
of professional practice.
7. To ensure the availability of disaster Management Plan in each district.
8. To ensure the health services of high quality, effective and accessible to all delivered by a
well performing and sustainable health system.

2.1.4 Functions of Ministry

1. Coordination and Issue of guidance to PDHS, PDIM & RDDHS of the Province to maintain
efficient administration, planning and improvements of Health activities in order to meet
the needs of the Public.
2. To have control over the Financial Management.
3. To have coordination with the line ministries in obtaining funds, manpower (Doctors,
Specialists), Medical Equipments, Drugs, etc.
4. Arrange scholarships to medical professionals in concurrence with the Line Ministry.
5. To obtain funds for Development works from various funding agencies.

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 6. To organize and supervise areas shattered by ethnic disturbances in development work
to be undertaken in the future with funds anticipated from the donors.
7. Follow-up action by rendering assistance and guidance to Health sector institutions to
achieve the target aimed.
8. To analyze the information for the development.
9. Monitoring and coordinating the progress of Western and Traditional health activities.

2.2 Mission & Objective of the Office of Provincial Director of Health Services.

2.2.1 Mission

To provide efficient, effective and qualitative health services to the people of the
Northern Province by implementing policies and strategies formulated by national and
provincial health ministries to enable to face issues and challenges emerging in the
provision of services within the province.

2.2.2 Objective to be achieved to accomplish the above Mission

01. To establish and develop Health Surveillance and Information System at Provincial
and Regional level.

02. To ensure and organize curative health services of standard quality.

03. To ensure the availability of comprehensive health services in each districts of

Northern Province.

04. To Rehabilitate and Reconstruct health facilities on priority basis.

05. Improve the nutritional status of the vulnerable groups.

06. To ensure the sustainability of Projects and Programmes.

07. To promote health and quality of life by preventing and controlling disease, injuries
and disabilities.

08. To ensure the better Financial Management for the benefit of the health Sector of
Province.

09. To improve the capacity and proper deployment of competent Health care workforce.

10. To coordinate and facilitate all stakeholders in the Health sector to achieve the
national goals for health.

2.2.3 Functions of Office of the Provincial Director of Health Services

1. Improve the clinical training facilities and ensure the regular staff training.

2. Ensure the quality services rendered by implementing quality assurance.

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 3. Co-ordinate with health policy matters at the provincial level and provide

technical assistance in making decisions.

4. Link between Provincial Ministry, Provincial Authorities and Line Ministries.

5. Regulate private health sector facilities within the province and coordinate with
Central Ministry.

6. Attend to public complaints promptly and ensure the investigation and disciplinary
actions are carried out properly.

7. Ensure better Financial Management for the benefit of the Health Sector of the
province.

8. Organize ways and means of inventory control and ensure periodic Board of
Surveys atleast once a year.

9. Organize disposal of unserviceable and obsolete items and grant write off authority.

10. Co-ordinate the health activities among districts with all Regional Directors of Health
Services.

11. Ensure provision of Primary Health Care Services to the returnees and internally
displaced population.

12. Organize activities of prevention of Communicable diseases like Malaria, Sexually

transmitted diseases and Rabies.

13. Implementation, Supervision, Monitoring and Evaluation of Annual Implementation

Programme and other Capital Programmes.

14. Collecting & Maintaining Health Sector Data Base including Sectoral Atlas for the
Health Sector, Northern Province.

15. Create better environment to improve ability and work efficiency of the health staff.

16. Make effort to fulfill the vacancies of the departments and institutions.

2.3. Vision, Mission and Objective of the Indigenous Medicine

2.3.1 Vision
Excellence in physical, mental, spiritual and economic health status of people of Northern
Province.
2.3.2 Mission
Improving the health status of the people of the Northern Province through best
traditional, indigenous and other knowledge systems while preserving the identity and
strengthening the role and contribution of the Indigenous Systems of Medicine (ISM) in
the National Health Care System.

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2.3.3 Objectives
To develop the Indigenous Medical Care Services to the people of Northern Province to
attain systemic qualities in order to achieve National and Global recognition.

2.3.4 Functions:
01. Operating, Monitoring and Upgrading dispensaries, hospitals and other relevant
institutions.
02. Provision of primary Indigenous Medical Care.
03. Monitoring and coordinating the progress of traditional physician.
04. Improve the capacity of employees in order to meet the challenges of globalization.
05. Encourage community participation in health care provision through Indigenous
Medicine.
06. Resource mobilization from relevant agencies.
07. Conservation and Preservation of traditional medicine.

2.4. Mission & Objective of the Department of Regional Director of Health Services.

2.4.1 Departmental Mission

Provision of efficient and effective quality healthcare services to the people of the district
through healthcare institutions by implementing policies and strategies formulated by
national and provincial health ministries’ to face issues and challenges emerging in the
provision of services within the district.

2.4.2 Objectives

1. To establish and develop Health Surveillance and Information System at district

level.

2. To ensure comprehensive and high quality healthcare services in the district.

3. To identify and prioritize the health facilities which need rehabilitation and
reconstruction.

4. To make healthcare services accessible and available to the vulnerable groups of the
district.

5. To adapt better Financial Management for high productivity.

6. To improve stewardship and capacity building in health institutions in the district.

7. To coordinate and facilitate all stakeholders in the Health sector to achieve the
national and provincial goals for health.

8. To ensure health services available and accessible to all in the district.

9. To ensure availability of disaster preparedness plans in connection with health

needs.

10. To establish and maintain Management Information Systems.

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2.4 Objectives of Curative Care Institutions (Hospitals).

01. To ensure provision of comprehensive patient care services in hospital.

02. To ensure quality assurance in patient care.

03. To prepare and implement comprehensive human resource plan.

04. To exercise effective financial management measures over the expenditure.

05. To develop and implement proper drug management system.

06. To develop and implement proper inventory management system.

07. To develop and implement proper office management system.

08. To ensure optimum utilization of available equipment plant and machineries.

09. To ensure uninterrupted essential healthcare services by providing necessary

drugs, equipments and services.

10. To ensure availability of disaster preparedness plans.

11. To adapt provincial procurement guidelines.

2.5 Objectives of Preventive Care Institutions

01. To reduce the prevalence of communicable diseases in the areas.

02. To improve the maternal and child healthcare services in the area.

03. To improve nutritional status of the vulnerable population of the area.

04. To coordinate with other sectors to improve the environmental sanitation.

05. To promote healthy life style among the community.

06. To enforce public health legislations in the area.

07. To improve the health among school children.

03. ORGANIZATIONAL ARRANGEMENTS FOR VARIOUS FUNCTIONS

The responsibility of the Provincial Health Ministry is the executive management of the
Health Services under Patient Care Services and Community Health Services.
The entire Provincial Health Service are covered by the five Regional Directors of Health
Services who are responsible for the overall administration of Health Institutions through

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 planning, supervision, co-ordination with other sectors, monitoring of performance and
training.
Organizational Charts for Office of the Ministry, PDHS, PDIM and RDHS is shown below.

ORGANIZATION CHART FOR MINISTRY OF HEALTH & IM (NP)

Provincial Secretary
Health & IM
PDHS PDIM

RDHS
Deputy Dir ector Deput y Director
Construction Finance

Asst. Asst. Director Internal Audit

S ecretary Planning Accoun tant

A.O
P PO/SSO

Prog. Man ag. Technical P rog. Pr og. Manag.

Asst. Asst. Gr. I Manag. Translator Data Entry Officer Asst. Asst. Asst. Gr I Manag.
Asst. Gr. II Operator Asst. Gr II

Telephone Bi nder Roneo Machine Driver OES

Operator Operator Sanitary
Labourer

Chart 1

8
Chart 1

Chart 2
Chart 2

Chart 3
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 Organization of Health Services under RDHS
DPDHS

Divisional Director of Health services

Medical Regional
Officer Epidemiologi DMO
(MCH) st District MO i/c
Supervisi Public School Field DMO Hospit M.O STD
Reg. Regional ng Public Health Dental Staff Base al Chest Clinic
Malaria dental Health Nursing therapi AMC Hospi Clinic
officer/ Reg. Surgeon Inspector Sister st /AFC tal
Medical off.
(malaria)
Administrat Accountant Public Supervising
Health Public
ive officer Inspecto Health
r M.O RMO/AMO
Midwife
Peripheral Rural
Regional Unit Hospital
Health
RMO
education
officer
PHM
Statistical
Planning & RMO RMO/AMO
Survey Officer
Programmin CD/MH Central
g Officer Dispensary

Regional Div.
Supervising Supervision
Public Public Health
Health Inspector. Branch
Nursing Dispensar
Officer y
Food & Divisional
Drugs Pharmacist
Inspector
Leprosy Visiting
Supervising Stations
Control School dental
Public Therapist
Health
Inspector
Divisional
Drugs stores
Store Keeper

Chart 4

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3.1 Patient Care Services / Curative Care Services.

The main objective of the Curative Services is to cure or heal diseases by providing
medicines and medical advice. According the General Circular number 02-61/2005
dated 11th May 2005 from Central of Ministry Health Care & Nutrition under the Hospital
Re-categorization Policy the Curative Care Institutions are re-categorized to provide
Health Services in uniform manner in order to provide equitable service to districts and
provinces. Provincial Director of Health Services initiated action to change the types of
the institutions as follows from 1st January 2008 according the circular.

Type of the Hospitals Type of the Hospitals

Before Re-categorization After Re-categorization
General Hospital - District General Hospital
Base Hospital - District Base Hospital
District Hospital
Peripheral Unit - Divisional Hospital
Rural Hospital
Central Dispensary & Maternity Home
Central Dispensary - Primary Medical Care Unit

The following services are provided by the Curative Care Institutions.

1. Providing both Indoor & Outdoor Medical Treatments to the sick in District General Hospital
District Base Hospital & Divisional Hospitals and the Primary Medical Care Units are
providing only outdoor treatment.
2. Providing basic specialist care to the patients in Tertiary Care Hospital and establishment of
clinics for specialized care at peripheries.
3. Providing Anti Natal and Post Natal Care of Mothers at Hospital.
4. Control of Tuberculosis, Chest Clinic is functioning separately from the Base Hospital.
5. Sexually transmitted diseases are treated in STD clinic is functioning separately in major
hospitals.

3.2 Preventive Care Services / Community Health Services.

The main objective of the Preventive Services is promotion of health and the prevention of
diseases. The Medical Officer of Health is the Chief Health Manager of the division for
preventive services. The following functions are carried out under Preventive Care Services.
01. General Preventive Service and Environmental Sanitation.
02. Health Education and promoting healthy life style.

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 03. Family Health including Maternal care , Child Care, Family Planning &
Immunization.
04. School Health Programme, including School Dental Health.
05. Prevention of Communicable diseases like Malaria, Sexually transmitted diseases
and Rabies.
06. Food quality Control.
07. Occupational Health.
08. Mental Health.
09. Care of the Elderly and displaced.

These Programmes are managed mainly by Medical Officers of Health, Public Health
Inspectors, Health Educators, Public Health Nursing Officers, School Dental Therapists
and Public Health Midwives.

3.3 Planning Unit

The major activities carried are as follows.

1. Preparation of Budget, Annual Investment Plan and Implementation Programmes.

2. Preparation of Five Year Programme for Health Sector, Northern Province.

3. Implementation, Supervision, Monitoring and Evaluation of capital projects for all

sources of funds approved for the year and progress reporting especially for Vadakkin
Vasantham Development Programmes.

4. Establishment of Health Information & Management System (HIMS).

5. Collecting & Maintaining Health Sector Data Base including Sectoral Atlas for the
Health Sector, Operational Information System and Statistical Hand Book.
6. Nominating Health Staff for Local Training Programmes and Scholarships.
7. Preparation of Foreign funded Project proposals.
8. Handling Human Resource Development including Cadre Proposals, Staff in Position
and updating Manpower information for Health Sector.

3.4 General Administration

The mission of this ministry is to improve the health status in the Northern Province and
to implement health policies in accordance with the National strategies to enhance the
quality of life of the masses. To promote the standard of the Indigenous Medicine by
research and enhance access by setting up Ayurvedic District Hospitals and Dispensaries.
To achieve the target of providing better health facilities, existing General Hospitals,
Base Hospitals and Divisional Hospitals are being developed with better facilities and
advanced technology. Effort was made to improve Nutrition, Public Health Services,
School Dental Clinics, and Family Health Services. Scholarships were organized in
collaborations with Foreign Governments and NGOO to acquire proficiency in the latest
12
 techniques in health sphere and to improve the capacity of the staff. Facilities were
made to professionals in medicine and Health Administration to participate in Seminars,
Conferences and Workshops organized by the Local & Foreign organizations.

3.5 Indigenous Medical Services.

There are sixteen curative centres function in Northern Province under the Department
of Indigenous Medicine. Among them, Rural Hospitals and District Hospitals provide
indoor care and special treatment in Vavuniya and Jaffna. Further seven herbal
medicine unit provided locally produced medicine and three herbal gardens are being
cultivated to provide medicinal plants in Jaffna and Vavuniya districts in future. About
400,000 patients were treated in 2009 in curative centres.

04. RESOURCE STATUS

Human Resources are the main problem in Health Sector in Northern Province today.
The total cadre for Northern Province is not approved yet; only cadre for Head Offices
and other living cadre were approved by Management Services Department in 2008.
This excludes Teaching Hospital which is falling under the purview of the Line Ministry.

As such, in the year 2002, the approved cadre for Northern Province was 5,527 and it
was reduced to 4,602 in the year 2008. The essential cadre requirement out of the total
requirement for Northern Province was sent to Management Services Department and
they have sent to the National Salaries and Cadres Commission for their observation and
recommendation on 18th September 2009, but the essential cadre for Northern Province
still not approved.

Present Human Resource status in Health Sector, Northern Province is also shown in
annexure (I & II). It is evident that there is an acute shortage in all categories of staffs.

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 Summary of Cadre Vacancies in Northern Province as at 31.12.2009

Categories Cadre Position Vacancies

1 Sri Lankan Medical Service

522 380 142
2 Sri Lankan Dental Service 43 41 2

3 Sri Lankan Adm. Service 0 1 (-1)

4 Sri Lankan Acct. Service 7 5 2

5 Bio Medical Engi. Service 5 0 5

6 Assistant Medical Service 64 28 36

7 Nursing Service 478 446 32

8 Para Medical Service 756 605 151

9 Middle Level Service 203 103 100

10 PPO & PA Service 152 118 34

11 Management Asst. Service 173 177 (-4)

7 Non Technical Service 2,417 2,202 215

Total 4820 4,106 714

Table: 1

4.1 Buildings and Facilities 2009

Out of the 252 total health institutions in Northern Province, except Divisional Hospital,
Pavatkulam in Vavuniya district, all the other major institutions are functioning in own
buildings in Vavuniya, Mannar and Jaffna districts (Kilinochchi & Mullativu districts details
not available properly). In 2009 and 2010, new buildings for Health Institutions with
quarters are being constructed under various donor funded projects especially in early
recovery areas, which will reduce this problem to a great extent in future.

4.2 Machineries and Equipment

Rs. 1.42 Mn was allocated for the Procurement of Medical Equipment, Surgical
Equipment & Non consumable items and expenditure was Rs.1.338 Mn for the Health
Sector, Northern Province.

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5. STATUS OF THE HEALTH SECTOR:
5.1 Health Institutions.
Details of Health Institutions which provide Curative and Preventive Care services in
Northern Province and population by district wise are as follows. (Details of Health
Institutions is shown in annexure I).
Population
Administrative Areas Land Area 2001 Estimated
Sq.Km Census Population
In 2009
01. Vavuniya 1,966.9 143,940 176,457

02. Mannar 2,002.0 106,940 93,961

03. Mullaitivu 2,517.0 77,181 112,056

04. Kilinochchi 1,205.0 100,678 26,107

05. Jaffna 1,023.6 738,788 624,644

Total 8,748.5 1,167,527 1,033,225

Table: 2

Availability of Curative Care Institutions in Northern Province – 2009

Kilinochchi

Mullaitivu
Vavuniya

Mannar

Institutions

Jaffna

Total
District General Hospital 1 1 1 1 - 4

District Base Hospital - - - - 2 2

(Type A)
District Base Hospital 1 - 1 1 2 5
(Type B)
Divisional Hospital 8 9 7 4 22 50

Primary Medical Care Unit 1 6 4 3 16 30

Total 11 16 13 09 42 91

Table: 3

In addition to the above, teaching Hospital is functioning in Jaffna district under the Line
Ministry. The special clinics for Chest (01 for each district) and STD (01 for each district)
are functioning under General Hospitals / Base Hospitals.

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Availability of Preventive Care Institutions in Northern Province – 2009

Kilinochchi

Mullaitivu
Vavuniya

Mannar
Institutions

Jaffna

Total
Gramodhaya Health 41 10 16 13 31 111
Centre

MOH Office 4 5 4 4 11 28

Anti Malaria Campaign 1 1 1 1 1 5

School Dental Clinic 3 2 1 1 10 17

Total 49 18 22 19 53 161

Table: 4

There are 28 MOH Offices and 111 Gramodhaya Centers, which are responsible for the
preventive and promotive aspects of Health care for the people especially for mothers
and children. Besides these there are specialized Campaigns for the control of Malaria,
Leprosy, Rabies, Respiratory disease control and Sexually transmitted diseases.

Out of these 252 Health Institutions in Northern Province, some of them are damaged or
not functioning due to the post conflict situation.
The following institutions are not functioning (Mannar & Jaffna).

NON FUNCTIONING HOSPITALS AND MOH OFFICES IN 2009

Vavuniya

Divisional Hospital, Nedunkerny

Divisional Hospital, Puliyankulam

MOH Office, Vavuniya North
Mannar

Divisional Hospital, Vidataltivu

PMCU Iranaiilluppaikulam

PMCU Marichukaddi

PMCU Periyamadhu

PMCU Pandivirichan

PMCU Vellankulam

MOH Adampan

MOH Madhu

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Jaffna

Divisional Hospital at Maruthankerny

Divisional Hospital at Mandaitivu

PMCU Kankesanthurai

PMCU Mulliyan

PMCU Palaly

Mullaitivu

District General Hospital, Mullaitivu

Divisional Hospital, Puthukudiyiruppu

Divisional Hospital, Mullaiyawalai

PMCU, Oddusuddan

PMCU, Alampil

MOH Office, Mullaitivu

MOH Office, Puthukudiyiruppu

Kilinochchi

Divisional Hospital, Akkarayankulam

Divisional Hospital, Pallai

Divisional Hospital, Tharmapuram

Divisional Hospital, Vaddakachchi

PMCU, Elephant Pass

PMCU, Iranaitivu

PMCU, Kandawalai

PMCU, Vannerikulam

MOH Office, Kandawalai

MOH Office, Pallai

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 Ayurvedha Institutions in 2009

Kilinochchi

Mullaitivu
Vavuniya

Mannar
Institutions

Jaffna

Total
District Hospital 01 01 02

Rural Hospital 02 02

Central Dispensary 02 01 01 09 13

Free Ayurvedha Dispensary 31 04 04 02 43 84

Total 34 05 05 03 55 101

Table: 5

5.2 Health Statistics:

5.2.1 Morbidity and Mortality

Morbidity and Mortality indicators amongst the vulnerable groups of the population have
increased compared to the national figures. Therefore, special emphasis has to be given for
development of these groups. The indicators for the Northern Province are shown below.

5.2.2 Health Indicators.

D/PDHS
Divisions IMR MMR CBR CDR

Vavuniya 25.6 49.00 34.69 6.40

Mannar 15.19 89.37 11.91 3.31

Kilinochchi NA NA NA NA

Mullaitivu NA NA NA NA

Jaffna 14.9 80.6 13.3 6.10

Table: 6 NA- Not Available

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IMR - Infant Mortality Rate
MMR - Maternal Mortality Rate
CBR - Crude Birth Rate
CDR - Crude Death Rate
NA - Not Available

The information presented in the above table has clearly indicated that the Health Situation in
the North is worse than the National figures. But, the health statistics are under reported in
most of the area especially Kilinochchi, Mullaitivu, Vavuniya north and Manthai and Madhu area
in Mannar district. Therefore, the above indicators are not reflecting the actual figures in
Northern Province. It will be improved in future with development initiatives.

The information gives an indication that the district Health System that was so well established
in the Northern Province before the war is badly eroded. To improve the Health Indicators
immediately, it is most desirable to develop the district Health System based on Public Health
Care at the shortest time.

6.HIGHLIGHTS OF PERFORMANCE IN THE YEAR 2009

1. Human Resource Development

A. Appointments in 2009

The following appointments have given by Line Ministry and Ministry of Health, Northern
Province during the year 2009.

Category of Staff No of Appointment

Medical Officer 323

Consultant Physician 05

Consultant Paediatrician 01

Public Health Inspector 09

Health Management Assistant 31

Management Assistant 03

Pharmacist 39

Divisional Pharmacist 01

Midwives 19

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 Nursing Officers 193

Radiographer 06

Bio Medical Technician 04

Spray Machine Operator 16

Sanitary Laborer (Casual) 97

Ordinary Laborer (Casual) 48

Physiotherapist 02

Medical Laboratory Technologist 14

Entomological Assistant 08

Occupational Therapist 01

Table: 7

Promotion in the year 2009

Category of Staff Amount

Nursing Officer Grade- l 02

Nursing Officer Grade – 11 14

Nursing Officer Special Grade 04

Pharmacist Special 02

Pharmacist II A 02

Pharmacist I 02

School Dental Therapist 02

RMO 14

RMO I 01

RMO Special grade 12

Medical Laboratory Technician 01

PHLT (Microscopist) 02

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 SPHI 01

Health Management Assistant I 07

Health Management Assistant II 12

Management Assistant II 01

Drivers I 07

Drivers II 03

Dispensers II 03

PHFO II 01

PHFO I 01

Ordinary Labourer 01

Family Health Officers I 20

Family Health Officers II 05

Table:8

B. TRAINING PROGRAMMES CONCUCTED DURING THE YEAR 2009

Foreign Trainings

• Training Programme for Young Leaders in Japan was conducted under JICA funding from
28th September to 15th October 2009. Dr.K.Nanthakumaran, Medical Officer / Planning from
RDHS office, Jaffna & Dr.P.Sathiyalingam, MOH Office, Vavuniya were participated on it.
• SCPTA Course on Hospital Management in Singapore was conducted on 13th November to
19th November 2009. Dr.(Mrs).B.Pasupathyrajah / Medical Superintendent, DGH, Vavuniya
attended from Northern Provincial Council and selected through Provincial Public
Administration.

Local Trainings

• Three day workshop on Basic Strategic Planning was conducted at SLIDA for Health Staff
from Northern Province from 2nd - 4th December 2009 for 20 participants under HSDP fund.
• In-service Training Program on NIE was conducted in Vavuniya district.

21
• 24 Nos. of Training Programme on HIV/AIDS was conducted for Health staff, Forces,
Youths and NGOO staff in Mannar district.
• 6 Programmes on TB control activities were conducted for Medical Officers, Health staff
and DOT providers.
• TB control activity carried out in Mannar in January 2009 and 110 participants attended
the programme.
• 04 Programmes on capacity building for Public Management Services staff were
conducted in January 2009 in Mannar district.
• World TB Day Programme conducted.

Under GAVI – HSS funds

Mannar.
• In-services Training for Nurses & Midwives on EmOC & Neonatal care in Camp
Management.
• In-services Training for Nurses & Midwives on Lactation Management.
• In-services Training for Health Staff on Prevention of Communicable Diseases.
• In-services Training for Health Staff on Infection Control.
• In-services Training for Health Staff on Re-introduction of Pentavalent Vaccine.

Jaffna
• Conduct training programmes for supervising staff on monitoring and supervision in a
devolved health system.
• Staff performance appraisal will include assessing the completion and timely submission
of monthly and quarterly reports from MOH divisions.

Vavuniya
• In-service Training Programmes were conducted for Public Health Care workers on the
following areas.
1. Control of Communicable Diseases.
2. Nutrition In Emergency.
3. Immunization & Adverse Effective following Immunization.
• In-service training programme was conducted on Importance of Brest feeding.
• In-services training programme on First Aids was also conducted.

Under Unicef fund

Mannar
• Training Programme on inpatient management, malnutrition of children with
complication.
• Training Programme on community based nutrition programme.

22
 Jaffna
• Support for 45 Rural Health Volunteers in the underserved areas.
• Support for Monthly District Health Review Meetings.
• Training programme for adolescent school girls on the importance of adolescent nutrition
• Campaign on the prevention of breast milk substitutes.
• Training Programme on Implement the Nutrition Package (INP), including and Young
Child Feeding Practices for Health Care Works.
• Training Programme on Health life for community leaders .
• Support for Nutrition Exhibition and Community awareness.
• Training Programme on improve knowledge on HIV/AIDS prevention and reproductive
health for Health Volunteers.
• Training Programme on improve knowledge on HIV/AIDS prevention and reproductive
health for Teachers, adolescent out of school.
• Launching Health Campaign through Mothers Club in IDP Camps.
• Training Programme on Emergency Obstetric Care (EmOC) including labour room
Management.
• Training of Trainers Programme to improve knowledge of husbands of pregnant &
lactating mothers.
• Training Programme for low BMI mothers in Jaffna District.
• Support for conduct of monthly maternal mortality prenatal review meetings.
• Training programme for teachers to reactivate school health clubs & coordination the
School Health Club activities.
• Access to water & sanitation to improved in our hospitals & health centers.

Vavuniya
• Two Nutrition Rehabilitation training programme conducted for Public Health Care
Workers.
• Nutrition Rehabilitation Programme was conducted for health staff.
• NIE Training programme was conducted for health & NGO staff.

Under NECORD fund

Training programme for newly recruited Midwives is being carried out with lower qualification
(G.C.E. (O/L)) qualifications at Nurses Training School at Jaffna and Vavuniya for the period of
seven months. The Ministry of Health Care & Nutrition, Colombo has agreed to fund for the
balance 11 months to complete the training by 18 months.

Under World Health Organization fund

• Training on Psychosocial Health Care for Hospital staffs was conducted at District
General Hospital, Vavuniya.

23
2. MAJOR CAPITAL PROJECTS COMPLETED UNDER VARIOUS FUNDED PROJECTS

A. Provincial Specific Development Grant – PSDG

Vavuniya

• Construction Semi Permanent Ward at GH, Vavuniya.

• Completion of Psychiatric ward at BH, Cheddikulam.

• Construction of semi permanent ward (male & female) at Base Hospital

Cheddikulam.
• Construction of Temporary shelter for wards (5nos) at BH Cheddikulam.
• Extension of Labour Room and refurbishment of Maternity Ward at DGH,
Vavuniya.
• Extension of Premature Baby Unit and Mother Baby friendly unit at DGH,
Vavuniya.

Mannar

• Construction of Surgical Complex (3Storey) StageIII at DGH Mannar.

( It will be continued in 2010 annual plan).
• Construction of Temporary Shed (5 Nos.) including Toilets (8 Nos.) & bath tab
at DGH Mannar.
• Extension of Intensive Care Unit at DGH, Mannar.

24
 Jaffna
• Construction of Drugs stores at BH, Chavakachcheri.
• Construction of Divisional Hospital at DH, Karaeddy.
• Construction of Primary Medical Care Unit at Illavalai.
• Construction of Maternity Ward (Stage I) at DH, Manipay.
• Construction of MO Quarters at DH, Karainagar.
• Construction of Gramodhaya Health Centre at Athiyady.

B. Health Sector Development Programme (HSDP)

Vavuniya
• Construction of hostel for the Nurses Training School.

• Construction of Covered way at DGH, Vavuniya and DH, Nudunkerny.

Jaffna
• Construction of Bio Medical Engineering Unit at BME unit, Jaffna.

C. North East Community Restoration Development Project (NECORD).

Jaffna

• Construction of Administrative Block at BH, Chavakachcheri.

• Construction of Drug Store at BH, Point Pedro.
• Construction of consultants’ quarters at BH, Point Pedro.
• Construction of Drug Manufacturing Unit at Atchuvely.
• Provision of Water Supply system to BH, Chavakachcheri.
Vavuniya
• Construction of a workshop for artificial prosthesis at DGH, Vavuniya.
Mannar
• Completion of Building for 3 Storied Ward Complex Stage II at DGH,
Mannar.
• Construction of Central Dispensary with Medical Officers Quarters at PMCU
at Thiruketheeswaram.

25
D. Australian Red Cross

Jaffna
• Construction of Doctors’ quarters at DH Valvettithurai.
• Construction of Drug Stores at DH Valvettithurai.

E. ICRC
Mannar
• Construction of 5 Nos. of Semi Permanent Wards for the IDP’s at DGH
Mannar.

F. UNICEF
Mannar
• Construction of Maternity Ward DH Chilawathurai.
• Construction of GHC at GHC Pallimunai & GHC Nanaddan.

Vavuniya
• Construction of Paediatric ward at BH, Cheddikulam.
• Extension of Paediatric & Maternity Ward at DGH, Vavuniya.
• Construction of 10 Therapeutic Feeding Centre for Nutrition Rehabilitation
Programme at RDHS region.
Jaffna
• Establishment of Mothers and New Born Care Unit at DH Varany especially
for internally displaced population.
• Establishment of Lactation Centres at BH Point Pedro and Chavakachcheri.

F. Japan Assisted Project

Vavuniya
• Construction of Chest Clinic at DGH, Vavuniya.
G. Canadian Red Cross

Vavuniya
• Construction of Medical Officers and Nurses quarters at DGH, Vavuniya.

26
H. German Red Cross
Vavuniya
• Extension of Paediatric Ward, Maternity ward and construction of Surgical
Ward (male & female) with provision of necessary Medical Equipment to BH,
Cheddikulam.

I. World Health Organization

Mannar
• Construction of Semi Permanent Rehabilitation ward at DGH, Mannar.

K. Additional Health Sector Development Project (Addl. HSDP)

Under this project in Kilinochchi and Mullaitivu districts following major renovations
are done to cater the needs of the newly resettled population.
Kilinochchi
• Renovation of Gramodhaya Health Centres at Nachikudha, Murippu
and Sivanagar.
• Renovation of Hospital buildings at BH Mulankavil, DH Uruthirapuram,
DH Akkarayankulam, PMCU Veravil, PMCU Vannerikulam and MOH office at
Jeyapuram.
Mullaitivu
• Renovation of Gramodhaya Health Centre at Muthaiyankaddu.
• Renovation of Hospital buildings at DH Mallavi.
• Renovation of MOH Office, Mallavi.

4. MAJOR MEDICAL EQUIPMENT PROCURRED UNDER VARIOUS FUNDED

PROJECTS
A. Provincial Specific Development Grant (PSDG 2009)
Vavuniya
• Installation of Pipe Medical Gas system at DGH, Vavuniya.
Kilinochchi
• Hospital Furniture & Medical Equipments to all health institutions procured
at a cost of Rs.21.00Mn.
Mullaitivu.
• Hospital Furniture & Medical Equipments to all health institutions procured
at a cost of Rs.5.1Mn.
B. Health Sector Development Project (HSDP)

Jaffna
• Five numbers of Dental Chairs procured for major hospitals and School
Dental Clinics.
27
 Mannar
• Provision of two numbers of Dental Chairs and Medical Equipment to major
hospitals was procured.
Kilinochchi
• Provision of medical equipment to BH Mulankavil at a cost of 4.41Mn.
Mullaitivu.
• Provision of Medical equipment to all health institutions at a cost 4.61Mn.
Vavuniya.

• Provision of Medical Equipment and Bio Medical Reagents to DGH,

Vavuniya.

C. North East Community Restoration Project (NECORD)

Jaffna
• Provision of computed Radiography to upgrade the existing X-Ray machine
at Base Hospital, Tellipalai.

Mannar
• Provision of Pipe Medical Gas System at DGH, Mannar
• Provision of Eye Equipment to DGH, Mannar

D. UNFPA
Vavuniya
• Procurement of CEMONC Equipment, Test Kits for Ante Natal Clinic and
Ultra Sound Scanner to DGH, Vavuniya.
Mannar
• Provision of EmOC Equipment to DGH, Mannar.

E. IOM
• Supply of GI Endoscope to DGH, Mannar.

5. VEHICLES PROCURRED / DONATED UNDER VARIOUS SOURCES OF FUNDS

A. Provincial Specific Development Grant (PSDG)

Kilinochchi
• 01 No Mobile Clinic Bus purchased for the whole RDHS region.

Vavuniya
• 01 no of Bus purchased for Nurses Training School, Vavuniya for the
transportation of students & field visits.
28
B. Health Sector Development Project (HSDP)
Vavuniya

• O2 Ambulances procured for DH Nedunkerney & DH Puliyankulam.

• 01 No. of Auto procured for Nurses Training School, Vavuniya.

Mannar.
• 03 nos.of Ambulances procured to DH Adampan, DH Periyapandivirichchan, DH
Vidattalthivu.

Kilinochchi.
• 03 nos. of Ambulances procured to BH Mankulam, DH Urththirapuram & DH
Akkarayankulam.

Mullaitivu
• 03 nos. of Ambulances procured to DH Mallavi, DH Vaddakkachchi & PMCU
Thunukkai.

Jaffna
• 01 no. of Ambulances procured to DH Ampan.

C. United Nations Population Fund (UNFPA)

Vavuniya
• 01 no of mobile bus donated for RDHS office.

D. Global Alliance for Vaccines Immunization / Health System Strengthening

(GAVI / HSS) funded by Line Ministry

Mannar.
• Ministry of Health Care & Nutrition, Colombo provided 03 Nos. of Motor Bikes to
Public Health Inspectors and 02 Nos. of Mopeds for Family Health Officers.

Vavuniya
• 11 Mopeds distributed among Public Health Midwives.

E. International Organization for Migration (IOM)

Kilinochchi
• One Ambulance with driver sponsored to District General Hospital, Kilinochchi.

Mullaitivu
• Two ambulances with driver sponsored to the hospitals in Mullaitivu district.

29
F. Medical Team International (MTI)
Kilinochchi
• 29 Bicycles donated to the officers attached to RDHS region.
• 02 Nos. of Three-wheelers donated to the use of Institutions in RDHS region.

Mullaitivu
• Pushbikes provided to the staffs attached to RDHS region.

Jaffna
• 01 Ambulance boat to DH Nainativu & 01 Ambulance to BH Chavakachcheri was
donated.

G. Line Ministry fund

Kilinochchi
• One Ambulance donated to DGH, Kilinochchi.

Vavuniya
• 01 Ambulance donated to RDHS region.
• 01 Land Cruser donated by Ministry of Nation Building and Estate Infrastructure
Development to RDHS office.
Jaffna
• 01 Ambulance donated for the purpose of emergency Ambulance services to
RDHS Office.

H. Provincial Fund (By Provincial Public Administration)

Kilinochchi
• 50 Nos. of Bicycles issued to the officers attached to RDHS region.
Mullaitivu
• 06 Pushbikes provided to the Field Officer attached to RDHS region.

I. Unicef
Vavuniya
• 15 nos. of Mopeds for MOH office, Vavuniya.
• 5 nos. of Scooty-peps provided for Coordinating office, Cheddikulam.

6. SPECIAL EVENTS IN HEALTH SECTOR/ NORTHERN PROVINCE

Mannar
• District Tobacco Control Cell was established.
• Endoscopy Unit established at DGH, Mannar with the donation of GI Endoscope
Equipment by IOM.

30
 • World HIV/AIDS day 2009 was celebrated and prizes were given for winner of
HIV/AIDS related art competition for Grade 10 students under NECORD fund.
• School exercise books and school bags were issued for IDP students in Mannar
district under NECORD funding.
• The awareness programme on tobacco control was conducted among school
children.
• Foundation stone laid for the construction of Mental Health ward complex at DGH
Mannar by Line Ministry.

Other Agencies and Organizations involved in Health Related Activities in

R.D.H.S Division, Mannar.

Name of the Organization Activities

1) CARE a) Construction of Toilets.

b) Conduct health awareness programmes.
c) Assisting in emergency WATSAN activities.
d) Distribution of Hygiene packs.
e) Renovation of wells.

2) DRC Conducting awareness programme on

HIV/AIDS.

3) ICRC a) Protection issues related to IDPs.

b) Ensuring access of patients seeking
treatment.
c) Supply of hygiene packs.

4) IOM a) Construction of Toilets.

b) Construction of wells.
c) Conduct health awareness programmes.
d) Assisting in emergency health care
(Eg. Supply of Medical Equipment).

31
5) LEADS Home gardening

6) MARDAP Rehabilitation of differently able persons

7) NECORD a) Rehabilitation of health infrastructure.

b) Supply of medical equipment.
c) Capacity development programmes.

8) OFERR a) Funding mobile clinics in vulnerable areas.

b) Provision of supplementary food to children.
c) Conducting health awareness programmes.
d) Conducting medical camps.

9) OXFAM (GB) a) Lead agency for WATSAN activities.

b) Funding agency for WATSAN activities.
c) Distribution of hygiene packs.
d) Water quality testing.

10) PSL a) Supply of delivery packs.

b) Supporting Health Coordination Meetings.

11) SARVODAYA a) Construction of toilets.

b) WATSAN activities.
c) Assisting in Dengue Control activities.
d) Community Mobilization.

12) Sewa Lanka Foundation a) Assisting in Water and Sanitation activities.

13) SLRCS a) Assisting in Water & Sanitation activities.

b) Providing free night ambulance service.
c) Supply of Hygienic packs.

14) SOLIDAR a) Quick Impact Projects.

1. Supply of solar refrigerators, lighting systems.
2. Supply of generators.
b) Conducting health awareness programmes.

15) UMCOR Funding agency for health promotion activities.

16) UNHCR funding agency for emergency health care activities.

32
17) UNICEF a) Assisting in MCH Activities.
b) Maternal and Child Nutrition activities.
c) Water and Sanitation activities.
d) EMOC.

18) Valvuthayam Assisting in Water and Sanitation activities.

19) ZOA Assisting in Water and Sanitation activities.

Vavuniya
• Mobile Medical and Dental clinics were conducted at IDP camps.
• Accommodation, Meals & other facilities were provided for Mobilized officers for IDP
care.
• Improved Malaria control programme.
• District Health coordination committee established with all stake holders to
coordinate health issues related to IDPs in the district.
• Establishment of Community optical unit & Low vision ophthalmology unit at General
Hospital.
• Established mental health Unit at General Hospital.

7. OPENING CEREMONEY OF HEALTH INSTITUTION / BUILDINGS HELD IN

2009 UNDER VARIOUS SOURCE OF FUNDS.

Mannar
• DH Adampan re-opened.

• PMCU Thiruketheeswaram Opened.

33
Jaffna
• Construction of building for Drug store at BH Point Pedro.

• Construction of two storied consultant quarters at BH Point Pedro.

• Construction of a building for manufacturing of Ayurvedic Drugs in

Atchchuveli.

• Construction of a building for OPD Block at Primary Medical Care Unit at

Urumpirai.
• Completion of Administrative Block with OPD at Base Hospital,
Chavakachcheri.
• DH Karaveddy opened in new place.
• PMCU Illavalai opened.
• MO Quarters & Drug Store at BH Point Pedro opened.

34
 Vavuniya

• Extension of Maternity & Pediatric Ward at DGH Vavuniya.

Kilinochchi
• Renovation & Re-opened of DGH Kilinochchi.

Mullaitivu
• Renovation & Re-opened to DH Mallavi.

35
07. A. ISSUES RELATED TO HEALTH SERVICES IN NORTHERN PROVINCE

1. Shortage of Health Personnel

In Northern Province, there is severe shortage of Health Personnel specially Consultants,

Medical Officers, Para Medical and other category of staffs.
After de-merger of the Northern and Eastern Provincial Councils the Management Service
Department agreed the cadre only for Head offices. The cadre for Health Institutions
and upgraded hospitals is not approved yet.
In the year 2008, cadre approval was given by Management Services Department as the
approved cadre in 2002 reduced in 2008 to the then in position. The cadre requirement
has to be approved in all categories of staffs.

a) Shortage of Specialists (Consultants)

At present 27 Consultants are available in Northern Provincial Hospital including 19

consultants were appointed temporarily for IDP care services at District General Hospital,
Vavuniya. The Cadre for the entire Northern Province for Specialists is 101 before the
de-merger of Provincial Councils and reduced to 7 at present.
There are no Consultants in Kilinochchi, Mullaitivu & Jaffna RDHS divisions. Province has
almost 90% of vacancy for the specialists.

b) Shortage of Medical Officers in Northern Province.

There is acute shortage (more than 50%) of Medical Officers especially in whole districts
in Northern Province. Only 320 Medical Officers are working including the 105 Medical
Officers were appointed temporarily for IDP care services to Vavuniya district. In all the
above stations the Medical Officers have been transferred within a short period without
replacement.

c) Shortage of Paramedical Staffs in Northern Province.

At present only 604 Para Medical Category of staffs are available according to approved
cadre of 653 in 2009.

36
2. Appointment & Transfer of Medical Specialists, Medical Officers &
Paramedical Staff
Appointments & transfers of Medical Officers, Dental Surgeons, Nursing Officers and Para
Medical staffs are made directly by the Line Ministry to the respective Health Institutions
of the Northern Province without consulting the Provincial Authority.

According to 13th amendment training of Medical & Para medical staff is concurrence
subject. To be devolved to the Provincial Council and provide facilities and technical
input such as syllabus and guide lines to conduct examination to maintain the national
standard.
Appointment, transfer, promotion and disciplinary action of Medical officers and Dental
Surgeons are done by Line Ministry. The provincial authorities only empowered to hold
preliminary inquiries and payment of salary in other benefits such OT, Holiday Pay and
loans etc. The authority to transfer officers within the province according to the needs
and existence of service and disciplinary authority (as per E-code) to be devolved to the
provincial council. And also unwillingness of Medical & Para Medical personnel to serve
in un-cleared areas is affecting the medical services to the population.

3. Inadequate Technical staff such as Engineers, Technical Officer & Health

Planners
(Architect)

Technical staffs are inadequate for development work such as Engineers, Technical
Officers, Health Planners (architect) to minimize the delay and to maintain the accuracy
in preparation of Plans & Estimates.

4. Insufficient allocation from Provincial Treasury for payment of OT, Holiday payment,
advanced to Public Servants and for Salary Revision.

5. Insufficient allocation for drugs, dressing and instruments by the Central Treasury.

6. Non availability of special investigation facilities in the Tertiary care Institution in

Northern Province. (E.g. CT Scan, MRI & Echo Cardiogram and biochemical test such as
Lipid Profile, Serum and Urinary Creatinine tests).

7. Laboratory facilities are not sufficient in some institutions.

8. Accommodation facilities are limited for visiting staffs from other provinces and also
quarters for the staffs working in early recovery areas are not available at present.
Staffs are facing severe hardship to work in these areas.

37
9. Medical and Paramedical staff reluctant to work in Early Recovery Areas due to lack of
facilities as transport and communication.

10. Emerging and re-emerging the following diseases.

o Dengue
o Mental Health
o HIV / AIDS
o Tuberculosis

There was an epidemic of dengue fever reported in Vavuniya and Jaffna district in 2009.
Dengue fever cases increased with the onset of monsoon rain in November. In
December 2009 the Hon. Governor appointed Task Force for Dengue Control to
coordinate and control dengue in Vavuniya district. Clean up campaign were organized
at community level in all the places. Department of Local Government also involved in
garbage removal activities with the help of NGOs.
Regular aerosol fogging was done to destroy mosquitoes in affected pocket areas.
Awareness programmes were conducted in schools to promote school children in dengue
control activities in their houses and vicinity. Number of cases reported in Vavuniya and
Jaffna were 1,089 and 308 respectively and deaths were 20 in Vavuniya and 5 in Jaffna
district in 2009.

11. Inadequate Training to staff in Modern Techniques.

To improve and maintain the Health of people, the preventive services staffs are very
essential. The present Training Programme for most of these categories taken for
training each year is inadequate.

12. Scholarships
The quota of Scholarships for Northern Province for the Health Personnel is not
adequate. Foreign Scholarships for Medical Officers and other Health Personnel
presently available to the Ministry are not sufficient to meet the training needs of the
Medical Officers and other Health Personnel.

13.Difficult to provide Emergency Hospital Care.

Access to emergency health care to the Early Recovery Areas is very difficult as the
development activities are in progress and inadequate human resources especially
Specialist Medical Officers, Medical Officers and Para Medical Staffs etc.

38
14. Improper Clinical Waste Disposal Methods.

In some institutions, Clinical disposal methods are not available. It will cause
environmental hazards to the people.

Inadequate water sanitation facilities to the IDPs, it is difficult to construct latrines due
to non availability of building materials.

15. Temporary Recruitment of AMOO

At present 52 AMOO/RMOO are working (including 24 re-employees) at the in Northern

Province out of the cadre of 64. According to the General Circular No. 09/2007 re-
employment is stopped above 67 years of age. Therefore, recruitment of Assistant
Medical Officers is long felt need as they are covering the vacancies in the peripheries in
most of the districts in Northern Province.

08. FINANCE

The Finance Division of the Ministry of Health & Indigenous Medicine is headed by Chief
Accountant of Ministry and there is separate Chief Accountant from Head Quarters also
responsible for the regional finance discipline in each Provincial Departments.

The finance division of the Provincial Department of the Indigenous Medicine comes
under the purview of the Ministry earlier. Now it is functioning separately under
Provincial Director of Indigenous Medicine from 1st January 2006.

In January 2009, Procurement Cell was established and it is functioning under the
Accounts branch with the help of Bio Medical Engineer of the Health Ministry. Great
need is felt for the establishment of an Internal Audit and stock verification Branch for
the effective working of the Health Institutions. The delay in the establishment of the
above branches is due to lack experienced staffs.

PROGRESS OF SPECIAL PROJECTS (HEALTH AND AYURVEDIC SECTOR)

A. Progress of the Capital Works in 2009

In 2009, the financial progress is 78% against the imprest received. The total allocation
for the sector including the provincial and project funds including NGOs and INGOs was
Rs.1, 378,154 and Rs. 1,080,220 expenditure was reported for the whole year.
Allocation and Expenditure under PSDG which is the major source from the local
contribution for the Health Sector for last 10 years is given in Annexure ……

39
Provision of Capital Expenditure under PSDG in 2009

Departments Allocation Imprest Expenditure

(In ‘Mn’) Released (In Mn’)

Jaffna 72.170 67.209 67.209

Vavuniya 59.808 59.416 59.589

Mannar 41.120 38.542 38.542

Mullaitivu 5.752 5.726 5.726

Kilinochchi 26.150 26.107 26.107

205.000
Total 197.000 197.173

Table: 9

Chart 5

40
 Provision of Capital Expenditure under HSDP in 2009

Departments Allocation Imprest Expenditure

(In ‘Mn’) Released (In Mn’)
PDHS Office 5.117 5.096 5.096

Vavuniya 38.190 37.010 35.496

Mannar 27.342 27.342 26.643

Kilinochchi 5.410 5.410 5.409

Mullaitivu 5.605 5.605 5.605

Jaffna 32.397 32.397 32.326

Total 114.06 112.86 110.575

Table: 10

Chart 6

41
 Provision of Capital Expenditure under HSDP in 2009 / 2010

Departments Allocation Imprest Expenditure

(In ‘Mn’) Released (In Mn’)
PDHS Office 30.00 - -

Vavuniya 231.53 47.755 50.45

Mannar 207.23 53.138 53.84

Kilinochchi 168.45 41.095 41.10

Mullaitivu 200.04 29.483 29.48

Jaffna 244.18 64.390 64.46

Total 1,081.43 235.861 239.33

Table: 11

Provision of Capital Expenditure under Additional HSDP 2009 / 2010

Chart 7

42
 Capital Expenditures under HSDP 2005- 2009

Allocation Expenditure
Year
(In Mn) (In Mn)

2005 52,000,000 51,955,201

2006 89,155,410 88,425,203

2007 101,958,700 101,770,187

2008 100,649,568 100,649,000

2009 114,063,319 46,131,624

Total 457,826,997 388,931,215

Table:12

Capital Expenditures under HSDP 2005- 2009

Chart 8

Chart 8

43
 Capital Expenditures under UNICEF in 2009

S.No RDHS Allocation Imprest Expenditure

Divisions (in Mn) Released (in Mn)
(in Mn)
1 Jaffna 8.119 8.119 8.119
2 Vavuniya 24.267 24.267 24.267
3 Mannar 16.113 16.113 7.062
4 Mullaitivu - - -
5 Kilinochchi - - -
Total 48.499 48.499 39.448

Table: 13

Chart 9
Progress of Recurrent Expenditure in 2009 ******

S. No Sector Provision(Rs.) Expenditure(Rs.)

01. Recurrent Expenditure (Health) 1572,159,500.00 1571,990,823.03

02. Recurrent Expenditure 48,876,000.00 48,399,150.00

(Indigenous Medicine)
03. Capital Expenditure PSDG 197,200,000.00 197,172,710.12
(Health)
04 Capital Expenditure PSDG 32,000,000.00 24,340,643.44
(Indigenous Medicine)
05. Capital Expenditure HSDP 553,000,000.00 355,496,595.64

06. Capital Expenditure CBG (Health) 3,232,000.00 3,223,103.01

07. Capital Expenditure CBG 37,500,000.00 34,107,614.21

(Indigenous Medicine)

Table 14

44
 Annexure II

Approved Cadre as at 2008.12.31- Head Office

Department of Indigenous Medicine, NP

DMS
Approved Present
S.No Post Service Cadre position Vacancy

1 Provincial Director SLAyur.s I 1 1 0

2 Accountant SLAcS II / II 1 1 0

3 Medical Officer SLAyur.s II / I 17 17 0

Ayurvedic Medical Officer
4 (Public Health) SLAyur.s II / I 16 17 -1

5 Administrative Officer MAS Supra 1 1 0

6 Ayurvedic Pharmacist Para MS 1 0 1

7 Nursing Officer NOS 8 8 0

8 Public Nursing Sister NOS 1 0 1

9 Ayurvedic Dispensar DL 3 3 0

10 Programme Assistant - 11 11 0

11 MLT MLTS 1 0 1

12 Management Assistant MAS I 1 0 1

13 Management Assistant MAS III, II 8 6 2

14 Driver IIA, IIB 2 2 0

15 Watcher OES II 1 1 0

16 Office Employee OES III, II, I 3 3 0

17 Pharmacy Labourer Labo. Gr 4 4 0

18 Attendant Labo. Gr 4 4 0

19 Ordinary Labourer OES III 10 10 0

20 Sanitary Labourer (Hospital) OES III 8 8 0

Total 102 97 6

50
 Annexure III

Details of Vehicles in Health Sector / Northern Province on 31.12.2009

Tractor / Tractor Trailor

Bus / Mobile Bus/

Vaccine Carier
Gully Emptier
RDHS Division Institution

LandCruiser
Ambulance

Dental Bus
Wheeler
Pick Up

Three
Lorry
Jeep

Van
B.H.Point Pedro
Jaffna 3
D.H Kopay
1
D.H Karaveddy
1
DH Alaveddy
1
D.H.Kodikamam

D.H.Kondavil
1
D.H.Pandaththarippu
1
D.H.Vaddukkoddai
1
D.H.Velanai
1
BH Chavakachcheri
2
BH Kayts
1
DH Tellippalai
1
DH Valvettithurai
1
DH Atchuvely
1
DH Chanakanai
1
DH Karainagar
1
DH Maruthankerny
1
D.H.Analaitivu
2
DH Nainativu
1
D.H.Delft
1
RTC Jaffna
1
Cancer Unit Jaffna
1
Chest Clinic
1
RE/MO Planning
1
Cancer Hospital Tel
1
Psychiateract team
1
Mobile Lab
1
A.M.C Jaffna
2
DTCO Jaffna

MOH Thellippalai
2
MOH.Point Pedro
1 1
MOH.Manipay
1 1
Health Cordinator O
1

51
 Annexure III

Tractor / Tractor Trailor

Bus / Mobile Bus/

Vaccine Carier
Gully Emptier
RDHS Division Institution

LandCruiser
Ambulance

Dental Bus
Wheeler
Pick Up

Three
Lorry
Jeep

Van
Colombo
1
BME
1
R.D.H.S Jaffna
5 2 3 4 2 2 1

Kilinochchi DGH / Kilinochchi 1

Div.Hos / Akkarayan 1

BH Mankulam 1

Div.Hos / Tharmapuram

Div.Hos / Mulankavil

Div.Hos / Uruthirapuram 1

Div.Hos / Vaddakachchi

Div. Hos / Veravil

PMCU / Kandawalai

PMCU / Arasapuram1

PMCU / Jeyapuram

Kallaru Centre

MOH Office / Poonakary

MOH Office /
Kilinochchi
MOH Office /
Kandawalai

AMC / Kilinochchi

RDHS Office 4 2 1 1

Vavuniya DGH / Vavuniya 1 6 1 1

BH / Cheddikulam 1

Div.Hos / Nedunkerny 1

Div.Hos / Ulukulam 1

Div.Hos / Pavatkulam
Div.Hos /
Poovarasankulam 1

Div.Hos / Neriyakulam 1
Div.Hos /
SIthamparapuram 1

PMCU / Mamaduwa 1

PMCU / Puliyankulam 1

AMC / Vavuniya 3

MOH Office / Vavuniya 2

MOH Office /
Vavuniya North

51
 Annexure III

Tractor / Tractor Trailor

Bus / Mobile Bus/

Vaccine Carier
Gully Emptier
RDHS Division Institution

LandCruiser
Ambulance

Dental Bus
Wheeler
Pick Up

Three
Lorry
Jeep

Van
MOH Office /
Vavuniya South 1
MOH Office /
Cheddikulam 1

NTS 1 1

IDP Pampaimadu 1

Chest Clinic 1

RDHS Office 3 1 5 2 1 1

Mannar DGH / Mannar 1 4

Div.Hos / Adampan 1

Div. Hos / Talaimannar 1

Div. Hos / Chilawathurai

Div. Hos / Murunkan 1

Div. Hos / Vidathaltivu 1

Div. Hos / Pesalai 1

PMCU / Vellankulam

PMCU / Periyamadhu 1

Div.Hos / Erukkalampiddy 1

Div.Hos / Nanattan 2

Div.Hos/ Vankalai 1

PMCU/Thiruketheeswaram 1
PMCU /
Periyapandivirichan

MOH Office / Mannar 1

MOH Office / Musali

MOH Office / Adampan 1 1

MOH Office / Murunkan 1

AMC / Mannar 2

RMSD

RDHS Office 5 2 2 1 1

Mullaitivu DH Mallavi 1

DH Vaddahachchery 1

PMCH Thunukkai 1

51
 Motor Car / Motor Coach

Annexure III
51
 Motor Car / Motor Coach

Annexure III
51
 Motor Car / Motor Coach

Annexure III
51
 Annexure IV

Details of Generators in Health Sector / Northern Province on 31.12.2009

District Institution No. District Institution No.

Jaffna BH / Point Pedro 3 KilinochchiDGH / Kilinochchi 4

Div. Hos / Valvettithurai 2 Div.Hos / Akkarayan 2

BH/ Tellipalai 4 Div.Hos / Tharmapuram 2

BH / Chavakachcheri 2 Div.Hos / Mulankavil 2

BH / Kayts 2 Div.Hos / Uruthirapuram 1

Div.Hos / Delft 1 Div.Hos / Vaddakachchi 1

Div.Hos / Punkudutivu 1 Div. Hos / Veravil 1

Div.Hos/ Kopay 2 PMCU / Kandawalai 1

Div.Hos / Atchuveli 2 PMCU / Arasapuram 1

Div.Hos / Karainagar 1 PMCU / Jeyapuram 1

Div.Hos / Nainativu 1 MOH Office / Poonakary 1

Kilinochchi
Div.Hos / Analaitivu 1 & AMC Office 1

Div.Hos / Chankanai 2 RDHS Office 1

Div.Hos / Pandaterippu 1

Div.Hos / Velanai 1

Div.Hos / Maruthankerni

Div.Hos / Vaddukoddai 2

Div.Hos / Alaveddi 1

Div.Hos/Gurunagar 1

Div.Hos / Kondavil 1

Div.Hos / Karaveddy 1

Div.Hos / Kodikamam 1

MOH Office / Manipay

MOH Office/ Point Pedro 1

MOH Office / Kayts 1

MOH Office / Chavakachcheri1

MOH Office/ Tellippalai 1

RDHS Office 1

RMSD Jaffna 1

Regional Training Centre 2

54
 Annexure IV

District Institution No. District Institution No.

Mannar DGH / Mannar 2 Mannar Div.Hos/ Nanattan 1

Div.Hos / Adampan 1 Div.Hos / Vankalai 1

Div. Hos / Talaimannar 2 MOH Office / Mannar 1

Div. Hos / Chilawathurai 1 MOH Office / Musali

Div.Hos / Pesalai 1 Div.Hos/ Murunkan 1

Div. Hos / Vidathaltivu 1 MOH Office / Adampan

PMCU / Vellankulam MOH Office / Murunkan 1

Div.Hos/Periyapandivirichan 1 RMSD

Div.Hos/ Erukkalampiddy 1 RDHS Office 1

54
 Details of Generators in Health Sector / orthern Province on 31.12.2009

District Institution o. District Institution o.

Vavuniya DGH / Vavuniya 2 Mullaitivu DGH / Mullaitivu 3

BH / Cheddikulam 1 Div.Hos / Puthukudiyiruppu 2

Div.Hos / Nedunkerny 1 Div.Hos / Mallavi 1

Div.Hos / Puliyankulam 1 Div. Hos / Mankulam 1

Div.Hos / Poovarasankulam 1 Div. Hos / Nanattan 1

Div.Hos / Neriyakulam 1 PMCU / Oddusuddan 1

Div.Hos / Ulukulam 1 PMCU / Alambil 1

Div.Hos / Sithamparapuram 1 MOH Office / Mullaitivu 1

PMCU / Mamaduwa 1 MOH Office / Puthukudiyiruppu 1

MOH Office / Vavuniya 1 MOH Office / Mallavi 1

MOH Office / Vavuniya North 1 MOH Office / Oddusuddan 1

MOH Office / Vavuniya South 1 RDHS Office 1

MOH Office / Cheddikulam 1

RDHS Office 2

District Institution o. District Institution o.

Mannar DGH / Mannar 2 Mannar Div.Hos/ Nanattan 1

Div.Hos / Adampan 1 Div.Hos / Vankalai 1

Div. Hos / Talaimannar 2 MOH Office / Mannar 1

Div. Hos / Chilawathurai 1 MOH Office / Musali

Div.Hos / Pesalai 1 Div.Hos/ Murunkan 1

Div. Hos / Vidathaltivu 1 MOH Office / Adampan

PMCU / Vellankulam MOH Office / Murunkan 1

Div.Hos/Periyapandivirichan 1 RMSD

Div.Hos/ Erukkalampiddy 1 RDHS Office 1

41
 Annexure V

CAPITAL EXPENDITURE (JBIC/PSDG) - 1999 to 2009

HEALTH SECTOR, NP

Year Allocation Expenditure Percentage

1999 313,300,000 157,294,180 50.21%

2000 353,000,000 248,580,000 70.42%

2001 375,000,000 219,699,902 58.59%

2002 280,000,000 223,261,084 79.74%

2003 125,000,000 105,270,080 84.22%

2004 125,000,000 81,159,520 64.93%

2005 210,000,000 126,507,283 60.24%

2006 275,000,000 200,000,000 72.73%

2007 30,000,000 17,899,874 59.67%

2008 30,000,000 30,083,730 100.28%

2009 205,000,000 197,172,710 96.18%

56