Journal of General Practice

Family Physicians without a Defined Target Population in Sri Lanka

Abstract

Rasnayaka M Mudiyanse

Sri Lanka is known for its commendable healthcare indices in the region. Now the country is going through a transition of economic development after the devastation as a result of a 30-year war and the natural disaster of a tsunami in 2004. At the same time, there is a demographic and epidemiological transition. The proportion of older population is increasing with a simultaneous increase in non-communicable diseases. The country is achieving its millennium development goals through improving neonatal mortality, infant mortality maternal mortality, vaccination coverage and life expectancy, mainly because of the maternal and child health care services delivered to the public on a well-structured target population. However the target population for delivery of ambulatory care has not been strictly defined. Freedom of visiting doctors without referrals in a background of not having a target population has created many problems. Optimum utilization of expert services has been hampered due to overcrowding and maldistribution of service demand. Commercialization of healthcare has extended to inappropriate importation of drugs and opening up of pharmacies. Out-of-pocket spending for out-patient care has escalated over the years at a significant rate probably contributed to by individual investments in health promotion or NCD prevention. Lack of responsibility to a target population has undermined the doctor patient relationship that is probably contributing to some of the prevailing undesirable behavior patterns of healthcare professionals. Organizational reforms including recognizing target populations and promoting patient centered approaches in establishments and teaching and training on competencies for family physicians, starting from the undergraduate curriculum, would be a worthy investment in the future health of the nation.