Health and health services on plantations in Sri Lanka

Abstract

The health status of Sri Lankan plantation workers and their families has dramatically improved since nationalization in 1975. Before this time the health status of estate workers most of whom are Indian Tamils was adversely affected by poverty overcrowding poor water and sanitation and inadequate health services. After independence most of the estates joined the Planters Association Estates Health Scheme which undertook activities such as collection of vital and disease statistics family planning education and mobile clinics for vasectomy laboratory services and in-service training of medical assistants. However as privately owned profit-making concerns the estates did not implement a uniform policy or provide uniform health services. As a result health indicators remained static on the estates while they improved steadily in Sri Lanka as a whole. State ownership of the plantations and the uniform health policies that followed have had a clear impact on the health status of estate workers. The infant mortality rate for example has dropped from 74/1000 live birth in 1982 to 46/1000 in 1985 and the gap in mortality rates between the estate and village sectors is narrowing. The components responsible for this shift in health status include full-time staff responsible for health and social development within the plantation organizations; systematic provision of maternal-child health services in the form of antenatal and family planning clinics improved access to facilities for delivery and immunization services; recruitment and training of assistant medical practitioners and midwives by the Ministry of Health; and the establishment of a health information system. At present the Ministry of Health is debating whether health services for plantations should be integrated with national health programs and structures.