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LABORATORY SERVICES

Introduction

The term the Lab Service's is a misnomer.  A better term for this programme area would be Medical Technological, Investigative & Supply Services. The service institutions involved are; the Laboratories, Radiological imaging services, Cancer control inclusive of the Cancer institute, Rehabilitative Services, the National Blood transfusion service, Medical Supplies division, Bio Medical Engineering Services, Division of Medical Technology and Supplies and the national Drugs Quality Assurance Laboratory.

Policy Perspective

The overriding policy concern is to provide cost-effective investigative services using appropriate technology, to ensure essential medical supplies.

Problems

A major concern has been the inability to maintain electro-medical equipment in working order.  Prophylactic maintenance has been conspicuous by its absence.  Medium term maintenenace agreements have therefore been incorporated  into tenders for purchase of electro-medical equipment of high cost.

Intra/Inter Sectoral Implications

The responsibilities of the Laboratory Services has implications for Public Health Services in addition to the obvious role in the curative services.  Use of radio isotopes in investigative services and the use of deep ray therapy makes it mandatory to work in close co-operation with Atomic Energy Authority.

External Assistance

The main external assistance to the Lab services was the pledge of supply of equipment through the Korean assistance project, and the negotiation of equipment for the new Cardio thoracic unit of the Kandy hospital, through French aid 1.

Main achievements

A CT scanner was commissioned in the Galle hospital.  Mini laboratory facilities were provided to a number of rural institutions, with the understanding that the Medical officers will, with existing staff, perform basic laboratory investigations.  This initiative needs to be evaluated.  ECG machines were also provided on the same basis.  It is hoped that the image of  the peripheral level institutions will be enhanced by these initiatives and that they will be better utilised.

Problems and Issues

Resource constraints continued to hamper supplies of equipment.  The efforts to decentralise the BES were also affected by lack of manpower.  The acute shortage of manpower in the middle level technical grades is a major impediment to the expansion of investigative services in the rural areas.

Policy Analysis

The BES decentralisation should be persued more vigorously.  The technical manpower should be recruited, trained and deployed.  The provincial councils should consider investing in Provincial BES branches.  Preventive maintenance should be undertaken on a planned and regular basis.  All high tech/cost equipment should have maintenance agreements built into the tender specifications.

Main strategies to ensure better programme output

All staff handling equipment should be trained, initially as well as at regular intervals.  Manuals should be available on handling of these items.  Spares should be available in the institution itself, where feasible.

MEDICAL SUPPLIES DIVISION   (MSD)

Introduction

Medical Supplies Division (MSD) supplies pharmaceuticals and other supplies except those that supplied by Bio Medical Engineering Division to all health institutions in the country either directly or through regional Medical Supplies Division, which are under Provincial Councils. The total budget is approximately is 13% of the health budget. The number of items supplied is about 5,000 at the request of the institutions and are supplies quarterly, annually or on urgent request. The Director is a Medical Administrator under whom there is a Senior Assistant Director and eight Assistant Directors, two Planning & Programming Assistants, Administrative Officer, two Accountants and Eight Sectional Heads. There are 23 stores which are In charge of Storekeepers.

Policy

Is to supply safe effective, quality drugs and other supplies whenever and wherever needed equitably at a reasonable cost to the state.

Legislations, Rules and Regulations

Medical Supplies Divisions procedures are governed by Cosmetics, Devices and Drugs Act, Poisons Opium Dangerous Drugs ordinance, Manual of Managements of Drugs, Establishment Code, Financial Regulations and circulars issued by Public Administration and Ministry of Health Development Activity

One of the major development activity was the Phase I of the computerization of MSD supplies costing 3.3 million which has included all items supplies by MSD compared to what was available, was only the drug. Application software development is in the process. Establishment of Drug Information Centre and obtaining part of the manpower requirement. Proposals for the material requirement has been completed and pending approval by WHO. Revision of Estimate Books after 3 years and identifying special drugs required and also "Orphan Drug" which are required occasionally.

 Division of the Laboratory Stores in to two separate stores as glassware and chemicals and giving these two sections in charge of separate Storekeepers(S.K.) Pricing of all p items in the Lab Stores which has not been done from the time it has been transferred from MRI.

 Obtaining Telephone Facilities to Dispatch Section. Expanding the main security building and re-modeling main gate to check all vehicles entering MSD. Also building security huts, numbers 3. to strengthen the security of the institution.

 Inter sectoral co-ordination

Co-ordination will all NGOO to receive all gift items supplies to North & East and transferring them through departmental channels. Participating in all NGO meetings, Clearing all gift items consigned to Ministry of Health from various organization local and foreign.

Providing transport to local and foreign agencies to distribute gift items to Health institutions and other ministerial programs. Conducting meeting with SPC with respect to management of medical supplies. Establishment and participation of drug review committees in other institutions.

 International Health Issues

 MSD in its activities conforms to international issues with respect to pharmaceuticals and other supplies, particularly the policies of WHO with respect to quality safety and efficacy. Also the conventions held by international narcotic control board with respect to Narcotics, Psychotropic, substances and precursor control abuse.

International Assistance & co-operation

External assistances is obtained by WHO,UNICEF,JICA,JICKWEIL and other agencies in providing supplies, advice and monitoring, training programmes.

Personal Administration

The administration of staff with 13 categories is done according to the existing rules and regulations. Some of the vacancies of staff categories like Pharmacists, Storekeepers and Clerical were filled during the year of reference.

 Training of Storekeepers were done one for the year and the training of new storekeepers were done when they reported for duty. Regular inspection of staff for attendance was done with the assistance of Assistant Directors, Directors during the year. Welfare activities are carried out adequately providing financial aids whenever necessary by the welfare Society .First Aid facilities were provided to the staff.

Main achievements

Up to 1996 no recoveries had been made for any lab items due to non pricing of the same. Bills have not been send to the institutions. This has been streamline and recoveries are made after sending the bills to the institutions.

Out of almost 5000 items supplied only about 650 items were entered to the computer. This year all items had been given stock reference Nos.(SR Nos.) and entered into the computer. Once the software is developed completely, supplies and financial accountability will be greatly streamlined. Regular inspection staff and random checking of stocks have been intensified with the help of other staff officers to prevent not being in the work palace and pilferage. The amounts of money spent on local purchase of drugs have been reduced compared to the previous years.

Stock out position in the health institutions have been reduced to the minimum with respect to estimate book drugs.

 Problems

Shortage of staff

Senior Asst.Director post has not been confirmed

01 post of Assistant Director is vacant

01 post of Storekeeper is vacant

05 posts of drivers are vacant

01 post of Medical Laboratory Technologist is vacant

Reconciliation of outstanding debts from provincial councils for supplies made have not been confirmed.

Non payments for items transferred out with respect to surgical and laboratories non consumables from their capital votes of the institutions have not been settled.

Delays in recovering moneys for supplies made to institutions.

Delays in supplies to MSDF after sending order list (long lead time).

Schedules given for supplies to MSD are not adhered to.

Non realistic estimates from peripheral institutions due to non functioning of Drug Review Committee.

Lack of co-ordination of personal between health institutions, RMSD and MSD. Inadequate Cool Room facilities.

Finance

 Allocation for year 2002 for purchase of medical items Rs. 4,900,000,000

Total expenditure and commitments up to 31.12.2002  

Future options and Strategies

Expanding the computer system to the proposed phase II & III.

Expanding Cool Room facilities at MSD and RMSD.

Expanding telecommunication facilities to all stores and other sections.

Developing dispatch section to accommodate all items. (Surgical & Lab. Items) Update circulars which has been published up to now.

Conducting in-service training programme for storekeeper and pharmacist in charge of stores.

Intensifying inspection and monitoring of the process of management of drug supplies at MSD.

Co-coordinating and establishing Drug Review Committee.

Minimizing condemning of items due to past expiry dates.

Minimizing our of stock positions.

NATIONAL DRUG QUALITY ASSURANCE LABORATORY

Introduction:

The National Drug Quality Assurance Laboratory (NDQAL) provides the technical support needed to operate the quality assurance system in Sri Lanka. This is done by monitoring the compliance of Pharmaceutical products with respect to quality, safety and efficacy at Pre and Post marketing stages and issuing recommendations on suitability of the product based on the findings of the laboratory. 

Organisation:

Staff at NDQAL consists of the Director, Deputy Director, Pharmaceutical Analysts, Pharmacists and other laboratory and office staff.

Main Achievements

1.      804 samples were analysed at both Pre and Post marketing stages and recommendation were given on those.

2.      Action has been initiated to purchase the following Laboratory equipment for a value of Rs 4,684,768.00 to NDQAL during the year 2002.

Cool incubators (2), Laminar air flow, Oven, Analytical balance, Potentiometer, Disintegration apparatus, Vacuum oven, pH meter with printer.

Problems and Issues

1.      Long delays in recruitment of technical staff categories.

 2.      Non availability of continuos funding for obtaining postgraduate qualifications

      for officers of the scientific service to fulfill the second efficiency bar within the

      stipulated 08year period.

 3.      Expansion of the laboratory and increasing of the cadres of the technical staff to

      handle the increasing workload.

 4.      Non availability of continuous foreign funding for upgrade of technical training of

      staff.

5.      Delay in locating specific batches of pharmaceuticals, which are of substandard

      quality for further analysis, hamper recommendation on final decision on  

      withdrawals.

 NATIONAL BLOOD  TRANSFUSION SERVICE (NBTS)

National Blood Transfusion Service in Sri Lanka consists of Central Blood Bank (CBB)   and 57 Regional Blood Banks (RBB).  Main function is supplying safe blood in adequate amount.  All Blood Banks perform the above functions.  They are been regularly monitored by the Central Blood Bank and collects data every month from regional Blood Banks

 Existing system had been reviewed to get maximum productivity and quality. Therefore structural pattern of the NBTS was updated.  Draft National Blood policy is in pending approval of the Cabinet.  Guidelines for Blood collection were distributed among all the Blood Banks.

Following the International Conference on Blood safety which was held on World Health Day 7^th of April 2000, at BMICH, expertise of Transfusion Medicine from India, Pakistan, Bhutan, Nepal, Bangladesh and Sri Lanka decided to formulate a SAARC Association of Transfusion Medicine for the upliftment of blood transfusion in these countries.  D/NBTS was selected as the President of this association.

According to new system 9 provincial Blood Banks attached to major hospitals will be updated to the standard of Central Blood Bank.  Small Regional Blood Banks will come under the relevant provincial Blood Banks under the National Blood Programme.

Therefore screening and processing of Blood will be done only at PBB. RBB are involved in collecting and issuing screened blood for recipients.  Blood Banks in Private Institutions will be getting screened blood from relevant PBB/ RBB for transfusions.

Blood storage guidelines and curriculum for training of MOO in Private Institutions are formulated.

Steps were taken to implement a new project to house NBTC at Narahenpita with aid of JBIC.

Mobile Blood Collection

Most of the Mobile Blood donation programmes in the provinces were allocated to relevant PBB/RBB.  Mobile Blood collecting vehicles were allocated to 4 provinces.  Public Health Inspectors were appointed to 4 provinces, to initiate National Blood Programme.

 Education Programme

 3^rd Batch of MOO to train in Dip in TM was selected in August and 1^st batch sat for the final exam in October.

 4 MOO were nominated for followships to update their knowledge in RCR technique and new plasma component techniques.  International Conference was held on the World Health Day to update the knowledge in safe Blood Transfusions.

 Blood  Collection

 From Jan – Dec 2000 Blood collected from 153,729 donors.  Donor organizers were awarded with certificates and Regular donors who donated blood more than 25 times were awarded with medals and certificate on World Health Day.

 Screening of Blood.

 Screening of blood for Hbs Ag and HIV I/II are done by ELISA technique and HIV screening and VDRL testing are taken up by NBTS from STD laboratory.

 New buildings were donated to Blood Banks at Kandy and Maharagama.

 Total no. of  Donors

bled from Jan – Dec. 2000

CBB   11,769

            Mobile  39,153

            RBB  102,729

 Total  153,729

  No. of mobile programme done – 778

 Requests for Blood     CBB  -   56135

(450 ml units)             RBB  - 290282

Blood cross matched             CBB  -   39873

(450 ml units)             RBB  - 273479

Blood Issued               CBB  -   51648

(450 ml units)             RBB  -  107087

 Blood component preparation

                                             CBB

Red cell concentrate               11526

Fresh frozen plasma              44413

Platelet concentrate                25915

Cryoprecipitate                          7094

Cryosupernatant(CPP)             1813

Buffy coat                                    432

Washed red cells                           1139

  Central Blood Bank work Performance 

 HEALTH LITERATURE LIBRARY & INFORMATION SERVICES (HELLIS)

 The Education, Training and Research Unit coordinates all activities of HELLIS network in Sri Lanka.

 The HELLIS network was launched with the assistance of the WHO with a view to promote resource sharing between libraries involved in the health sector including university libraries.  HELLIS has been actively engaged in this since its inception.  To keep pace with the giant strides in the health and information fields, it is imperative to improve and expand the scope of health information services in order to carry out the tasks successfully.  The HELLIS Sri Lanka Network comprises twenty libraries, active in several fields of health services and is monitored by the national focal point, which is locate at the Medical Faculty of the University of Colombo.

 The massive body of information generated in the health sector is of vital importance for the enhancement of the quality and efficiency of health services.   Dissemination of specific information from this mass has become a continuous challenge to the health and health related professions.

 Its mission is to enhance the capacity and efficiency of the member libraries to fulfill the ever increasing demand made by different categories of personnel involved in health sector for information and resources which could be realized by equipping all member libraries with adequate resources and technology.

 The major activities of HELLIS are as follows: 

(1)               Provision of resources to libraries.

(2)               Enhance the competence and kills of library work force

(3)               Develop constructive attitudes of users and employees towards the information services.

(4)               Launch a rigorous and continuous user education programme

(5)               Develop effective communication links between libraries.

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