Substandard housing ‘barrack-type ‘line room’, Difficult transport access poor water supply lack of sanitary facilities ignorance illiteracy
History of Health care provision in thePlantation
The Colonial period and the years followed up to the mid 1970s. The period of total state ownership and management (Land reform) The period of restructuring. The Colonial period and the years followed up to the mid 1970s. Individual planters kept stocks to treat the labour. Groups of estates employed a dispenser and at times a doctor. 1865 – Master Servant law enactment – mandatory for an employer to provide lodging, food, and medical care in times of sickness for employed labour. 1872 – Ordinance N0 14 – planter managed medical scheme- limited scope with minimal government control or supervision. 1879 – Commission appointed by Governor found the estate health system to be inadequate. 1880 – Medical Wants Ordinance No 17 – Its main provision was for Government to undertake the medical care of estate workers Estates grouped to form plantation districts ( plantation districts did not conform to the administrative districts) Each district provided with district hospital under DMO with one or two medical assistants MO visit to estate. Government Civil hospitals in or near plantation districts were kept accessible for the benefit of estate labourers. 1893 – reported death rate among the immigrant labour admitted to district hospitals was much higher than the general population. Hospital Mortality Commission recommendation – facilities for treatment should be made available as near to the work place as possible.
1900 – Origin of estate dispensary Scheme (No. increased from 15 in 1893 to 143 in 1906) 1912 – Medical Wants Ordinance No 9 1912 – Medical Wants Ordinance No 12 (Amenment) Appointment of inspecting medical officer for monitoring and reporting of estate sanitation tax rebate for those compiled with the Ordinance. 1930 – Ceylon Administrative Report of the Director of Medical and Sanitary Services identified – lack of maternity wards, and the need of well trained midwives with the hardship of pregnant mothers. 1932 -1949 – No of Midwives increased to 89 – 272
1948 – Independence to Ceylon 1949 – Citizenship Act – “Stateless”- isolated within confined to estates – Social changes including health and education bypassed this immigrants and social indicators remaining static. 1964 – Sirima Shastri Pact 1986 – Citizenship to all indian origin decendents 1988 – Grant of citizenship to stateless law Grant of Citizenship to Persons of Indian Origin Act No. 35 of 2003, CITIZENSHIP PROBLEM WAS SOLVED only by 2003
1948 – after independence ‘Citizenship Act’ caused ‘Stateless’ state Until 2003 – citizenship problem existed (Social insecurity) Up to mid 1970s very high morbidity and mortality due to bad housing, insanitary and congested living conditions, high levels of illiteracy and limited health care
The period of total state ownership and Management
1972-1975 – Land Reform stage I and II All company owned estates were nationalized Under the management of (The Janatha Estate Development Board (JEDB), and Sri Lanka State Plantations Corporation. (SLSPC) Following nationalization provision of Health care became government responsibility 1973- Agreement between Govt. and UNFPA – Funding for Family Health services on estates Family health Bureau was given the responsibility for implementing the Estate Family Health Project. Medical Officer was appointed to FHB to plan, coordinate, and monitor the execution of the project. 10 medical officers (estate) with transport facilities along with PHNS were appointed to establish a network of 200 polyclinics. Estate health staffs were trained to deliver the service competently. Women were given paid leave to attend the clinics. Medical officers estates were overall under the supervision of FHB and immediate supervision by RDHS (Superintendents of Health Services) 200 polyclinics were expanded to 400 polyclinics. 1978 JEDB and SLSPC developed their own Social Development Divisions (SDD) to be directly responsible for health and welfare activities on estates 1978 – Plantation Family Welfare Supervisors were appointed – ‘link worker between Management, health services,and the estate community. 1980 – EPI introduced to estate sector funded by UNICEF. Asian Development Bank and World Bank to fund to built maternity units to promote institutional birth. 1981 – these two estate agencies appointed their own medical staff on the role of health managers With the companies effort to look after the health of the estate labour the medical officers (estate) were gradually withdrawn.however, FHB provides technical guidance and monitor health activities on the plantation.
Remarkable Achievement through selectedDirect Health Intervention
Progressive decline in infant mortality from 104/1000 live births in 1973 to 38.6 in 1990. This was still higher than the national average but this achievement is in a relatively short period of time with selected direct health intervention. It is obvious that the current health care provision infrastructure was built during this period of nationalization with Government direct intervention.
Important Lesson to be learned -Model from Education Sector
1977 – All schools managed by the estate management were taken over to the Government. Most underutilized schools were closed down Currently 843 plantation schools under the Department of Education with a separate Director Education in charge of Plantation schools No mediators from the estates.
The period of restructuring (Privatization)
1992 – tea industry was affected. Estates were privatized by forming 23 Government owned Regional Plantation companies – operational management was contracted out to private sector 1998 – 23 fully privatized companies to form the Regional plantation Companies (RPC) (400 estates) This changed the management structure for health and welfare SDD ceased and instead a new limited liability company called the Plantation Housing and Social Welfare Trust (PHSWT) was established under the Companies Act in 1992. 1993 – PHSWT presently changed as PHDT (Plantation Human Development trust) start to function; to facilitate, coordinate the health and social welfare activities. post privatization scenario -Focused on minimizing expenditure and maximizing profit.