The urgent need for a well planned referral system for health care delivery in Sri Lanka Dr

eventually took him to be first Medical Officer appointed as Secretary/Ministry of Health. His period of stewardship as Director General and Secretary/Ministry of Health saw the implementation of several important development projects, with assistance from the World Health Organization and the Government of Japan. He was a household word in the WHO. Dr. Fernando was also a member of the Executive Board of the WHO from 19861988. He was a Medical Administrator par excellence. He epitomized the professionalism, which is lacking in most professions today.

strong penchant for Medical Administration, which eventually took him to be first Medical Officer appointed as Secretary/Ministry of Health.His period of stewardship as Director General and Secretary/Ministry of Health saw the implementation of several important development projects, with assistance from the World Health Organization and the Government of Japan.He was a household word in the WHO.Dr. Fernando was also a member of the Executive Board of the WHO from 1986WHO from -1988.He was a Medical Administrator par excellence.He epitomized the professionalism, which is lacking in most professions today.
The greatness of an institution cannot thrive on mere memories of the glorious past, particularly in the case of an important public institution such as the Ministry of Health of which we proudly belong, the greatness must necessarily be measured by the standards of integrity This evening I am reminded of the famous quotation of propriety and the consequent credibility enjoyed in the Thomas Campbell, I quote "To live in the hearts we leave public eye.behind is not to die" unquote.Sarikkalige Deepal Malinga Fernando has certainly lived up to the quotation and indeed There is no doubt that posterity will remember Dr. Malinga this is the reason that has directed this gathering towards a Fernando as one of the greatest Medical Administrators of common purpose, to remember an individual who has all times.touched our lives and left a lasting impression despite his As a Medical Administrator he brought this country much untimely demise two years ago.He was an individual who renown.As Director General and Secretary/Ministry of preserved and fostered the greatness of his office.It is with Health he served the Sri Lankan community with great a sense of pride that we who lived in his shadow look back distinction as a man of gentle conviction and sincerity he at our own individual careers and recall the profound served this country in his own fashion.shaping influence that Dr. Malinga Fernando had in Mr. President -I am therefore greatly honored to have the numerous ways.He belonged to that rare breed of Medical privilege of delivering this oration in memory of Dr. Administrators who breathed life to health care through a Malinga Fernando.profound empathy for the human condition.I remember him standing tall not because of his considerable height, The post independence period of this country witnessed but because he was decent and ethical.Throughout our unprecedented development in the health and more career in the Department of Health, his mere presence important in the preventive health component which had provided us with a great sense of security where he its beginnings in the health unit system pioneered by Dr. S. carefully guarded, guided and protected us.Although he is F. Chellappa the then D.D.M & SS and Dr. W. P. Jacobs of no more he has no doubt left a rich and humane legacy for the Rockefeller Foundation, under the direction of Dr. S. T. us to emulate.
Gunasekara the first Sri Lankan Director of Medical and Sanitary Services.Simultaneously the curative services Dr. Malinga Fernando was born on the 19th October, 1929 which comprised, primary, secondary and tertiary care to a conventionally elite family from Panadura.He had his services too expanded.Free education provided the primary education at Sri Sumangala College and later at necessary impetus for rapid development in the area of Ananda College.Qualifying as a doctor from the health, which was reflected in the improved health indices University of Ceylon in 1954 he served as DMO Weligama which were comparable to some of those in developing and Panadura Hospitals, which he managed with countries -thus this country was referred to as a success exceptional ability.From the very beginning he had a

DR. MALINGA FERNANDO ORATION 2010
The urgent need for a well planned referral system for health care delivery in Sri Lanka story in health in spite of its being developing economy.
institutions due to the outpatient departments and wards of The great dedication and commitment of the health these institutions.Overcrowding is the bane of hospitals, personnel of that bygone era contributed in no small which hinder proper patient care and the attendant negative measure to the success.Diffusion of the health services consequences.This situation is due to the large influx of both preventive and curative was responsible for patients who call over at the OPDD and seek admission on improvement of health of population.flimsy grounds.Often MOO/OPDD are reluctant to use their discretion due to various reasons.If one were taken Notwithstanding the above considerable changes have the case of the National Hospital as an example the annual taken place by way of demographic patterns, political OPD attendance is around three million with an average scenario as well as developments in technology which has daily attendance of 2500 to 3000.Likewise the daily necessitated some degree of modification to the existing admissions number around 500.Thus one can imagine the health care delivery system.Dr. Malinga Fernando with his magnitude of the problem.Efforts to curb this vast inflow vast experience in Medical Administration was of the firm by way of observing wards and other methods have not had view that the PHC complex should be strengthened to the the desired effect.Thus there remain one solution and one maximum to enable the Secondary and Tertiary care alone a properly designed referral system.services develop its full potential.The changes so envisaged could not be implemented during that period Patient referral -is a system of providing for the continuity due to various constrains particularly due to the trained of care from a primary care level to secondary or tertiary personnel in the medical, nursing and paramedical sectors.level.It is a time-tested method of providing quality health However, time is now opportune to effect these changes, care the world over.It is used with good outcomes in lest irreparable damage be done to the health care delivery countries that boast of very good health indexes.It is based system which has stood the test of time.
on many factors -one being that the majority of illnesses that necessitate access to a health care provider is There is an excellent distribution of primary care spontaneous and self-limiting and can be resolved institutions throughout the Country comprising Hospitals, successfully at the primary care level.The other is that Peripheral Units, Rural Hospitals as well as large number many chronic illnesses can be managed with good Central Dispensaries.The Secondary and Tertiary care outcomes at the primary care level.institutions are by and large confined to towns and cities -Teaching Hospitals, District General Hospitals and base A referral system has benefits for all who use it.The Hospitals.
primary health care provider has the benefit of all the expertise and skill of the specialist to fall back on.The Notwithstanding the above considerable changes have specialist can concentrate all his attention and give of all taken place by way of demographic patterns, political this expertise for problems within his specialty.Beside, scenario as well as developments in technology which has referral back to the primary care provider ensues necessitated some degree of modification to the existing continuity of care and resolution of problems of the patient health care delivery system.Dr. Malinga Fernando with his outside the purview of the specialist.vast experience in Medical Administration was of the firm view that the PHC complex should be strengthened to Above all the patient receives patient centered health care enable the Secondary and Tertiary care services develop its by the combined efforts of both these service providers.full potential.The changes so envisaged could not be Policymakers and health managers will do well note that implemented during that period due to various constrains the benefits of this system to them-primary economic.It is particularly due to the shortage of trained personnel in the a well-known fact that primary care is inexpensive and medical, nursing and paramedical sectors.However, this is requires less technology to set up and maintain.Secondary how opportune to effect these changes, lest irreparable and tertiary levels of care need more capital investment and damage be done to the health care delivery system which the input of specialized technology and its attendant has stood the test of time.Notwithstanding the availability requirements. of a large number of primary care institutions, a sizable Deficiencies in primary care -and there are many can be number of patients bypass them and seek treatment at met by continuing medical education, professional Secondary and tertiary care institutions travelling development and greater recognition and support to the considerable distances at great expense and inconvenient Primary care system -not by increasing, strengthening or in the erroneous belief that the outpatient treatment in providing easier access to secondary and tertiary care these institution is superior to those in the periphery.
services can be realized to the country.Bypassing results from lack of confidence in the

Dr Joe Fernando*
MB. LRCP.LRCS, DPH, FCMA, FCCP, Privileges of Board certification in Medical Administration * Former Director of Health Services SRI LANKA JOURNAL OF MEDICAL ADMINISTRATION Volume 13, March 2011