| The Review also highlights that the Plantation sector has separate rules and provisions for health care provision, where preventive services fall under Provincial authority and Curative Care falls under estate management through estate dispensaries and estate medical assistants (EMAs) and Government run health facilities. Full integration of the Plantation sector health system into the National Health System is seen as one way to address prevalent health issues , along with enhanced education, housing and infrastructure development. |
A recent policy review on health of plantation populations indicate poor nutrition conditions, high levels of disease spread and precarious reproductive health, calling for speed up of the integration of plantation health provision into the national system
There exists large differences in health indicators between estate populations and national figures, giving rise to public health concerns,states a recent Policy Review of Status of Health in the Plantation Sector.
According to the Review, these poor indicators are determined mainly by factors such as poverty and daily wage system, line rooms, lack of access to safe water and sanitary facilities, low level of education, poor access to health, poor transport facilities and language barrier.
The Review, conducted by Public Health Expert from Ministry Of Health, Kandy, Dr. Nithershini Periyasamy in collaboration with Médecins du Monde (Doctors of the World) and Human Development Organization (HDO), attempts to highlight the current health system in the estate sector, gaps in policies, challenges and steps for improvement.Financial support for the preparation of the document was provided by the Agence Francaise de Developpement.
Line rooms, a bane
Accordingly, the Review indicates that poor living conditions provided by line rooms is a main cause of health problems experienced by plantation workers. A line room is a 12 feet by 10 feet barrack like structure built back to back as double rows. One room, originally meant for a household unit, currently holds four to seven people from extended families, who cook, eat, live and reproduce within this space. A 67. 8% of the plantation population occupies line rooms.
“ Line rooms are the start of all health issues, where it contributes to child abuse, domestic violence and intimate partner violence,” says Dr. Periyasamy, speaking at a recent discussion on the publication. She adds that water supply is available only at the end of the row of line rooms where all the families use this pipe for their washing, including babies’ nappies. According to Household Investment and Expenditure Survey (2012 – 2013), around 25 % of plantation population also lives without sanitary facilities.
The Review further notes that , the poor living conditions of the plantation workers, which allows close contact, combined with poor ventilation, results in exposure to infectious diseases such as tuberculosis, skin diseases, leprosy and so on. Also, the Review notes a rise in Non Communicable Diseases such as hypertension, oral cancer, cervical cancer and kidney failure. Further, women of the sector lack knowledge on HIV/AIDS and only 47.7% have heard of it. There is also a high level of adolescent pregnancies and very low level use of contraceptives. Also indicated in The Review is that under nutrition is highly prevalent among children under five years of age and pregnant mothers, with 35.9 % being underweight as per World Bank,2017 statistics.
Stunting among children under five remains of high public health significance among Regional Plantation Company Programme, Private and Government estates, according to World Health Organization ( WHO), with the average coming up to 36.4 %. “ Compared with national level, this is almost double,” says Dr. Periyasamy.
Estate Medical Assistants( EMAs) and midwives remain the frontline health workers in the plantation sector. “ However, one of the main challenges to improving health of plantation workers lie in not having an adequate number of Tamil speaking midwives and inaccessibility of families during the normal working hours. However, this can be resolved if midwives are hired from the same geographical areas,” says Consultant Community Physician, Dr. Amanthi Bandusena.
At the same time, hiring midwives from the same geographical area only remain possible if schools in the areas provide for this need, by delivering suitable candidates with necessary qualifications. Thus, the Provincial education sector has a part to play in uplifting the health of plantation workers, says WHO Consultant, Dr. Padmal De Silva.
Also, plantation health facilities are available only to the workers, who now remain a small fraction of the plantation communities. “Approximately 85% of the estate population are non workers, who do not receive health services, which remain a challenge, says Dr. Bandusena.
Doomed by attendance incentives
According to The Review, combined with the high levels of poverty ( poverty head count ratio of 10.9% ), the attendance based daily wage system has resulted in poor health seeking behaviors. “ According to Collective Agreement, 2016, workers need over 75% attendance to be eligible for attendance incentive. “ If the management expects the workers to work 19 days to meet this over 75% requirement, if they lose one day, they lose Rs. 1,080 for that month. These incentives in day wage breakout can be used to pressurise the workers to attend to work, which results in neglecting health needs.
The Review also highlights that the Plantation sector has separate rules and provisions for health care provision, where preventive services fall under Provincial authority and Curative Care falls under estate management through estate dispensaries and estate medical assistants (EMAs) and Government run health facilities. Full integration of the Plantation sector health system into the National Health System is seen as one way to address prevalent health issues , along with enhanced education, housing and infrastructure development.
“This talk has existed since 1990, however, thus far, it has not happened. I hope this Review would act as a push towards nationalising the plantation health provision,” says Dr. Periyasamy.
Dr. Periyasamy further said this integration will need amendments to the Medical Wants Ordinance, which is over a century old and considers plantation workers as immigrants. “ Amendments that consider the plantation workers as citizens, would be adequate legal provision for the moment. After being incorporated into the National Scheme it can be decided whether a separate health policy is needed to address the issues among plantation populations.”
The recommendations of the Review include speeding up the integration process of the health services,especially the curative health services in estates, filling human resources gaps in existing cadres and hiring necessary new cadres and regularisation of vertical health programmes such as sexual reproductive health programmes.
At the discussion, integration was seen as a mode of addressing the segregation of plantation populations into workers and non workers in health care provision. It was further discussed that one solution to ensure EMAs do not lose their jobs in the integration process, is for the Government to absorb them into the system, based on their educational and professional qualifications.
While emphasising the plantation community have rights to access health services from national system, the Review aims to act as a tool for advocacy to bring meaningful changes in plantation sector.