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The University of Southampton
Southampton Business School

Healthcare workforce planning in Sri Lanka

Computer simulation models based directly on University of Southampton research are now in routine use by the Sri Lankan Ministry of Health for planning the recruitment and training of health professionals.

As result, over 1.5 million people with no previous access to state-funded care are now able to visit a dentist once a year, and the number of unemployed qualified dentists has fallen to zero.

Context

From the early 1990s, Sri Lanka suffered from a chronic oversupply of qualified dentists. By 2010 there were more than 250 dental surgeons awaiting government employment – one quarter of the total number of dentistry graduates. Many either left to work overseas or to establish private practices.

As a result of her longstanding work and reputation in health operational research (OR), Professor Sally Brailsford was contacted by a qualified dentist, Dr Dileep de Silva, working as an administrator in Sri Lanka’s Ministry of Health, Nutrition & Indigenous Medicine. Together, Brailsford and De Silva developed a simulation model that determined the demand for dentists in the country.

Research challenge

Professor Sally Brailsford has led a number of research projects in health OR in close collaboration with healthcare organisations and clinical stakeholders. She has also developed methods for including human behaviour in simulation models, using concepts from health psychology.

National Oral Health Survey Sri Lanka
National Oral Health Survey Sri Lanka 2015-16. Colombo: Ministry of Health, Nutrition and Indigenous Medicine (Sri Lanka), 2018

Brailsford and De Silva’s simulation model used several findings from this longstanding body of research: the need for clinician engagement, the importance of including human behaviour, and ways to facilitate and support the clinical champion role to engage with decision-makers.

The journal article describing the model and its early impact won Brailsford her third Goodeve Medal, awarded annually for the best paper published in the Journal of the OR Society.

In 2010 De Silva presented the model at a Sri Lankan Government Cabinet meeting and demonstrated the impact of different policy options. As a result, the Ministry of Higher Education agreed to fix the intake of dentistry students for ten years and the Ministry of Health created 400 additional government-funded posts over four years (2011-14).

Benefit to dental services and oral health in Sri Lanka

The Sri Lanka National Oral Health Survey is carried out every 10-12 years. The 2015/16 survey showed that the numbers of dental surgeons and government clinics had doubled since 2002-03, rising to 1,535 and 712 respectively.

Dental services and oral health in Sri Lanka

The survey reported that “there has been a reduction in the oral disease burden and an improvement in oral health habits of the Sri Lankan population, regardless of age, sex, ethnic and sector variations” and “an improvement in dental service utilization patterns”.

The benefit to oral health was also clear: the overall percentage of visits for extractions, an indicator of poor general oral hygiene and lack of regular preventive dental care, had fallen from 51 per cent to 33 per cent.

 

Benefit to the Sri Lankan Ministry of Health

Benefit to the Ministry of Health

The Sri Lankan Ministry of Health, Nutrition & Indigenous Medicine has been in existence for 120 years and employs over 125,000 staff. However, prior to 2017 the Ministry had no human resources (HR) division.

The creation of a new HR Division, headed by De Silva and with a staff of 10, was a direct consequence of the dentist simulation model. It represented a recognition by the Sri Lankan Government that planning the future healthcare workforce is a complex task, requiring detailed analysis often over long timescales.

Benefit to dental professionals

In 2019 De Silva conducted a survey of the 455 dentists – roughly one third of the total dental surgeon workforce at the time – who had graduated since the implementation in 2011 of the original recommendations from the simulation model.

Benefit to dental professionals

87 per cent of respondents had obtained government employment within a year of graduation – less than a third of the former average wait of over 40 months.

96 per cent of respondents were happy or very happy that, unlike their predecessors, they were able to start their clinical careers immediately, remain in Sri Lanka and do the job they had been trained to do. 91 per cent of respondents reported a job satisfaction score of at least 7 on a scale of 1 to 10, where 10 is high.

The survey also found that 78 per cent of respondents had been posted to rural areas, 17 per cent to semi-urban and 5 per cent to urban areas. This finding was particularly important given the low level of rural provision in the past.

Overall, more than 1.5 million people across Sri Lanka who had no previous access to state-funded care are now able to visit a dentist once a year.

Key Publications

List of all staff members in
Staff MemberPrimary Position
Sally BrailsfordProfessor of Management Science
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