analysis of the health system in Sri Lanka was grounded on a
conceptual framework with five major components (Figure 1): health outcomes; behaviour of individuals and households; performance of
health system; external environment; and health care system. These components
are interlinked such that the health system is an organic whole.
Health System Conceptual Framework
health achievements made over the last several decades need to be
consolidated and further advanced given the rapidly changing demographic and
epidemiological transitions seen in the country.
Cooperation Strategy underlines a process of prioritisation
within WHO to meet the health needs of Sri Lanka.
The WHO works with
the Ministry of Health and other relevant partners towards achieving the
objectives in six strategic areas.
Enhance fairness and financed risk protection
on health care and optimal use of resources
Enhance management and quality in delivery of
services and interventions
areas in the health systems addressed:
Stewardship in the health sector: The changes
needed in the health sector will present the managers of the health system
with major challenges. There is a need to increase equity to ensure that all
men and women, especially the poor, have better access to affordable health
care and are protected from catastrophic health expenditure. Stewardship also
involves engaging and regulating the private sector, collaborating with the
education and other sectors as well as other stakeholders, and providing
certainty in the direction of the health sector.
Health financing: Although the government has
always supported a policy of providing universal health services for all its
citizens, actual government expenditure cannot meet the financial
requirements of health needs. Tax-based financing is currently insufficient
and there needs to be greater emphasis on social health insurance. The rapid
development of technology will bring deficiencies in health financing into
ever greater perspective.
District health system development: Although Sri Lanka was one of the first countries in Asia to decentralize its health sector, the process of
decentralization has been slow and uneven. For sustainable and efficient
district health systems, the capacity of health managers and planners as well
as the instruments for management and planning (e.g. health information,
financing, human resources and procurement systems) need to be substantially
improved. Further, centre-district communication and coordination need to be
Reorganizing hospitals: Over the last two
decades, public hospitals have undergone major expansion and re-organization
without achieving all the anticipated improvements. Standardized care
packages at each level and a properly functioning referral system are needed
to reduce overcrowding of the specialist institutions and increase
utilization of primary care units.
Information technology (IT): The existing
health information systems of the Health Ministry, based largely on a
traditional paper submission system and relying on manual reporting, urgently
need technical and logistical improvement. Very few of the country’s major
hospitals and the provincial health services have a computer network to
support their heavy burden of documentation and information processing.
Solving this deficiency will involve a triad of activities – training in
computer usage, use of simple but workable software, and installation and
maintenance of reliable and well-maintained computer networks. The human
resource gaps in health institutions must be reviewed keeping in mind these
Strengthening public-private partnership: The
private sector in Sri
Lanka has been growing exponentially
particularly in urban areas. Although this gives a choice to consumers,
several issues merit consideration. Private facilities are concentrated in
urban areas and have to be paid for outof- pocket,
raising access and equity issues. Most private sector health professionals
are, at the same time, state-sector employees, exacerbating staff shortages
and geographical maldistributions. Statistics on
private sector patient workload and disease profiles are not collected,
making a comprehensive overview of the entire health sector impossible.
Enhancing community response: Sri Lanka does not have a
patients’ Bill of Rights to protect health service consumers. Operationally,
there are few formal mechanisms to ensure quality of the services provided.
Moreover, health care consumers are not well informed about the health
services and their rights. Empowerment of the community could help achieve a
higher degree of responsiveness and better quality of health services.