Health System Development


The situational 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.


Figure 1: Health System Conceptual Framework


The significant 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.


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.


Strategic Objectives:

*     Enhance fairness and financed risk protection on health care and optimal use of resources

*     Enhance management and quality in delivery of services and interventions


Key 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 better institutionalized.


*     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 new challenges.


*     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.

Essential Medicines

*      Essential Medicines – WHO Focus