The document outlines several key challenges facing Sri Lanka's health system, including an increasing burden of non-communicable diseases due to an aging population and epidemiological transition. Emerging infectious diseases like dengue and COVID-19 also present challenges. Funding shortages constrain health sector development as most funds are spent on recurring costs rather than capital projects. There are issues with uneven distribution of healthcare workers, lack of continuous training programs, and overcrowding of secondary and tertiary hospitals due to direct access without proper referrals. Trade union interventions also pose problems for health sector reforms.

1. Challenges facing the Sri
Lankan health System
DR S. D. U. M. RANGA
MBBS (SL), MSC, MD,DIPPCA (SLIDA).

2. Outline
 Components of health System
 Introduction on Sri Lankan health System
 Main challenges faced by health system of Sri Lanka
 Increasing trend in non communicable diseases
 Emerging infectious diseases (Dengue fever, Covid -19)
 Funding issues for state health sector development
 Issues related to health system responsiveness
 Maldistribution of health care workers.
 Lack of proper continuous professional development programme for health
care workers
 Overcrowding the secondary and tertiary care hospitals.
 Trade union interventions

3. Component of health system
 Leadership and governance
 Health information systems
 Health financing
 Human resources for health
 Essential medical products and technologies
 Service delivery
(WHO,2010)

4. Mihintale Hospital – 9th century

5. Introduction on Sri Lankan health System
 Sri Lanka is an island with 65 610 km2 and 20.1 million people
.
 The Sri Lankan health system is a pluralistic system.
 Allopathic medicine is the leading sector.
 Allopathic medicine is provided through both public and the
private sector
 The public sector provides the bulk of inpatient care (MoH,
2018).

6. Introduction on Sri Lankan health
System
 Government-sponsored health services are free at point of delivery.
 Spent 3.4% of GDP for health in 2015 and public sector contribution
was 46% (Amarasinghe et al, 2018).
 Upper-middle-income country.
 Has excellent life expectancy and indicators for neonatal, infant, under-
five and maternal mortality (WHO, 2015).

7. National Hospital Sri Lanka, 1860 Dutch Hospital Colombo, 1681

8. Challenges

9. Increasing trend in non communicable
diseases
 The demographic transition significantly change in
the population structure - resulting in rapid aging of
the Sri Lankan population.
 Parallel to the demographic transition - an
epidemiological transition,
NCDs, which are non-infectious in origin and of ‘adult
onset’, have become more apparent (WHO, 2019).

10. Emerging infectious diseases (Dengue fever, Covid -19)
 Infections such as dengue, tuberculosis, acute respiratory infections are still highly
prevalent, but at a gradual decline.
 Also affected by current Covid -19 global pandemic.
 Sri Lanka's COVID-19 response is characterised by a strong focus on the preventive
approach and contact tracing with rational utilization of available resources.

11. ( Covid 19)
 Only 2100 cases per million population and a case fatality rate of 0.46%,
the Sri Lankan statistics are lower than the global average (Epid unit,
2020).
 Facing severe financial difficulties as Covid – 19 badly affected it main
incomes.
 Finding finances for PPEs, PCR Test kits, emergency care equipment and
for vaccination is a real challenge.

12. Funding issues for state health sector
development
 Due to the poor economic growth and high foreign debt of
the country during last few years,
 Government contribution for health becomes low.
 Most of the health budget was spent for recurrent
expenditure with few capital development.

13. Maldistribution of health care workers.
 The density of doctors, nurses and midwives per 10 000 population
was 30.5 in 2012.
 This above the minimum density threshold set by the 2006 World
Health Report of 22.8 skilled health professionals/10 000 people to
provide the most basic health coverage.
 Provincial maldistribution is also striking and needs to be rectified
through systematic human-resource planning and training
programmes (De Silva et al, 2016).

14. Lack of proper continuous professional
development programme for health care workers
 Currently, continuing professional development is not a mandatory
requirement for any health staff category .
 There are no structured regular programmes for CPD or
reaccreditation processes for medical officers or for any other
category at present.
 Practising as a first contact doctor without any continuous training is
a problem, especially with regard to patient safety (WHO, 2017).

15. Issues related to health system
responsiveness
 Although, health system of Sri Lanka achieved good coverage of services,
there are several issues related to,
 Health system responsiveness.
 Health care quality and patient safety.

16. Overcrowding the Secondary and tertiary
care hospitals
 There is no proper referral system in Sri Lanka.
 Bypassing the primary care institutions and visit bigger
secondary and tertiary care hospitals.
 Secondary and tertiary care hospitals are overcrowded and
primary care institutions are under utilized.
 There is no waiting time to meet specialist or tertiary care.
 Benefit of choosing the care provider(responsiveness)

17. Trade union intervention
 Unnecessary influences of trade unions of doctors, nurses and
paramedical staff are another challenge to heath sector
development in Sri Lanka.

18. References
 Amarasinghe, S.N.,Dalpatadu,K.C.S., and Rannaneliya,R.P.(2018). Sri Lanka Health Accounts: National Health
Expenditure 1990-2016. http://www.ihp.lk/publications/docs/HES1805.pdf
 Department of Census and Statistics. Statistical Abstract 2012. Colombo: Department of Census and Statistics, 2012.
Available from URL: http://www.statistics.gov.lk/Abstract/ index.htm.
 De Silva, A., Ranasinghe, T., & Abeykoon, P. (2016). Universal health coverage and the health Sustainable
Development Goal: achievements and challenges for Sri Lanka. WHO South-East Asia Journal of Public Health, 5(2),
82.
 Epidemiology Unit, Ministry of Health, Sri Lanka. Novel Coronavirus (2019-nCoV) – Situation Report – 339 ; 31/
12/2020 - 10.00 am. https://www.epid.gov.lk/web/images/pdf/corona_virus_report/sitrep-sl-en-31-12_10.pdf
 Ministry of Health, Sri Lanka (2018). Annual Health Bulletin. Introduction to Sri Lankan health Sector, p10-11.
http://www.health.gov.lk/moh_final/english/public/elfinder/files/publications/AHB/2020/AHB_2018.pdf

19. References
 World Health Statistics 2015. Geneva: World Health Organization; 2015
(http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_
eng.pdf?ua=1&ua=1,
 World Health Organization. Country Office for Sri Lanka. (2019). Status, determinants
and interventions on cardiovascular disease & diabetes in Sri Lanka: desk review of
research 2000-2018. World Health Organization. Regional Office for South-East Asia.
https://apps.who.int/iris/handle/10665/329430.
 WHO, 2010. Key components of a well functioning health system,
https://www.who.int/healthsystems/EN_HSSkeycomponents.pdf?ua=1

20. Thank you