This document provides an overview of healthcare in Sri Lanka. It is divided into sections written by different authors. Fathima Shazna Saleem's section provides general information about Sri Lanka's government and economy. Hong Chia Hao's section discusses Sri Lanka's population statistics, noting the country has a population of 21 million with the majority being Sinhalese. Shylagan Aruran's section analyzes characteristics of Sri Lanka's population, finding the top causes of death are ischemic heart disease and self-harm. Yeap Dee Sheng's section will discuss the organization of Sri Lanka's healthcare service.

1. Project by:
Fathima Shazna Saleem 631D
Yeap Dee Sheng 631D
Hong Chia Hao 631D
Shylagan Aruran 631D

3. Contents
• Introduction
• General info and Economy- Fathima Shazna Saleem
• Population statistics - Hong Chia Hao
• Characteristics of the Population – Shylagan Aruran
• Organization of Healthcare service – Yeap Dee Sheng

4. General information
- Fathima Shazna Saleem

5. • Sri-lanka is a socialist democratic republic and is the oldest democracy in Asia. It
was the first country to conduct elections under the British colonial rule in 1931
and by doing so elected Sir Don Baron Jayathilake as Sri-lanka’s first ever Leader of
the House.
• Today, His Excellency Maithripala Sirisena serves as the President of Sri-lanka with
Hon. Ranil Wickremesinghe serving as his deputy and the current Prime Minister
of Sri-lanka.
• President, directly elected for a six-year term, is head of state, head of
government, and commander in chief of the armed forces.
• The President leads the executive branch of the Sri Lankan government and is the
commander-in-chief of the Sri Lankan Armed Forces. He is the head of the Cabinet,
appoints the prime minister, and could dissolve parliament (after one year has
passed since the convening of parliament after a parliamentary election).

6. • Sri Lankan presidents are involved with every aspect of the government decisions
and are able to hold cabinet portfolios, or can bypass the cabinet posts by
delegating decisions to the Presidential Secretariat.
• They can place the country in a state of emergency, under which they can override
any law passed and place any regulation without needing legislative approval.
• The Prime Minister is the leader of the Cabinet business and also functions as a
deputy to the President. In the event a president dies in office, the Prime Minister
becomes the acting president until the Parliament convenes to elect a successor or
new elections can be held to elect a new president. This was the case in 1993,
when President Ranasinghe Premadasa was assassinated and Prime Minister
Dingiri Banda Wijetunge took office as President

7. His Excellency President Maithripala
Sirsena
Hon. Chairman Ranil Wickremasinghe

8. Territorial Subdivisions
The country is divided into 25 districts, each of
which has a district secretary (the GA, or
Government Agent) who is appointed. Each
district comprises 5–16 divisions, each with a
DS, or divisional secretary.

9. The Island consists mostly of flat to rolling coastal plains, with mountains rising only in the
south-central part. It has a total area of 65,610 km². The highest point is Pidurutalagala,
reaching 2,524 meters above sea level. The climate is tropical and warm, due to the
moderating effects of ocean winds. Sri Lanka's climate can be described as tropical, Mean
temperatures range from 17 °C in the central highlands, where frost may occur for several
days in the winter, to a maximum of 33 °C in other low-altitude areas. Average yearly
temperatures range from 28 °C to nearly 31 °C. Low Day and night temperatures may vary
by 14 °C to 18 °C.
Sri-lanka hosts many tourists each year to Sigiriya, Polonnaruwa, World’s end, Bakers falls
and Kandy. In 2013, Sri-lanka welcomed 1.5 million tourists including 47,200 Russian
nationals

10. Economy
• In 2015, SL boasted a total revenue of 80.591$ Billion and a per capita GDP
of about $11,068.996 . The main economic sectors of the country are
tourism, tea export, apparel, textile, rice production , agricultural products
and IT. In addition overseas employment contributes highly in foreign
exchange, 90% of expatriate Sri Lankans reside in the Middle East
• Sri-lanka is currently the world’s fourth largest supplier of tea
• The average Growth for the year 2015 was 6.3%

11.  There are about 900 factories
throughout country serving
companies such as Victoria's Secret,
Liz Claiborne and Tommy Hilfiger
 Out of the total population in Sri
Lanka, 31.8% engages in agricultural
activities
 EU was the biggest apparel export
destination in 2014 closely followed
by the US

12. • Sri-lanka’s major market for export comes from the US with around $1.8 Billion in 2002
which equates to nearly 38% of all exports
• Sri Lanka has met the Millennium Development Goals (MDG) target of halving extreme
poverty and is on track to meet most of the other MDGs, outperforming other South
Asian countries
• Moreover, in 2014 the largest foreign-investment deal was signed with China for $1.4
billion for a Colombo port expansion- Colombo Port City, which will also include a
Formula one track. This project once completed is expected to generate at the minimum
83,000 jobs and investments totaling $13 billion
Year Gross Domestic Product(GDP) USD - LKR
1980 66 167 16.53
1985 162 375 27.20
1990 321 784 40.06
2000 1 257 637 77.00
2005 2 363 669 100.52

13. Population statistics
- Hong Chia Hao

14. Population Statistics
• With a population of approximately 21 million people, Sri-lanka is the 57th most populated
country in the world. The population growth percentage of the nation is approximately
0.73% and encompasses Sinhalese the majority, Srilankan Tamils, Muslims, Moors and other
minority groups.

15. • The Sinhala language is spoken by the Sinhalese people, who constitute approximately
75% of the national population and total about 13 million.
• The Tamil language is spoken by Sri Lankan Tamils, as well as by Tamil migrants from the
neighboring Indian state of Tamil Nadu and by most Sri Lankan Moors. Tamil speakers
number around 4.7 million.
• The Muslim community in Sri Lanka widely uses Arabic for religious purposes. Seldom
used nowadays is Arwi, a written register of Tamil that uses the Arabic script and has
extensive lexical influences from Arabic.
• There are more than 50,000 speakers of the Sri Lankan Creole Malay language, which is
strongly influenced by the Malay language. There are also a large Maldivian population
and they speak Dhivehi as their primary language

16. Statistics
• Total population (February 2016) 21,128,754
• Gross national income per capita (PPP international $, 2013) 9
• Life expectancy at birth m/f (years, 2013 72-78
• Probability of death between 15 and 60 years m/f (per 1 000 184/75
• population, 2013)
• Total expenditure on health per capita (Intl $, 2013) 304
• Total expenditure on health as % of GDP (2013) 3.2
**Latest data available from the Global Health Observatory,2013
Sri Lanka’s population density is 321.6 people per square kilometer as of February 2016.
Density of population is calculated as permanently settled population of Sri Lanka divided
by total area of the country. Total area is the sum of land and water areas within
international boundaries and coastlines of Sri Lanka. The total area of Sri Lanka is 65,610
km2 according to the United Nations Statistics Division

17. Demographics
Population (thousands) 2013, total 21,128,754
Current male population (49.3%) 10,424,581
Current female population (50.7%) 10,704,174
Net migration 2013 -45 150 people
Population (thousands) 2013, under 18 6261.5
Population (thousands) 2013, under 5 1874
Population annual growth rate (%), 2012-2030 0.5
Crude death rate, 2012 7
Crude Death Rate , 2014 6.06
Crude birth rate, 1970 30.6
Crude birth rate, 1990 20.6
Crude birth rate, 2012 18.1
Crude Birth Rate, 2014 est. 16.24
Life expectancy, 1970 64.1
Life expectancy, 1990 69.5
Life expectancy, 2012 74.1

18. Total fertility rate, 2012 2.3
Urbanized population (%), 2012 15.2
Average annual growth rate of urban population (%), 1990-2012 0.3
Average annual growth rate of urban population (%), 2012-2030 2
Infant Mortality Rate (per 1000 live births) (2014 est.) 9.02
[Male - 9.98 Females-8.02]
Adult literacy rate: females as % of males 2008-2012 97.2
Survival rate to the last grade of primary: females as a % of males 2008-2012 94.6
Contraceptive prevalence (%) 2008-2012 68.4
Antenatal care (%) 2008-2012, At least one visit 99.4
Antenatal care (%) 2008-2012, At least four visits 92.5
Delivery care (%) 2008-2012, Skilled attendant at birth 98.6
Delivery care (%) 2008-2012, Institutional delivery 98.2
Delivery care (%) 2008-2012, C-section 23.8
Maternal mortality ratio , 2008-2012, Reported 39.3
Maternal mortality ratio , 2010, Adjusted 35
Maternal mortality ratio , 2010, Lifetime risk of maternal death 1 in 1200

22. Conclusion: The decrease in crude birth rates in the earlier comparison may be a
consequence of increase population awareness and sex education. Moreover, even use of
contraception and family planning would have played roles.
Life expectancy had seen an increase due to significant improvements in Health care,
number of qualified personnel and dedicated funding for specified sectors. Achievements in
terms of improved markers of Neonatal and maternal mortality can also be attributed to the
same.
Majority of numbers of migrations that had occurred prior to 2010 were a result of the 30
year civil war. The Civil war had officially ended in May 2009

23. Characteristics of population
- Shylagan Aruran

24. Top causes of death in Sri- Lanka
Conclusion:
Ischaemic heart disease
was the leading cause of
death, killing 32,6
thousand people in
2012!
Such numbers can be a
result of the western
trend in diet and lifestyle

25. Conclusion: In terms of the number of
years of life lost (YLLs) due to premature
death in Sri Lanka, ischemic heart
disease, self-harm and cerebrovascular
disease were the highest ranking causes
in 2012

26. Conclusion:
We can conclude
that in both female
and male groups
the majority of
deaths were due
to increase of CV
diseases and
oncological
problems with
reduce in other
diseases

27. Conclusion: This chart compares Sri Lanka with other regional countries and it can be noted that the highest cause
of disability is self harm( inclusive of the 30 yr civil war) and typhoid fever compare to other countries. In addition,
other causes like COPD, IDA, Asthma and migraine are quite common.

28. Age specific disability and place
Conclusion: It can be derived from the above table that the majority of disability comes to
the working class individuals and incidentally via road injuries.

29. Infectious Diseases
Sri-Lanka is classified as a High risk zone as per the Mundi Index(**). It shares most of its
major infectious diseases with Malaysia, that is currently classified as an Intermediate risk
zone. This difference may be attributed to the lack of primary care in specific rural areas,
insufficient medical staffing and Insufficient funding
**
In addition, HIV and Tuberculosis are important causes of Infectious disease mortality.
In recent years the increasing prevalence of seasonal H1N1 Flu has also been a cause
of significant mortality. Vector borne diseases such as Filariasis and Malaria are
prevalent. The Anti-Malarial campaign has successfully eradicated Malaria in Sri-lanka
since 2012. Filariasis is currently at an all-time low as a result of the Anti-Filariasis
campaign.
Conclusion:
Sri-Lanka is classified as a high risk zone as per the Mundi Index(**). Bacterial diarrhea,
hep A, dengue, leptospirosis, rabies, hiv, TB and H1N1 are all the common infectious
disease happened in Sri Lanka.

30. List of Notifiable
Diseases

31. Tuberculosis

32. TB in Sri-Lanka
Case Detection of
TB by District of
Registration in
2013
Conclusion:
We can see that
the TB cases in Sri
Lanka happened
mostly in
Colombo which is
2300 cases.

33. TB in Sri-Lanka

35. Conclusion on TB in Sri-Lanka:
Overall treatment success rate of 82.9% (7743 cases) was recorded for 2013.
MDR-TB is not a big threat to Sri Lanka when compared to other countries in the SEARO
region. Only Four cases of MDR-TB were reported in year 2013 and all of them were
enrolled for treatment.
TB/HIV Co-Infection
HIV testing of all TB patients was made mandatory since 2013. In 2013, 4646 TB patients
were screened for HIV. Of these patients, 6 patients were found positive. In addition, there
were 9 patients with known HIV status at the time of diagnosis of TB, contributing to a total
of 15 patients with HIV/ TB co-infection in 2013

36. H1N1

37. Conclusion:
In year 2015, we can see that the most common influenza is influenza B, especially in
January and March while in March and April there is outbreak and increasing of
number of cases of H1N1.

38. Dengue
*From Kalubowila South teaching hospital, Colombo 2015
Conclusion:
Dengue cases in Sri Lanka is 29777 in a
year. The highest cases occurred in
January. From the picture we can see that
the highest incidence rates were recorded
in Colombo which is 2849 cases.

39. Leptospirosis
** www.epid.gov.lk 2015
Conclusion:
We can conclude that
leptospirosis cases in Sri Lanka in
a year is 4402 cases. The highest
incidence happen in November.
The majority or nearly all the
cases were of farmers and
individuals living in farming
zones with exposure risk

40. Oncology
Most commonly detected
cancer in males is Oral ca.
which can be attributed to
betel leaf, smoking and
alcohol use which are
independent risk factors.
In females, Breast Ca. forms
the majority.

41. Prevalence of Non-communicable diseases:
• Cerebrovascular Accidents (Strokes & TIA’s) – 170000 (1999) and 210000 (2005)
• Hypertension (Essential HTN) - > 20 years old 10.3%
Admissions increased from 86 to 226 per 100000
persons in almost two decades
• Chronic Respiratory Diseases – Bronchial asthma 20-25% among adults depending on the
geographical location
• Smoking – as per 2008 MOH, 22.8% of males and 1% of females smoke
• Alcoholism – is a huge problem due to Cirrhosis and dependence

42. Conclusion: Alcoholism results in social and personal despair. Its inevitable sequelae to
Cirrhosis and Cancer makes it a huge burden to the nation, that can be reduced with more
stringent laws. As evident from the comparison above the abuse of alcohol by males in the
country is greater than double the set value for SE Asia by WHO

43. Healthcare system
- Yeap Dee Sheng

44. “Health is defined as the a state of complete physical, mental and social
well-being and not merely the absence of disease ” – WHO 1948
Healthcare system in Sri-Lanka

45. The Healthcare system encompasses all agencies, facilities and all providers of
healthcare in a defined geographic area. In Sri Lanka, the healthcare system can
be subdivided at different levels:
 Primary care
 Secondary care
 Tertiary care

46. Minister of Health
Dr.Rajitha Senaratne
Director of Health
services
Dr.P.G.Mahipala
Deputy minister of
health
Hon.Faisal Cassim
Secretariat of Health
Dr.J.Anura
Additional secretaries
Scheme representing Structure of MOH

47. Primary care is where every individual usually enters the healthcare system. It
mainly deals with early Detection and Prevention of disease in general. It also
includes the regular screening and follow-up of common health problems &
chronic illnesses that can be managed at home or on an out-patient basis.
Providers : MOH, Community health centers/clinics, hospital OPD, GPs, industrial
health units, and school health units etc.
“ Easily Accessible, Acceptable, Affordable and Appropriate’’-WHO
Primary Care

48. Secondary Care
Secondary or acute care is concerned with emergency treatment and critical care
involving intense and elaborate measures for the diagnosis and treatment of a specified
range of illness or pathology.
Provider groups for secondary care include both acute- and long-term care hospitals
and their staffs.
Tertiary Care
Tertiary care includes highly technical services for the treatment of individuals and
families with complex or complicated health needs.
Providers of tertiary care are health professionals who are specialists in a particular
clinical area and are competent to work in such specialty agencies
Ex. psychiatric hospitals and clinics, chronic disease centers, and the highly specialized
units of general hospitals; for example, a coronary care unit.

49. National Hospital 01
Teaching Hospitals 20
Provincial General Hospital 03
District General Hospital 18
Base Hospital Type – A 22
Base Hospital Type – B 46
Divisional Hospital type – A
(More than 100 patients Beds) 42
Divisional Hospital type - B
(Between 50 to 100 patients Beds) 129
Divisional Hospital type - C
(Less than 50 patients Beds) 322
Primary Medical Care Unit
(Central Dispensaries & Maternity Homes) 474
Board Managed Hospitals 02
Special Hospitals 05
Total Number of Medical Institutions 1084

50. National Hospital Srilanka
Lanka Hospitals group
Neville Fernando Teaching
Hospital

51. *2012
Local Brain drain

52. Health care to Urban population:
• Health care services have been organized with the various levels in sync with
administrative activities i.e. central, provincial, district and divisional levels.
Central level- ex: organization of programs like anti-malnutrition, anti-Filariasis, anti-
malarial campaigns and their surveillance
District level- ex: consists of a healthcare specialist, a health education officer, an
epidemiologist, health inspectors and may or not involve head nurses
Divisional level- Level where the actual implementation takes place, ex: includes
divisional Medical house officer(MOH), Public Health Nursing Sister (PHNS), Public
Health Inspectors (PHI) and Public Health Midwives (PHM) responsible for approximately
thousands of people living in the specified area. Right now 330
• The Private sector that mainly consists of Lanka Hospitals ltd, Durdans hospitals,
Nawaloka Hospitals, Oasis hospital, Golden ENT hospital, also contribute a significant
amount to the population. It is a common trend to seek private health care rather
than govt. institutions due to ease of access

53. • Anti Leprosy Campaign
• Anti Malaria Campaign
• Anti Filarial Campaign
• Tuberculosis Control Chest
Diseases
• Epidemiological Unit
• Public Health Veteranary
Services
• Environment &
Occupational Health
• Quarantine Services
• Youth, Elder, Disabled &
Displaced
• Estate & Urban Health
• Maternal & Child Health
• Nutrition Coordination Unit
• Nutrition Division
• Health Education Bureau
• Nursing (Public Health)
PHS-I PHS - II
DGHS- Director general of health
service

54. Health care to Rural population
• Though health care is free across the country, various other factors play a role in its
ineffectiveness
• Certain objectives such as 100% coverage, supply on demand for nation’s obligatory
list of medicines still have not been fruitful
• In addition, the health care centers are located at considerable distances from
villages and hence adds to the problem
• Problems with availability of laboratory and radiological diagnostic testing which
translates into poor detection and subsequently poor treatment.
• Widespread educational programs are seldom organized within the rural
population. This trend appears to have changed now

55. The pre-hospital care sub-committee has established minimum standards for EMT
education in Sri Lanka. Currently, EMTs and Pre-Hospital personnel are currently working in
four distinct areas:
1. Fire Brigades
2. Hospitals
3. Community based relief Organizations
4. Private services
EMT training is divided into four training levels:
EMT-Level 1: Referred to as Medical First Responders. Typically, first responders may be fire
fighters, police officers, lifeguards, coaches, or teachers. Level 1 EMTs are trained in basic
rescue, oxygen use, CPR, splinting, and safe ambulance operations.
EMT-Level 2: Level 2 EMTs are sometimes referred to as EMT-Basics or EMT-Ambulance
Officers. Some examples of the skills of an EMT include
Principles of Emergency Care Organization

56. Airway management with the use of oral and nasal airways - Automatic External
Defibrillators - Extrication of Trauma Patients with spinal injuries - Medical & Trauma Patient
Assessments - Assisting patients with prescribed medications (NTG [gtn], Aspirin, albuterol
inhalers) - Spinal Immobilization - Assessment of Vital Signs - Assisting with unexpected
emergency deliveries during transport
EMT-Level 3: Level 3 EMTs or EMT-Intermediate Level is a more advanced professional level
of pre-hospital care providers. Typically, level 3 EMTs are more senior and experienced EMTs
and also have additional training in establishing IV cannulation, and in some areas limited
access to lifesaving medications and advanced emergency airway management.
EMT-Level 4: Internationally, EMT-Paramedic represents the highest level pre-hospital care
professionals. Currently EMT-Paramedics, or Level-4 EMTs are not being trained in Sri Lanka.
New Falck Ambulance

57. System of prenatal protection of fetus, health protection of newborn, health protection of
preschool and school-age children
Prenatal care
Midwives provide Prenatal care to women at home visits and in health clinics. These visits
include blood pressure screening, measurement of weight and education related to
nutritional needs during pregnancy. The midwife registers all pregnant women, and most are
registered in first trimester of pregnancy. Nearly every pregnant woman (98.5%) receives
antenatal care
Registration of Birth
Every birth should be registered with the government to obtain a birth certificate which act as
the main legal document for a citizen in Sri Lanka. The name of the child (which is given by
the parent), details of the mother and the father will be entered in the birth certificate. The
birth certificate will be required to obtain the National Identity Card, Passport and many more
legal activities. An application form should be obtained from Divisional Secretariat and
proceed with the registration.
Educational Institutions comprise
a. institutions for pre-school children
b. primary school
c. secondary school

58. The tasks of female consultation (as per SLCOG):
• Giving the outpatient treatment-and-prophylactic care to women during pregnancy and
after delivery;
• Decrease of maternal and prenatal death rates, spontaneous abortion;
• Carrying out of physical and psychological prophylactic preparations of the pregnant
women for delivery;
• Giving the outpatient care at gynecologic diseases;
• Examination of the work conditions for working women;
• Organization of health educational work with women;
• Giving social and legal aid to women according to the legislation of protection of
motherhood and the childhood.
• Prevention of complications of pregnancy, delivery, postnatal period, gynecologic
diseases;
• Giving the obstetric-and-gynecologic aid using the modern diagnostics and treatment;
• Advisory activity on questions of contraception and prophylaxis of abortions

59. Pediatric institution activity:
• Fetal and infant mortality
Perinatal mortality consists of fetal and infant deaths occurring between 28 weeks΄ gestation
and 1 week of postnatal (till 6 days, 23 hours and 59 minutes), with fetal or infant weight
more than 500 g. The perinatal mortality rate is calculated per 1000 cases of live birth and
still birth.
• Neonatal mortality consists of deaths of live born infants within 28 days of age.
Lady Ridgeway Hospital, Colombo is a premier tertiary children’s care hospital. It is now
considered to be the largest children’s hospital in the world. It has specialized units in
Cardiology and Cardiothoracic surgery, Orthopedic, Rheumatology and Rehabilitation,
Dermatology, Ophthalmology, Psychiatry, Neonatology, Intensive Care, Orthodontics, Maxillo-
Facial Surgery, Plastic Surgery, Burns and ENT Surgery.
The Durdans Hospital, Colombo also handles a considerable number of pediatric cases in
wide areas of specialties.

60. References
www.who.org
www.en.wikipedia.org
www.mundi-index.net
www.epid.gov.lk- Sri lanka epidemiological unit
www.health.gov.lk/en - Sri lanka ministry of health
www.tradingeconomics.com/sri-lanka
http://www.imf.org/external/country/LKA/index.html
*Sri lanka’s economy, a perspective