Healthcare triumphs and challenges

Recording its latest healthcare triumph, Sri Lanka has eliminated measles, with the World Health Organisation (WHO) giving its official recognition to the achievement this week. The last case of local infection was recorded in 2016 and healthcare officials have been swift in containing any infection from foreigners. 

This is a truly remarkable achievement and comes in the wake of Sri Lanka being declared free of malaria and containing other dangerous diseases such as rubella. While many would readily admit Sri Lanka has punched above its weight in providing basic healthcare to its population, challenges remain on how standards and access can be expanded.

Even though healthcare is provided, continuous upgrading of the healthcare delivery system is needed in order to face emerging health challenges in Sri Lanka, especially given Sri Lanka’s rapidly ageing population that will demand a higher level of care than what the system is used to giving over the next decade.  

The macro-organisational structure of the healthcare system affects the efficiency and quality of health services. Therefore, a restructuring of the macro-organisational framework to improve efficiency and equity by splitting outpatient and inpatient services, reclassification of existing healthcare institutions, and reallocation of resources in order to enhance equal facilities at outpatient services throughout the country are some of the recommendations made by the Institute of Policy Studies in a recent evaluation.Despite an increase in the numbers related to human and physical resources, the country still lags behind global averages for most of the indicators related to health workforce and infrastructure, indicating a dearth of resources in the health sector. Focus should also be given to regional disparities in the distribution of physical and human resources. 

Despite decentralisation, the health system is centrally dominated by the Ministry of Health; and since most of the authority lies with the Central Government, it causes duplication and inefficient use of public resources. In order to rectify this situation, the Government needs to clearly define the role and responsibility of the National Government and clarify what is expected of its decentralised units.In recent years the private sector has expanded aggressively in healthcare but remains concentrated in the Western Province. Increasing coverage to rural areas, where the least access usually exists, could be benefited by Public-Private Partnerships (PPPs). Perhaps more urgent is private sector regulation and reform. The regulatory council, Private Health Services Regulatory Council (PHSRC), is independent of the Health Ministry. Returning the regulatory functions back to the ministry, as is the case in other countries with similar backgrounds, is an option that needs to be considered. Alternatively, the effectiveness of the council needs to be reinforced by limiting private sector provider representation, and training and strengthening the regulatory capacity of officers in charge. With the demographic and epidemiological transitions, the organisation, delivery and regulation of Sri Lanka’s health sector needs to be strengthened. Greater resources need to be brought to increase efficiency and effectiveness, and ensure consumer satisfaction. 

Further, greater inter-sectoral collaboration is needed to face imminent health challenges effectively as important influences that affect the health of the population are sometimes outside the health sector. Preventative medication needs to be developed more in Sri Lanka to educate the population to be healthier and reduce non-communicable diseases. Sri Lanka has the potential to not just continue its triumphs but scale them up exponentially.