Primary healthcare

The World Bank this week approved a loan of $ 200 million to help increase the use and the quality of Sri Lanka’s primary healthcare services as Sri Lanka faces the challenges of a rapidly-ageing population.

The funding will focus on detection and management of Non-Communicable Diseases in high-risk population groups, responding to the needs of the poorest of the population. Sri Lanka has the fastest-ageing population in South Asia, with the population over 60 expected to double in the next 25 years. This demographic transition has an impact on Sri Lanka’s health profile: 87% of deaths in Sri Lanka are caused by Non-Communicable Diseases. Out-of-pocket spending on health is at 38% of the total health expenditure, which is most burdensome for the poor. Even though healthcare is provided, continuous upgrading of the healthcare delivery system is needed in order to face emerging health challenges. 

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. Reforming Sri Lanka’s sprawling healthcare system is sure to create more headaches but if the country is to remain ahead of the curve it must make change possible. Better facilities and services are essential for Sri Lanka to continue punching above its weight in providing a healthy and productive workforce.