The Board of Directors of the Asian Development Bank (ADB) has approved a grant and loan package totaling $ 50 million to support the development of a more responsive and efficient primary health care system in four underserved Sri Lankan provinces.
“Sri Lanka has made impressive gains in ensuring access to and quality of health services for all,” said ADB Social Sector Specialist Brian Chin. “But challenges remain, including a dramatic increase in noncommunicable diseases, which are causing a surge in demand for health services and rises in costs. The ADB project will operationalise the Government’s policy to strengthen the delivery of high quality primary health services, particularly reaching vulnerable groups.”
During the period of the Millennium Development Goals (1990–2015), life expectancy has increased in Sri Lanka while maternal and infant mortality have fallen. Most diseases preventable by vaccines are at near elimination stage with immunisation coverage at more than 99%. Sri Lanka has also been free from polio since 1994 and malaria and filariasis since 2016.
But there has been a dramatic increase in noncommunicable diseases, driven by lifestyle, social, economic, and demographic changes, while resurgent and new communicable diseases are also putting pressure on the health system.
Since 1990, changing health challenges and population aging have led to investments being prioritized in secondary and tertiary health care services at the expense of primary curative and preventive care services.
Further, access to health, life expectancy, and risk of disease vary according to location, with certain rural populations and those on the plantation estates (for example, growing tea, rubber, and coconuts) especially at risk. Malnutrition in mothers and children is a particular issue in these geographic areas.
The ADB project will focus on enhancing the primary health care system in four provinces—Central, North Central, Sabaragamuwa, and Uva—while strengthening the health information and disease surveillance systems, and developing policies and capacity in the health sector.
The project will upgrade 135 primary medical care units and divisional hospitals in the four provinces, providing equipment for improving laboratory, emergency treatment, dental, and other clinical services. It will also refurbish 127 field health centres, providing equipment and staff training. Accompanying these will be a behaviour change communication campaign that will include health promotion, nutrition education, and community outreach activities.
The health information system will be strengthened to provide real-time sharing of information across health facilities and across different stages of patient care. At ports of entry, the project will boost health surveillance and quarantine capacity, including a web-based surveillance system and training for health personnel.
The project supports policy and strategy development and implementation for comprehensive primary health care, including capacity development in the line ministry and at provincial level.
The total cost of the project is $60 million, of which ADB is providing a grant of $12.5 million and a concessional loan of $37.5 million. The Government is providing $10 million toward the total cost of the project, which is due for completion at the end of November 2023.
ADB is committed to achieving a prosperous, inclusive, resilient, and sustainable Asia and the Pacific, while sustaining its efforts to eradicate extreme poverty. Established in 1966, it is owned by 67 members—48 from the region. In 2017, ADB operations totalled $32.2 billion, including $11.9 billion in cofinancing.