The Sri Lankan health system has achieved high life expectancy and low mortality rates. It is financed through government funding and provides largely free healthcare. However, maintaining long-term sustainability depends on affordability, acceptability, and adaptability. Affordability relies on reasonable budget allocations despite declining expenditures. Acceptability involves effective governance, regulations, and engaging stakeholders. Adaptability allows withstanding challenges through organized service delivery and resilient responses during crises like tsunamis.

1. Managing sustainability and resilience
in the Sri Lankan health service
DR S. D. U. M. RANGA
MBBS, MSc, MD, DIPPCA (SLIDA).

2. Introduction
 Sri Lanka is country with an impressive health indicators
compared to its neighbors in the South Asian region.
 Life expectancy is high, and maternal and infant mortality are
relatively low, and several communicable diseases have been
eliminated.
 The healthcare system has been financed by government and
delivered “free” to public was critical to these health
achievements (Kumar, 2019).
 Managing sustainability and resilience of Sri Lankan health
system depend on several factors.

3. A sustainable health system has three
key attributes:
 Affordability, for patients and families, employers, and the
government (recognizing that employers and the government
ultimately rely on individuals as consumers, employees, and
taxpayers for their resources);
 Acceptability to key constituents, including patients and health
professionals;
 Adaptability, because health and health care needs are not static
(i.e., a health system must respond adaptively to new diseases,
changing demographics, scientific discoveries, and dynamic
technologies in order to remain viable).

4. Affordability

5. Health financing
 Reasonable allocations from budget
 Sri Lanka’s total expenditure on healthcare, both
public and private, is 3.9 percent of GDP, similar to
lower middle-income countries’ health expenditure of
4 percent.
 But lower than upper middle-income countries health
expenditure of 5.9 percent.

6.  Public health expenditure (1.6 percent of GDP), Sri Lanka
compares favorably with regional peers in South Asia (0.9
percent of GDP) and lower middle-income countries (1.3
percent).
 But, spends just half the level of upper middle-income
countries (3.2 percent).
 Over time, Sri Lanka’s health expenditure has declined from
2.3 percent of GDP in the year 2000 to 1.6 percent of GDP in
2016 (Unicef, 2019).

7. Acceptability

8. Health care Leadership and governance
 Ministry of Health Sri Lanka take the responsibility for steering the
entire health sector.
 Dealing with future challenges as well as with current problems.
 Through transparent processes, national health policies, strategy,
plans, higher level steering committees and task forces that set a
clear direction for the health sector,

9. Health care Leadership and governance
Contd…
 Exa; National Health Policy 2016 -2025
National Policy on Organ, Tissue and Cell Transplantation of Sri Lanka
National Digital Health Guidelines & Standards
Mental Health Policy -2019-2030
Policy on Healthcare Delivery for Universal Health Coverage
National Health Development Committee
Presidential Task Forces

10. Health care Leadership and governance
Contd…
 Effective regulation through a combination of guidelines
and backed up by legal measures
 Increasing the multi-stakeholder engagement and
coordination and participation of non-health sector
agencies to achieve health targets.

11. Health care Leadership and governance
Contd…
 Almost all health managers of the country are Medical
doctors.
 Most of them are Qualified with MSc or MD in medical
administration at PGIM, Colombo.
 They introduced and maintained high level of productivity
and Health care quality at their institutions while assuring
patient safety.
 Preventive Health sector is managed by public health
specialist.

12. Health information
 Good governance is only possible with good information
on health challenges and on the performance of the
health system.

13. Health information
 Health information system of Sri Lanka is well organized.
EIMMR
MSIMS
HRMIS
 Surveillance system for communicable disease with notification and
case finding.
 Annual health bulleting
 Weekly epidemiological bulleting

14. Human resources for Health
 Continues production of health workforce and regulation.
 The public universities operate the medical schools and have been
graduating 1500 new medical doctors a year for the past decade.
 Admission is based strictly on grades in the school-leaving
examinations, and courses are free (as are all public university
courses).
 Other government universities and government training schools
produces Nurses, Paramedical and other health care staff annually
(Rannaneliya and Lankani, 2008).

16. The National Institute of Health Sciences (NIHS) is the premier public health training institute in Sri
Lanka. First health unit in the South East Asia was established in Kalutara ( 1926)

17. Essential medical products and
technology
Universal access to health care is heavily dependent on
access to
affordable essential medicines,
vaccines,
diagnostics and
health technologies of assured quality,
 Which are used in a scientifically sound and cost-effective
way.

18.  NMRA, Sri Lanka - medical products regulatory system
for marketing authorization and safety monitoring,
supported by relevant legislation, enforcement mechanisms.
 Medical products quality control laboratory
 National lists of essential medical products
 National diagnostic and treatment protocols (Medical services unit and
Professional colleges)
 Standardized equipment per levels of care
 MSD - Supply and distribution system to ensure universal access to essential
medical products and health technologies
 National medical products availability and price monitoring system(National Drug
policy)

19. Service delivery
 Sri Lankans benefit from extensive and organized health services, consisting
of parallel public and private sectors.
 Public health services was financed and provided by the Ministry of Health
and nine provincial Departments of Health.
 It ranges from preventive and basic primary care activities to complex
hospital-provided tertiary care.
 The public sector network ranges from teaching hospitals with specialized
services to small dispensaries that provide only outpatient services.

21. Health care institutions in Sri Lanka
Tertiary
care
hospitals
Secondary
care
hospitals
Primary
care
institutions
Other
Hospitals
Total
institution
Total
hospital
beds
Beds for 1000
populations
38 259 308 36 641 84728 3.9

22.  345 Medical Officers of Health units (MOOHs) provide preventive
and public health services through teams of doctors, community
midwives, public health inspectors and others.
 This organizational model was developed in the 1920s and
expanded in the 1930s and 1940, during British colonial era
(Rannaneliya and Lankani, 2008).
 Following independence, the country adopted a free health
policy and provided free health care for all Sri Lankans and it
helps to reach a higher Human Development Index than all other
countries in the South Asian region (MoH, 2018).

24. Adaptability/resilient

25. Adaptability/resilient
 Able to withstand or recover quickly from difficult
conditions.
 Because of above factors, Sri Lankan health system
Managed extremely well during;
 Tsunami
 After defeating terrorism of LTTE, managing 300000
thousands of internally displaced people.
 During Covid 19 Pandemic.

26. References
 Kumar, R. (2019). Public–private partnerships for universal health coverage? The future of “free health” in Sri
Lanka. Globalization and Health, 15(1), 1-10
 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
 Rannan-Eliya, Ravi P., and Lankani Sikurajapathy. 2008. Sri Lanka: “Good Practice” in Expanding Health Care
Coverage.” Research Studies Series, Number 3, Colombo, Institute for Health Policy.
http://www.ihp.lk/publications/docs/RSS0903.pdf
 Rajitha Senaratne & Shanthi Mendis.(2018). Prevention and Control of Non-communicable Diseases: Think
Globally - Act Locally; Lessons from Sri Lanka. Ministry of Health, Nutrition and Indigenous Medicine, Sri
Lanka. http://www.health.gov.lk/moh_final/english/public/elfinder/files/Downloade/NCDbook2018.pdf
 United nation. (2018). Sustainable Development Goals Knowledge platform. Voluntary National Review
2018,Sri Lanka. https://sustainabledevelopment.un.org/memberstates/srilanka
 Unicef (2019) , budget brief, Health sector Sri Lanka 2019.
https://www.unicef.org/srilanka/media/1706/file/BUDGET%20BRIEF:%20HEALTH%20SECTOR.pdf

27. Thank you