1. Health Scenario in Sri Lanka
Dr.Sarath Samaraga
Deputy Director General (Planning)

2. Sri Lanka Total Population 20.064 m (2004)
GDP per capita USD (2003)
GDP per capita (PPP US$) 4,300
Human Development Index (HDI) (2005)
Sri Lanka is ranked 93rd in the 2005 Human Development Report,
with an HDI value of

3. Sri Lanka Life expectancy at birth (years) 73 Adult literacy rate 92.3
Infant Mortality Rate / 1000 LB
Hospital beds: per 1,000 persons
Doctors: ,300 persons per doctor
Nurses: persons per staff nurse

4. Problems Malnutrition rapid increase in noncommunicable diseases
violence and injuries (intentional and unintentional)
malaria, TB, dengue and filariasis
the above-mentioned problems are compounded for the poor population, with an estimated 25% of the population below the ‘national’ poverty line and 7% on less than one dollar/day.

5. Health Sector as an organic system
Management
Resource Inputs
Organisation
Financial Support
Service Provision

6. SECTORS +
Others
Indigenous
Western
Private
Government

7. Human Resources

9. Doctors and Nurses in the Health Sector over the years.

10. Health Financing

11. Public Resource Mobilization and Resource Allocation: Issues Facing the Health Sector in Sri Lanka

12. Sri Lanka currently spending about $ 29 per capita 50% by the state
MINIMUM FINANCING NEED $ PER PERSON PER YEAR TO COVER ESSENTIAL INTERVENTIONS
Sri Lanka currently spending about
$ 29 per capita
50% by the state
50% Private
Only 1% Private Health Insurance
Per capita health expenditure % of GDP

13. Who Pays?
Source: Annual Health Accounts, Ministry of Health 2002

14. IS SRI LANKA INVESTING ENOUGH IN HEALTH?
NOT BY INTERNATIONAL STANDARDS
NHE/GDP% NHE/GDP%
Sri Lanka % UK 6.8%
Philippines % Canada 9.2%
Thailand % Australia 8.3%
Bangladesh % Japan 7.5%
Myanmar ?
Source: IPS-NHA 2002

15. Sri Lanka MOH Health Expenditure Share of GDP, 1939 to 2003
Figure 01
Figure 1 shows that since the 1960s, there has been a gradual decline in the health expenditure share financed by GOSL, with a clear decline in the most recent period since 1999.
Why?
Change in the capacity of the GOSL to generate public revenue (Case of reform of export taxes in 1977.
Tax revenue reform in 1977, when export taxes were repealed to “liberalize” the economy at that time, lead to a discontinuous downward shift in public sector revenue.
* MOH Health Expenditure combines Recurrent & Capital Expenditures , 2003 is based on Estimates

16. Trends in Sri Lanka Public Expenditure Shares of GDP
for Health, Education and Defence,
Figure 02
Trend in the buildup of internal conflict in the North. See Figure 2. This war has cost the country in many ways as enumerated in IPS study by Nisha Arunatilake, Sisira Jayasuriya, and Saman Kelegama, January They show how the buildup of military expenditures has changed the sectoral allocation of public funds over the period.
This reallocation has lead to a drop of 0.5 to 1.0 % of growth in GDP each year over the period.
Other Reasons?

17. Estimated Growth of Health Expenditure by Government of Sri Lanka 2001-2015
Scenario A = GDP share growing to 1.49 20 40 60 80
100
120
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Year
Billions of Rps
Low GDP Growth
Medium GDP Growth
High GDP Growth
Source: Health sector master plan study 2003

18. Age Pyramid 1981 and 2001

19. Planning Issues & Challenges
Required Policy Framework and Guiding Principles
1: Responding to Epidemiology (Service and System)
In order to meet the epidemiological changes, reorientation of the health care services and their delivery system is a must. This can be derived from the following three principles:
Principle 1: Prioritisation and Characterisation of Disease (Communicable/Non Communicable)
Principle 2: Exploration and Development of New Strategy
Principle 3: Linking and Integrating Services and Systems

20. Planning Issues & Challenges
Required Policy Framework and Guiding Principles
2: Responding to Patients’ Expectation (Culture and Care)
Not only through the global awakening of patient’s right and equity, but also by looking at the characteristics of the disease itself, patient participation and satisfaction bears greater importance in the success of treatment. Greater efforts are needed in educating patients as well as health service providers to make better choices. This calls for reorientation of people’s cultural norm on the health care in association with the following principles:
Principle 1: Improvement of “Quality and Safety”
Principle 2: Securing of “Patient Right”
Principle 3: Enhancement of “Client Satisfaction”

21. Planning Issues & Challenges
Required Policy Framework and Guiding Principles
3: Responding to Efficacy of the System (Mission and Management)
Reorientation of the health sector organisation, management and information systems is required to respond to efficacy of the system. In the changing situation, it must reframe the entire management system to:
Principle 1: Be Accountable
Principle 2: Be Flexible
Principle 3: Be Efficient

22. thank you!