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

Sri Lanka Total Population 20.064 m (2004) GDP per capita 947 USD (2003) GDP per capita (PPP US$) 4,300 Human Development Index (HDI) 0.751 (2005) Sri Lanka is ranked 93rd in the 2005 Human Development Report, with an HDI value of 0.751.

Sri Lanka Life expectancy at birth (years) 73 Adult literacy rate 92.3 Infant Mortality Rate 14.35 / 1000 LB Hospital beds: 3.6 per 1,000 persons Doctors: 2,300 persons per doctor Nurses: 826 persons per staff nurse

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.

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

SECTORS + Others Indigenous Western Private Government

Human Resources

Doctors and Nurses in the Health Sector over the years.

Health Financing

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

Sri Lanka currently spending about $ 29 per capita 50% by the state MINIMUM FINANCING NEED $ 30-40 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 3.2% of GDP

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

IS SRI LANKA INVESTING ENOUGH IN HEALTH? NOT BY INTERNATIONAL STANDARDS NHE/GDP% NHE/GDP% Sri Lanka 3.2% UK 6.8% Philippines 3.6% Canada 9.2% Thailand 3.7% Australia 8.3% Bangladesh 3.9% Japan 7.5% Myanmar ? Source: IPS-NHA 2002

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 Tax revenue reform in 1977, when export taxes were repealed to “liberalize” the economy at that time, lead to a discontinuous downward shift in public sector revenue.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

Trends in Sri Lanka Public Expenditure Shares of GDP for Health, Education and Defence, 1972-2003 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 2000. They show how the buildup of military expenditures has changed the sectoral allocation of public funds over the 1984-1996 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?

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

Age Pyramid 1981 and 2001

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

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”

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

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