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

Sri Lanka Total Population 20. 064 m GDP per capita 947 USD GDP per Sri Lanka Total Population 20. 064 m GDP per capita 947 USD GDP per capita (PPP US$) (2004) 4, 300 (2003) Human Development Index (HDI) 0. 751 Sri Lanka is ranked 93 rd in the 2005 Human Development Report, with an HDI value of 0. 751. (2005)

Sri Lanka • • • Life expectancy at birth (years) 73 Adult literacy rate 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 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 Managemen t Resource Inputs Organisati on Financial Support Health Sector as an organic system Managemen t Resource Inputs Organisati on Financial Support Service Provision

SECTORS Government Private Western + + Indigenous + + Others + SECTORS Government Private Western + + Indigenous + + Others +

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

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

MINIMUM FINANCING NEED $ 30 -40 PERSON PER YEAR TO COVER ESSENTIAL INTERVENTIONS Per MINIMUM FINANCING NEED $ 30 -40 PERSON PER YEAR TO COVER ESSENTIAL INTERVENTIONS Per capita health expenditure 3. 2% of GDP Sri Lanka currently spending about $ 29 per capita 50% by the state 50% Private Only 1% Private Health Insurance

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

IS SRI LANKA INVESTING ENOUGH IN HEALTH? NOT BY INTERNATIONAL STANDARDS NHE/GDP% Sri Lanka IS SRI LANKA INVESTING ENOUGH IN HEALTH? NOT BY INTERNATIONAL STANDARDS 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 * Sri Lanka MOH Health Expenditure Share of GDP, 1939 to 2003 Figure 01 * 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, Trends in Sri Lanka Public Expenditure Shares of GDP for Health, Education and Defence, 1972 -2003 Figure 02

Estimated Growth of Health Expenditure by Government of Sri Lanka 2001 -2015 Scenario A Estimated Growth of Health Expenditure by Government of Sri Lanka 2001 -2015 Scenario A = GDP share growing to 1. 49 120 Billions of Rps 100 80 60 40 20 Low GDP Growth 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 0 Year Source: Health sector master plan study 2003 Medium GDP Growth High GDP Growth

Age Pyramid 1981 and 2001 Age Pyramid 1981 and 2001

Planning Issues & Challenges Required Policy Framework and Guiding Principles 1: Responding to Epidemiology 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’ 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 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