HEALTH CARE SYSTEM-SRI LANKA
INTRODUCTION TO SRI LANKA
• Sri Lanka, formerly known as Ceylon, and officially the Democratic Socialist
Republic of Sri Lanka, is an island country in South Asia. It lies in the Indian
Ocean, southwest of the Bay of Bengal, and southeast of the Arabian Sea; it is
separated from the Indian subcontinent by the Gulf of Mannar and the Palk
Strait
• Sri jayawardanepura kotte is its legislative capital, and colombo is its largest
city and financial centre
• Population – 21.7 million (52% females)
• Life expectancy at birth- male: 71.9 years and female: 78.6 years.
• Literacy rate- male: 96.9% and female: 94.6% in 2012 census
SRI LANKA
↓
PROVINCES(9)
↓
DISTRICTS(25)
↓
DIVISIONAL SECRATORY(330)
↓
GRAMA NILADHARI(14,022)
INDEX
• Human Development Index:76(0.770)
• Health Care Access and Quality Index:73
• Universal health coverage : 72
• GDP Per capita : 4065.2 US Dollar
• WHO Ranking for Health Attainment: 76
• WHO Overall Ranking: 76
• % GDP spent on health care: 3.89% (2017)
• Global Health Security Index : 105(2021)
HEALTH SYSTEM
• PUBLIC(free since 1952)
• PRIVATE (high cost)
• INSURANCE(Individual and employee)
1.Voluntary health insurance
2.compulsory contributory health insurance
NATIONAL HEALTH EXPENDITURE
Source - https://apo.who.int/publications/i/item/sri-lanka-health-system-review
PUBLIC
• Under ministry of health,nutrition and indegenous medical services
1.Stewardship function
2.Tertiary and special/teaching hospital
3.Monitoring of govt. health services
• Under provincial ministers
1.provincial health services
2.powers to formulate their own statutes pertaining to subjects devolved to
them(DECENTRALIZATION)
3.Plantation sector hospitals
• Under ministry of defence and police department
Source - https://apo.who.int/publications/i/item/sri-lanka-health-system-review
PROVINCIAL LEVEL
Source - https://apo.who.int/publications/i/item/sri-lanka-health-system-review
VOLUNTARY PRIVATE HEALTH INSURANCE
• Reducing the demand on govt. sector facilities where higher income
groups could opt for private health care
• It mostly covers the health risk that are less frequent and require
expensive treatment
• why..?
VHI
– Upper class
Govt. – lower and middle class
• Overall contribution of private health insurance to health care
resource mobilization is minimal in sri lanka
• Eg CTC-eagle, Union insurance, Ceylinco insurance
COMPULSORY CONTRIBUTORY HEALTH
INSURANCE(AGRAHARA)
• Exist only for government sector employees and their families
• Contribution collected from monthly payroll and goes into the national insurance
trust fund
• It includes
1.Medical insurance scheme
2.personal accident and natural death insurance scheme
3.loan guarantee scheme
• Only inpatient care
and spectacles, hearing aids and some mobility aids, but
not outpatient care or drugs
SURAKSHA
• Health insurance policy cover school children between the
ages of 5 and 19 years
• Funding from President’s fund
• Provide inpatient (public + private)cover and few
outpatient benefits
• It specifies the list of hospitals where treatment could be
obtained
FUNDING
• Funds allocated to provinces for health from central is based
formula developed using principal components analysis(PCA)
• Indicators used for PCA analysis is population, provincial GDP,
poverty head count ratio, median per capita income of the
province, persons per MO and the candidates qualified for
universities in the science stream from the province
• However,
there is significant dependence of allocation on the
previous years
• Source - Tax
FINANCING SYSTEM
MAJOR HEALTH CARE REFORMS AND POLICY
MEASURES
HEALTH INDICATORS
source : https://www.researchgate.net/profile/sameerasenanayake/publication/334880613/figure/tbl5/as:787317778292740@1564722594599/key-healthindicators-sri-lanka.png
•
Parameters
INDIA
SRI LANKA
POPULATION IN MILLIONS
1352.6
21.7
PHYSICIAN PER1000
0.8
1
CURRENT HEALTH
EXPENDITURE IN % OF
GDP
3.5
3.8
GOVT. HEATH
EXPENDITURE IN %
27.1
43
OUT OF POCKET HEALTH
EXPENDITURE IN %
63.4
49.8
Source : https://cdn.thewire.in/wp-content/uploads/2020/05/09151820/Table-1.png
CHALLENGES
• Overcrowding in tertiary hospitals
• No gatekeeping in PMC results in over use of tertiary care
• Less fund from government on health
• Poor growth of VHI
REFERENCES
• https://apo.who.int/publications/i/item/sri-lanka-health-system-review
• Analysis of private health insurance in Sri lanka: Findings and policy
Implication by Ravi P.Rannan-Eliya
• https://en.wikipedia.org/wiki/Healthcare_in_Sri_Lanka
THANK YOU
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