The quality and the standard of a healthcare system tell the world a lot about a specific country. In fact, it is a reflection of the living standards, productivity, and economy of a certain nation. Hence, the quality of the healthcare system happens to be a key concern of any of the governments. And yes, it is the same with Sri Lanka as well. This splendid island is blessed with a good healthcare system, with a rich history that goes back to hundreds of centuries. And at present, the government is taking all possible steps to improve the country’s human health by providing access to affordable, high-quality health facilities.
However, there is simply a lot that you need to know about the healthcare system in Sri Lanka. Still, take it easy, because you will get to know everything with regard, as you complete this read. To get a headstart, let us first have a quick glance over the history of the healthcare system in Sri Lanka!
History of the Healthcare System in Sri Lanka
At present, Sri Lanka owns a free and universal healthcare system. Still, it is not something that this country could create all of a sudden. Yes, it is a result of a process that evolved through many hundred years while creating a rich history behind it. Basically, the Sinhalese and Hindus were the main ethnic groups that lived in Sri Lanka 3000 years ago. The birth of Ayurvedic medicine happened as a result of the combination of these two ethnic groups’ traditional medical techniques. Accordingly, the healthcare system of Sri Lanka was totally based on Ayurvedic treatments back then.
Besides, Mahavamsa reveals that the ancient kings of Sri Lanka built different hospitals in ancient cities. They have had good facilities, with toilets and baths attached to the living quarters. Besides, they have had better ventilation and free air circulation which depicts the aspects of psychological knowledge possessed by the ancestors of Sri Lanka. Furthermore, medical instruments such as forceps, scalpels, scissors, and even spoons that are believed to be used to mix or administer medicine have been found in excavations. Thus, it is no secret that Ayurvedic medicine in Sri Lanka had been in a very developed state with the ability to practice not only general medicine but also surgery, midwifery, and veterinary medicine too.
However, the ancient science of Ayurvedic Medicine is still living in the country, as it was passed from generation to generation. However, along with this ancient medical science, Sri Lanka embraced western medical practices as well. Sri Lanka being a colony for a certain time period, impacted this factor immensely, and accordingly, the history of the medical system in Sri Lanka later shaped with the influence of both these medical traditions.
The Present Status of the Healthcare System in Sri Lanka
The reviews reveal that at present Sri Lanka has reached a higher standard in healthcare service in relation to the spending allocated for the healthcare sector in Sri Lanka. However, there are several improvements to be done for the betterment of this sector in order to provide the services efficiently and conveniently. Furthermore, Ayurvedic medicine has become less active at present due to the negligence during the colonization among three nations as Portuguese, Dutch and British. Moreover, the introduction of western medicine to Sri Lanka became another reason for the gradual failure of traditional Ayurvedic medicine in Sri Lanka.
However, as a developing country, Sri Lanka has a significantly good healthcare system in relation to the other countries with similar economic growth at present. The statistics prove that Sri Lanka has a low child death rate and maternal mortality rate. In addition, the World Health Organization appreciates the vaccination programs conducted in Sri Lanka because these programs lead the nation to a healthy status. Besides, the organized structure followed by the healthcare system of Sri Lanka makes the system work in an efficient manner.
Is Healthcare Free in Sri Lanka?
Yes, the Sri Lankan government maintains a free health care system. The Ministry of Health, Nutrition, and Indigenous Medicine together with nine provincial councils have the responsibility regarding the healthcare system and services of Sri Lanka.
In 1951, the Sri Lankan government enacted the policy of free health. As a result, the life expectancy of people in Sri Lanka has improved because the general public could receive free healthcare services. The government and householders mainly fund the healthcare system. Furthermore, both Ayurvedic medicine practicing hospitals and western medicine practicing hospitals provide the services free of charge in the country. The government of Sri Lanka covers healthcare expenses through the general tax revenue. Yet, householders spend out of their pocket for healthcare services provided by private institutes. However, in 2013, the government contributed 55% of total healthcare expenditure while householders contributed 40%. Besides, tertiary care contributed the remaining 5% of the total healthcare expenditures.
Accordingly, the availability of OPD (Outpatient Department) facilities in the public hospitals situated in major cities along with the radiology and laboratory facilities have become an immense convenience to the general public. At present, the government of Sri Lanka builds different types of hospitals to treat specific illnesses free of charge. Most of the diseases can be treated in teaching hospitals since they contain higher technology and well-trained human resources in comparison to the other types of hospitals. Furthermore, district and base hospitals established all over the island supply efficient and effective healthcare services to everyone in need. Moreover, the healthcare system contains grass root level workers such as public health midwives and public health inspectors who go from house to house to provide their service in educating the public with regard to the common health issues related to health, nutrition, and communicable diseases free of charge.
Regulatory Bodies of the Healthcare System of Sri Lanka
Regulation is a key need of a healthcare system since it safeguards the public from many troubles and threats. Besides, regulation of the healthcare system allows the public for a number of programs for public health and welfare. Thus, protecting and regulating public health at every level is the main objective of regulating the healthcare system in Sri Lanka.
Let us now go through the list of crucial bodies that regulate the healthcare system in Sri Lanka.
- Sri Lanka Medical Council
- Ceylon Medical College Council
- Sri Lanka Nursing Council
- Private Health Services Regulatory Council
- National Medicinal Drug Regulatory Authority
- Ayurveda Research Committee and Ayurveda Formulary Committee
- Ayurveda Medical Council, Ayurveda Education, and Hospital Board
The government set standards for training and qualifying different types of health professionals by the medical ordinance enacted in 1924 and laid down rules on professional conduct in addition. Furthermore, all medical practitioners should register at the Sri Lanka Medical Council, and their membership has to be renewed every five years. Accordingly, it aims to protect the people in need of healthcare services by making sure that the medical practitioners maintain their professional and academic standards, discipline, and ethical practice.
The Private Health Services Regulatory Council regulates the private health sector in Sri Lanka. This was established with the intention of developing and monitoring the standards that should be maintained by the registered private medical institutions. Similarly, the Sri Lanka Medical Council has the responsibility to ensure the minimal recruitment qualifications and minimum standards for the training personnel by all private medical institutions along with assuring the quality of patient care services delivered by these institutions. Thus, the formulation of quality assurance programs for patients and monitoring their implementations can be used to achieve the above goal.
How Healthcare Services are Organized in Sri Lanka
The Sri Lankan healthcare sector provides healthcare services mainly under the following two categories.
- Allopathic healthcare
- Alternative healthcare
The allopathic healthcare system is the way of treating the symptoms and diseases of patients with surgery, medication, radiation, and other procedures by medical doctors, nurses, medical laboratory scientists, pharmacists, and many other professionals. Besides, the alternative healthcare system is the way of treating the patients by focusing on improving health through maintaining the balance between body, mind, spirit, and environment. These treatments include Ayurvedic, homeopathy, Chinese medicine, chiropractic care, and naturopathy.
The Ministry of Health or simply the central government controls allopathic healthcare as the public sector healthcare provider. Allopathic healthcare includes the following three sub-categories.
- Curative healthcare
- Preventive healthcare
- Rehabilitative healthcare
Moreover, the department of healthcare services in the Ministry of Health acts as the main organizational structure to deliver healthcare services. Besides, the following happens to be the principal functions of the department.
- Setting policy guidelines
- Training of health personnel
- Management of teaching and specialized medical institutes
- Bulk purchase of medical requisites
Similarly, Ayurvedic medicine comes under alternative healthcare. The department Ayurveda of the ministry has the responsibility to provide Ayurvedic healthcare to the public. Accordingly, 41 Ayurvedic hospitals and 106 Ayurvedic central dispensaries in the country provide their service.
The Deputy Director Generals for public health (DDG.PHS), medical services (DDG. MS), laboratory services (DDG.LS), management and planning, education, training, and research (DDG. ETR) have the responsibility regarding the technical aspects of healthcare services at the central level. In the same way, the healthcare-providing institutes in Sri Lanka are further divided into the following institutes for a better provision of health services to the public.
- Medical Officer of Health Offices
- District General Hospitals
- Teaching Hospitals
The following sections the main functionalities about these institutes furthermore.
1. Medical Officer of Health Offices
Medical Officers of Health acts as the head of Medical Officer of Health (MOH) offices. Under the guidance and supervision of MOH, public health nurses, public health midwives, and public health inspectors provide preventive services at rural levels. MOH offices hold more than 420 child and maternal clinics to identify their diseases which prevent complications in the future. The main duties of the MOH office are as follows.
Provision of Maternal and Child Health (MCH) Care from Birth to Adolescence and Care at Pregnancy
Let us go through each of the maternal and child health (MCH) care provided by MOH offices.
- Maternal Care: Prenatal, during birth, and postnatal care will be provided via home visits. The main goal is to prevent the diseases and complications that happen during pregnancy, delivery, and birth.
- Child Health Care: Vaccination programs for nine diseases and nutritional care along with the mediation of physical and mental development from birth to adolescence are provided.
- Family Planning: Educating and introducing healthy family planning methods to newly wedded couples.
- School Health Care: Annual medical inspections are carried out in schools in MOH areas with less than 200 students in total in grades 1, 4, and 7. These inspections identify the immunization needs, dental health needs and other health needs to be addressed.
- Well-women Health Care: This clinic prioritizes women of age between 35 and 60. Clinic checks these women for diabetes mellitus, hypertension, and early diagnosis of breast and cervical cancers.
Provision of Occupational and Environmental Health
Occupational and environmental health services are carried out by the public health inspectors under the supervision of MOH offices. These services include the following.
- Food Care: Inspecting, regulating, and educating all restaurants, food makers, and food stalls in the area.
- Sanitation: Inspecting all the water sources and sanitary facilities in the area.
- Controlling the Non-communicable Diseases (NCD): Inspecting and organizing prevention activities for the diseased area identified by the disease identification system in the hospital. Some of them include prevention programs for dengue and rabies.
2. District General Hospitals
District general hospitals spread throughout the country provide a full range of public healthcare services. These services are carried out in each district general hospital under the management of at least two general duty doctors. Furthermore, these hospitals contain the following set of several functional units.
- Outpatient Department (OPD)
- Waiting area/ Reception/ Registration/ Revenue
- Records Office (Biostatisticians office, active records, archives must be computerized)
- Consulting rooms
- Bed observation ward
- Public health/ MCH
- Injection room
- Dental unit
- Laboratory (hematology, microbiology/ parasitology)
- SMD – Design report 10
- Blood bank
- Casualty reception and treatment rooms (the treatment rooms should be big enough to be eventually equipped to the level of an operating theatre)
- Pharmacy or dispensary (the location should consider service to all patients and the general public)
Indeed, these hospitals offer plenty of healthcare services to the public. Some of these services rendered by the district general hospitals are as follows.
- Clinical services
- Ambulatory care services
- Adjunct clinical services
- Paraclinical services
- Social services
- Hospital equipment and ancillaries
- External services
3. Teaching Hospitals
A teaching hospital is also a type of general hospital that has the capacity to provide teaching purposes for medical students along with healthcare service delivery. They supply healthcare in 4 main specialties along with other subspecialties. The teaching hospitals are affiliated with medical faculties and nurses training schools to train the next generation doctors, nurses, and other health professionals. Moreover, these hospitals have the latest technology, higher human resources, and the necessary space to treat the patients in comparison to the other types of hospitals in Sri Lanka. Further, the largest 3 main teaching hospitals in Sri Lanka are located at Kandy, Colombo, and Galle. These teaching hospitals contain the following major functional units.
- Outpatients department (OPD)
- Honorary consultants (specialists) from the faculty
- Intensive care units for medical, surgical, and neonatal patients
- Special unit to treat sexually transmitted diseases
- An acupuncture center
In addition to the above units, teaching hospitals are facilitated with the following set of consultant (specialists) units.
- Judicial medicine
- Gynecology & obstetrics
- Eye surgery
- ENT surgery
- Chemical pathology
- Oral-maxillofacial (OMF) surgery
- Genito-urinary surgery
- Transfusion medicine
- Vascular and plastic surgery services
Categories of Healthcare Workers in the Public and Private Sector
The public healthcare workforce contains employees to operate both in curative and preventive sectors because the public sector has both curative and preventive categories under its supervision. The public allopathic curative health system contains the following set of healthcare workers.
- Specialists in family medicine
- Medical officers
- Hospital managers
- Medical laboratory technicians
- Support staff
In addition, the public allopathic preventive health system that is efficient contains the following healthcare specialists.
- Specialists in community medicine
- Medical officers of health
- Medical officers
- Public health inspectors
- Public health midwives
- Field officers
- School dental therapists
Furthermore, the public alternative curative health system contains healthcare workers such as Ayurvedic physicians and registered traditional medical practitioners while the public alternative preventive health system contains healthcare workers like community health officers, assistants, and Ayurvedic medical officers.
However, the healthcare workforce in the private sector mainly focuses on the allopathic and alternative curative category as the private sector mainly works in the curative primary care sector. The private allopathic curative health system contains healthcare workers such as general practitioners, government doctors in the dual practice, medical officers in large hospitals, outpatient departments, nursing assistants, and the support staff. Besides, the private alternative curative health system contains healthcare workers such as Ayurvedic physicians and registered traditional medical practitioners.
Furthermore, the medical faculties of the following universities in Sri Lanka provide graduate training for medical officers.
- University of Colombo
- University of Sri Jayewardenepura
- Eastern University in Batticaloa
- University of Peradeniya
- University of Kelaniya in Ragama
- Rajarata University in Anuradhapura
- University of Ruhuna in Galle
- University of Jaffna
- Kotelawala Defence University
- Wayamba University in Kuliyapitiya
- Sabaragamuwa University in Ratnapura
Challenges Faced by the Healthcare System in Sri Lanka
Even though Sri Lanka’s healthcare system is at a higher standard when compared with the other countries in the region, Sri Lanka’s healthcare system has faced a number of key challenges so far. The shortage of nurses and paramedical staff, severe geographic maldistribution of human resources related to the healthcare sector, insufficiency in facilities for basic and in-service training are significant challenges faced by the healthcare system. In addition, the following challenges have become more frequent.
- Significant imbalance in the distribution of current staff in the Northern part of the country due to the terrorist activities and the civil war that has happened for over 30 years.
- The migration of medical officers and nursing officers to other countries for further salaries and working environments has negatively affected the healthcare system.
- As a result of tertiary care health facilities, Colombo, Kandy, and Galle have a higher density of healthcare facilities while the Eastern part of the country has a lower density of healthcare facilities.
- The low expertise in the psychiatric field and the lack of organization in treating mentally ill people. Besides, the facilities reserved for mentally ill people are not sufficient in the country.
- The drugs required for general illnesses are widely available in Sri Lanka. Still, the country lacks certain crucial drugs for particular illnesses.
Furthermore, the poor distribution of facilities and technology related to healthcare in the country has become a challenge as it causes a huge inconvenience for the general public. Additionally, the frequent outbreak of dengue due to the tropical climate of Sri Lanka has become another challenge faced by the healthcare system of the country as its risk is getting higher.
Future of the Healthcare System in Sri Lanka
Most of the measures and acts that are taken by the government of Sri Lanka in the healthcare sector do not fulfill the requirements of the current issues. Hence, to cater to the present needs and the possible future issues that are likely to be arising, the healthcare system should prepare itself beforehand. Although the rate of maternal and child mortality had a great influence in the healthcare sector earlier, the government took necessary measures to minimize the rate. Thus, at present, it is not an issue anymore. But, the rise in non-communicable diseases like cardiovascular diseases (CVD), Ischemic heart diseases and strokes, cancers, diabetes, and respiratory diseases like asthma have become a major issue now. Therefore, the government should take necessary steps to increase the human and technical resources to treat these types of diseases as soon as possible.
Furthermore, the growth rate of the elderly population in the country should be kept under control in order to achieve the goals set in the health sector of the country. Moreover, the government hopes to give thorough attention to primary healthcare in the future. In addition, the director-general of health services has stated that 70-80% of all the care should be received at the primary care level, 10–15% of the care should be received at the secondary care level and the rest at the tertiary care level. Besides, the use of data and information should be improved for a people-centered service provision for the betterment of healthcare. However, the state has invested in human resources with the necessary skills to provide a remarkable service to the healthcare system in the future. So, we can certainly hope for a better healthcare system in Sri Lanka in the years to come.
The Bottom Line
Conclusively, it is a must mention that Sri Lanka holds a unique position in South Asia as one of the first of the less developed nations to provide its citizens with quality, free healthcare facilities that meet the universal healthcare standards. Besides, the efforts of the government and the contribution of the health sector employees, in maintaining and improving the healthcare system are indeed appreciable. However, its journey is not to stop here. This sector keeps improving, and thus, the healthcare sector in Sri Lanka tomorrow is certainly going to be more developed than in the present. And for sure, it is to achieve a celebrated success with no time!