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 (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.

• 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

Sri Lanka

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

PrivateGovernment

Ampara

Anuradhapura

Moneragala

Kurunegala

Badulla

Puttalam

Ratnapura

Matale

Galle

Kandy

Polonnaruwa

Mullaitivu

Mannar

Batticaloa

Kegalle

Vavuniya

Hambantota

Trincomalee

Kalutara

Matara

GampahaNuwara

Eliya

Kilinochchi

Jaffna

Colombo

53.2

26.9

30.1

19.0

53.7

32.9

30.6

38.0

26.3

23.6

21.3

45.8

25.3

95.1

13.3

17.7

30.9

38.5

57.1

33.8

35.5

2.2

113.1

23.5

Medical Offcers

0

1 - 25

25 - 35

35 - 55

55 - 115

Legend

Distribution of Medical Officers - 2002

Note : The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptanceby the United Nations.

Source : Annual Health Bulletin 2002 Department of Health Services - Sri Lanka

Ampara

Anuradhapura

Moneragala

Kurunegala

Badulla

Puttalam

Ratnapura

Galle

Matale

Kandy

Mullaitivu

Polonnaruwa

Mannar

Batticaloa

Kegalle

Vavuniya

Hambantota

Trincomalee

Kalutara

Matara

Gampaha

Nuwara Eliya

Kilinochchi

Jaffna

Colombo

128.4

47.9

81.5

34.2

55.1

68.0

45.0

80.6

38.8

44.4

65.9

66.1

49.337.8

28.4

151.8

66.7

55.5

109.4

54.2

68.6

8.2

172.1

60.7

Distribution of Nurses - 2002

Nurses per 100,000 population

0

1 - 50

50 - 100

100 - 150

150 - 200

Legend

Source : Annual Health Bulletin 2002 Department of Health Services - Sri Lanka

Note : The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptanceby the United Nations.

0

5000

10000

15000

20000

25000

1980 1985 1990 1995 2000 2005 2006

MO

SNN

Doctors and Nurses in the Health Sector over the years.

Public Resource Mobilization and Resource Allocation:

Issues Facing the Health Sector in Sri Lanka

MINIMUM FINANCING NEED $ 30-40 PER PERSON PER YEAR TO COVER ESSENTIAL INTERVENTIONS

Sri Lanka currently spending about $ 29 per capita50% by the state 50% Private

Only 1% Private Health Insurance

Per capita health expenditure 3.2% of GDP

49%44%

4%

1% 2%

Taxes

Employers

Out of pocket

Insurance

NGOs

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

0

0.5

1

1.5

2

2.5

1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000

Year

% S

har

e o

f G

DP

MOH Health Share of GDP Nominal (R+C) Exp.

* MOH Health Expenditure combines Recurrent & Capital Expenditures , 2003 is based on Estimates

Figure 01

Sri Lanka MOH Health Expenditure Share of GDP, 1939 to 2003

0.00

1.00

2.00

3.00

4.00

5.00

6.0019

73

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

YearHealth Share of Nominal GDP Education Share of Nominal GDPDefense Share of Nominal GDP

Trends in Sri Lanka Public Expenditure Shares of GDP for Health, Education and Defence, 1972-2003

Figure 02

Scenario A = GDP share growing to 1.49

0

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

Bil

lio

ns

of

Rp

s

Low GDP Growth

Medium GDP Growth

High GDP Growth

Estimated Growth of Health Expenditure by Government of Sri Lanka 2001-2015

Source: Health sector master plan study 2003

8.0 6.0 4.0 2.0 0.0 2.0 4.0 6.0 8.0

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

Over 75

Age

grou

p (y

ears

)

Percentage of population

Male Female

Age Pyramid 1981 and 2001

8.0 6.0 4.0 2.0 0.0 2.0 4.0 6.0 8.0

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

Over 75

Age

grou

p (y

ears

)

Percentage of population

Male Female

Planning Issues & Challenges

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

Required Policy Framework and Guiding Principles

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