5. Provision of services
Chapter summary Sri Lanka has an extensive health-care system encompassing both curative and preventive services, which have historically been separated into two parallel arms operating within the same organizational structure. Preventive health-care services are provided by 354 MOHs and a team of professionals covering all parts of the country. They provide a package of preventive services, including MCH services, to a defined population. Curative care comprises different levels, ranging from outpatient-only facilities and primary care institutions to tertiary-care institutions and specialized hospitals. These are organized into a hierarchical pyramidal network, the higher-level institutions acting as referral institutions for the lower-level facilities. The state-owned health system is free of charge for the care seeker and covers about 95% of inward care and 50% of total ambulatory care services in the country. Indigenous medicine services, though not the mainstream health system, have been included under the purview of the Ministry of Health since 2015. However, this document discusses mainly the allopathic system, since public demand is mainly for this sector. Private health services comprise general practitioners and private health institutions providing primary to tertiary care and is governed by the PMIRA. A separate directorate has been established within the MoH to coordinate private health-care services. The state health services in the country are well distributed as there is a health institution or facility within a distance of 4.8 km on an average (Ministry of Health, Nutrition and Indigenous Medicine, 2017b). There is also a free community ambulance service, which has increased health-care access in an emergency. The state also provides the required medicines and investigations free of charge to the patient. Together, all these have enabled Sri Lanka to achieve near UHC based on the principles of primary health care. However, the system has not evolved and transformed appropriately to meet the changing demands of the demographic and epidemiological transitions.
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