6. Principal health reforms
Chapter summary This chapter discusses some of the major health-care reforms and policies that have taken place from 2006 to date: the establishment of the National Authority on Tobacco and Alcohol (NATA), National Policy and Strategic Framework for Prevention and Control of Chronic Non-communicable Diseases, National Migration Health Policy, establishment of the National Medicines Regulatory Authority (NMRA), National Policy on Health Information, and Policy on Health Service delivery for UHC. These policies and reforms address the needs of the country brought about by demographic, epidemiological and social transition. Some of the problems in service provision are highlighted in Chapters 5 and 7. Despite strong policy commitment to health reform such as NATA, the National Human Resource Coordinating Division and NMRA, implementation gaps point to the need for strengthening the technical aspects of human resources in these new agencies to fulfil their mandates. The Health Services Act of 1952 was the basis for the first health reform and reorganization of services in an independent Sri Lanka. Some of the reforms and policies such as the establishment of the health unit system 93 years ago, which predates Independence, and the Dual Practice Act of 1977, remain relevant and have a considerable influence on how services are provided even today. Decentralization of administration to the provinces in 1987 and health becoming a partially devolved subject have had many implications on service provision, quality and equity. The ongoing health service delivery reform for UHC emphasizes PHC and attempts to shift focus from the current predominance of specialized care to that of more coordinated care across all levels. This is based on the evidence of the merits of patient-centred PHC combined with a proper referral system in achieving equitable access to care. It is envisaged that this would lead to better health systems efficiency and quality of services for chronic NCD conditions. This needs continued strong political leadership, as the key missing reform policy is an increase in fiscal space for health. The government should increase its spending on health, which currently stands at 8% of the GGHE (average 2009–2016). This is to help reduce the current high level of OOPE, which was 50.1% of CHE in 2016 (see Chapters 3 and 7). 139
