6.1 Analysis of the significant health reforms that affected health developments in Sri Lanka The reforms date back to 1926 when the MOH system was established. The principal reforms in Sri Lanka are described in Table 6.1 and can be categorized with reference to the six health systems building blocks. Although almost all these policies change the impact of multiple building blocks of the system, each is seen to have an impact on one component more than the rest. These reforms include the following: a. governance: legislation of the Health Service Act 1952; regulation of the private sector in 2006; addressing health risks such as the tobacco and alcohol policy in 2006; and establishing the framework for prevention and control of NCDs in 2009; b. medicines and medical products: establishment of the NMRA in 2015; c. health workforce: dual practice policy in 1977; establishment of HR coordinating division in 2016; d. health delivery systems: decentralization of health services to the provincial health departments in 1987; establishment of a DGH in each district in 2000; and policy towards health service delivery for UHC in 2018; and e. HIS strengthening in 2016. Table 6.1 Major health-care reforms and policy measures Year
Reform
1926
Establishment of health unit (Medical Officer of Health) system
1952
Health Services Act (No. 12 of 1952)
1977
Dual practice*
1987
Decentralization of health services and establishment of provincial health departments
1991
Management reform to amalgamate preventive and curative care services in keeping with local administrative boundaries
2000
Development of one hospital to the level of a district general hospital for each district
2005
National Medicinal Drug Policy
2006
Private Health Sector Regulation Act
2006
National Authority on Tobacco and Alcohol
2009
National Policy and Strategic Framework for Prevention and Control of Chronic NonCommunicable Diseases
2013
National Migration Health Policy
2016
Establishment of National Human Resource Coordinating Division
2017
National Policy on Health Information
2018
Policy on Health Service Delivery for UHC
* Government health professionals are allowed to engage in private practice during off hours. Source: Compiled by the authors
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