7. Assessment of the health system
Chapter summary The health system of Sri Lanka has a proven track record of satisfactory performance and has gained international recognition as a successful model of “good health at low-cost”. It has achieved commendable health outcomes above what is commensurate with its income level. The objective of Sri Lanka’s health services from inception has been to ensure and maintain health care of a high quality, free at the point of delivery to all its citizens. Sometimes, maintaining equity has had priority over quality. However, this has not been through a reduction in clinical standards of care but through accepting a lower quality of amenities. A key feature of the services is that they are provided close to people’s homes through a widespread network of government health institutions, and a person is free to seek care at any hospital in the country without a formal referral. This has ensured increased accessibility for all persons to any service offered in the government sector. However, there is increased inequity when the poor cannot afford to seek health care at higher-level institutions due to travel and incidental expenses. Free choice of health institution may also result in overcrowded tertiary care hospitals, leading to constraints in the quality of care. Health financing indicators demonstrate that the health system is both propoor and efficient compared to other low- or middle-income countries in the region (refer Table 3.2). Although OOP expenditure as a proportion of CHE has risen steadily during the past two decades, financial hardships due to illness are minimal, mainly because catastrophic illness is taken care of at public facilities. The country has a preventive system, which adopted a primary care approach from as far back as 1926. This, together with the prioritization of social interventions, such as female education and nutrition interventions, have delivered health indices, such as life expectancy at birth, neonatal, infant, under-five mortality and maternal mortality rates, better than those in countries with much higher incomes. Tracer UHC indicators on prevention show a high score while those for treatment coverage do not reach the same level, identifying the need for reform in the curative sector.
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