The major challenges facing the system at present are inadequate government spending on health to match the demand for services resulting from the epidemiological and demographic transitions, increasing allocative efficiency and maintaining equity and quality of services, particularly at the primary care level. There is a system mismatch since the prevailing system had been built mainly for managing episodic acute conditions. The level of GGHE, 8–9% of GGE, is inadequate, as reflected by the high level of OOPE, which has been more than 50% of CHE since 2008. The government health allocation since the beginning of the “good health at low cost” era in the 1980s cannot meet the current health challenges. Further, implementation of health system reforms to provide quality peoplecentric, first-contact curative care services, manage the rising burden of NCDs and the problems of an ageing population, while maintaining equitable access and improving the quality of services poses a challenge. Outbreaks of diseases such as dengue and H1N1 infections, and both acute and chronic undernutrition among children under 5 years of age continue to burden the system. In response to these challenges, a policy on health-care delivery for UHC (Ministry of Health, Nutrition and Indigenous Medicine, 2018e) has been launched and many supportive policies towards promoting health have been formulated in recent years. This chapter aims to provide an assessment of the health-care system in Sri Lanka, especially regarding financial protection, equity in financing, access to health care, user experience, health and service outcomes, quality of care, and health system efficiency, transparency and accountability.
7.1 Objectives of the health system The Constitution of the Democratic Socialist Republic of Sri Lanka does not explicitly state that health is a fundamental right. However, an indirect statement in Article 27 2 (c) reads as follows: “The realization by all citizens of an adequate standard of living for themselves and their families, including adequate food, clothing and housing, the continuous improvement of living conditions and the full enjoyment of leisure and social and cultural opportunities” (Parliament of the Democratic Socialist Republic of Sri Lanka, 1978). The present health-care system in Sri Lanka is a result of the Health Services Act of 1952 (Parliament of the Democratic Socialist Republic of Sri Lanka, 1952), many policy interventions since then and the Provincial Councils Act of 1987 (Parliament of the Democratic Socialist Republic of Sri Lanka, 1987). The founding principles of the health service of independent Sri Lanka has 158
