an improvement in technical efficiency over the years, although in some instances, overcrowding may also stimulate a high rate of turnover. Table 4.4 of Chapter 4 indicates the average duration of stay among different types of hospitals from 2004 to 2016. A decreasing trend has been observed in the average duration of stay in all hospitals over time. Except for a few unanswered questions such as indications for a high admission rate, an overall assessment of the system suggests that it is efficient in its use of resources. The points mentioned should be analysed to see the gaps and areas where efficiency can be improved. A good HIS will facilitate patient information reporting, prevent duplication of investigations/services, allow for disaggregation of data, analysis and monitoring of services. Currently, data cannot be tracked due to a lack of proper recording and information system at PHC facilities. Special efforts/measures in the reform process would be necessary to attract patients who use health care in an ad-hoc manner to these facilities.
7.6 Transparency and accountability In Sri Lanka, a top–down approach is mainly seen in health policy formulation. The persons involved in managing the relevant public health agencies, along with professional colleges and UN agencies for technical inputs, support the policy development process, mainly upon request. However, once the policy is drafted, it goes through a process of public hearing as well as relevant stakeholder consultations. All draft policies must be advertised to the public on the MoH website prior to subsequent approval, implementation and adaptation. However, public consultations do not occur routinely. The public is made aware of the policies through publication on the website of the MoH as well as through gazette notification, in the case of an Act. The public sector financial allocation, service provision and service utilization in health care are documented regularly in the Annual Health Bulletin and the National Health Accounts published by the MoH. These documents, published on the website of the MoH and other relevant websites of government departments, are freely accessible to the public. In addition to this, the health coverage indicators, health condition and risk factor survey reports are also made available to the public. As these are technical reports, the public may lack the technical knowhow to understand these. Advocacy briefs and short reports in simple language are seen to be lacking for the public. Although annual reports include hospital statistics, there is no reporting of hospital
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