Sri Lanka Health System Review

Page 35

1.2 Economic context The economy that evolved under British rule was oriented towards plantation agriculture. As such, at Independence, Sri Lanka inherited an agriculturebased export economy, deriving more than a third of its income from the export of tea, rubber and coconut. Favourable export incomes supported the pursuit of a welfare economy focused on equity, which paid dividends in the form of significant improvements in the area of human development. The high consumption, low investment in economic development, declining commodity prices and failure to diversify led to a decline in the economy. Plantations, the petroleum industry, the port and omnibus companies were nationalized by a socialist regime. The change of government in 1977 brought a change in policies that introduced a free-market economy, which promoted privatization, deregulation and promotion of private enterprise (Indraratna, 1998) (Table 1.5). Table 1.5 Macroeconomic indicators, 1970–2018 Indicators

1970

1980

1990

2000

2010

2016

2017

GDP (local current US$) in billions

2.3

4.0

8.0

16.6

56.7

82.4

88.0

88.9

GDP, PPP (current US$) in billions

..

..

40.5

82.5

168.8

261.7

276.2

291.5

GDP per capita (current US$) in thousands

183.9

267.7

463.5

869.5

2808.4 3886.3 4104.6 4102.5

GDP average annual growth rate for the past 10 years (%)

3.8

5.8

6.4

6.0

8.0

4.5

3.4

3.2

Public expenditure (% of GDP)/ gross national expenditure (% of GDP)

103.1

122.6

107.9

110.6

107.3

107.3

107.2

107.3

Current account balance (% of GDP)

..

-16.3

-3.7

-6.4

-1.9

-2.1

-2.6

-3.2

Tax burden (% of GDP)–tax revenue (% of GDP)

..

..

19.0

14.5

11.3

12.2

12.4

..

Public debt (% of GDP)–Central Government debt

..

..

96.6

96.9

71.6

..

..

..

Value added in industry (% of GDP)

24.2

29.9

26.3

27.3

26.6

27.3

27.3

27.0

Value added in agriculture (% of GDP)

28.8

27.8

26.7

19.9

8.5

7.5

7.8

7.9

Value added in services (% of GDP)

47.1

42.3

47.0

52.8

54.6

56.9

55.7

56.8

Labour force (total) in millions

..

..

7.4

7.8

8.2

8.5

8.5

8.6

Unemployment, total (% of labour force)

..

..

15.9

7.7

4.9

4.4

4.2

4.4

Poverty rate (poverty headcount ratio %)

..

..

..

..

..

4.1

..

..

Income or wealth inequality (income share held by lowest 20%)

..

..

8.7

..

..

7.0

..

..

Real interest rate Official exchange rate (US$)

2018

..

..

..

..

-10.2

6.2

..

..

6.0

16.5

40.1

77.0

113.1

146.5

152.4

162.5

GDP: gross domestic product; PPP: purchasing power parity Source: World Bank, 2020 11


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9. Appendices ................................................................................................ 206 9.1 References

21min
pages 230-247

9.3 About the authors

4min
pages 250-254

7.6 Transparency and accountability

18min
pages 220-229

9.2 HiT methodology and production process

2min
pages 248-249

7.4 Health outcomes, health service outcomes and quality of care

5min
pages 203-205

7.3 User experience and equity of access to health care

14min
pages 195-202

7.1 Objectives of the health system

4min
pages 182-183

7. Assessment of the health system .......................................................... 157 Chapter summary

1min
page 181

6.3 Future developments

10min
pages 174-180

developments in Sri Lanka

1min
page 164

6.2 Analysis of recent major reforms

17min
pages 165-173

6. Principal health reforms ......................................................................... 139 Chapter summary

1min
page 163

medicine

2min
page 162

5.11 Mental health care

5min
pages 157-159

5.13 Health services for specific populations

1min
page 161

5.8 Rehabilitation

3min
pages 153-154

5.7 Pharmaceutical care

3min
pages 151-152

5.6 Emergency care

2min
page 150

5.2 Curative care services

3min
pages 145-146

5.4 Inpatient care

3min
pages 148-149

4.2 Human resources

6min
pages 117-120

5. Provision of services ................................................................................ 113 Chapter summary

1min
page 137

4.1 Physical resources

1min
page 104

4. Physical and human resources ................................................................ 78 Chapter summary

3min
pages 102-103

3.7 Payment mechanisms

1min
pages 100-101

3.6 Other financing

1min
page 99

Figure 3.8 OOP spending on health by expenditure deciles, 2016

11min
pages 86-92

3.5 Voluntary private health insurance

3min
pages 97-98

3.2 Sources of revenue and financial flows

2min
pages 81-82

3.3 Overview of the public financing schemes

2min
page 85

Figure 3.6 Financing system related to health-care provision

0
page 83

3. Health financing ......................................................................................... 48 Chapter summary

1min
page 72

2.9 Patient empowerment

7min
pages 68-71

2.8 Regulation

8min
pages 64-67

2.7 Health information management

5min
pages 61-63

2.6 Intersectorality

3min
pages 59-60

2.4 Decentralization and centralization

3min
pages 56-57

2.2 Overview of the health system

1min
page 52

2.1 Historical background

2min
page 51

2.3 Organization

1min
page 53

2. Organization and governance ................................................................... 26 Chapter summary

1min
page 50

1. Introduction .................................................................................................. 1 Chapter summary

1min
page 25

1.4 Health status

11min
pages 37-43

1.3 Political context

2min
page 36

1.5 Human-induced and natural disasters

3min
pages 48-49

Figure 1.1 Map of Sri Lanka

1min
pages 27-28

1.1 Geography and sociodemography

1min
page 26

1.2 Economic context

2min
page 35

1 Analysis of the significant health reforms that affected health

2min
page 30
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