Sri Lanka Health System Review

Page 36

In 2018, Sri Lanka transited to an upper-middle-income country according to the World Bank definition, with a per capita GDP of US$ 4102.5 (however, in July 2020, World Bank downgraded Sri Lanka to lower-middle-income status). This led to a change in the beneficiary status for foreign aid and a limiting of the developmental assistance to the country. The economy grew markedly in the post-conflict period (8.0% in 2010) but has shown a declining trend at 4.5% in 2016 and 3.2% in 2018. The poverty headcount ratio was reported as 4.1 in 2016 (World Bank, 2020) and the income share held by the lowest 20% at 7.0, a decline from 8.7 in 1990 (World Bank, 2020). The main sectors of the economy are tourism, and tea, apparel and textile export while overseas employment contributes substantially towards foreign exchange earnings (Ministry of Finance, 2019).

1.3 Political context The documented history of the country begins with the arrival of the first Indo – Aryan immigrants from the north-western region of India, in the fifth century BC. The island was ruled by kings from then on, until the last kingdom, the kingdom of Kandy, was ceded to the British in 1815 (De Silva, 2005). The more recent political history of the country has been greatly influenced by its history as a British colony. In 1948, the country received autonomy within the British Commonwealth as the Dominion of Ceylon and continued to be governed as a parliamentary democracy. A new constitution adopted in 1978 provided for an elected executive president and a unicameral parliament. The President is the head of State, head of government and the commander in chief. The President heads the cabinet and appoints ministers from among the members of parliament. The Parliament of Sri Lanka is a 225-member legislature with 196 members elected from 22 multi-seat electoral districts and 29 elected from the national list allocated to the parties and independent groups in proportion to their share of the national vote (Parliament of the Democratic Socialist Republic of Sri Lanka, 1978). With the Thirteenth amendment to the Constitution in 1987, the administration was decentralized, and nine provincial councils were created. Provincial councils are directly elected for a 5-year term. The leader of the council’s majority party serves as the chief minister and is assisted by a board of provincial ministers. A provincial governor and a provincial secretary, who is the head of the provincial administration, are appointed by the President. Below the provincial level are several elected bodies. Municipal councils and urban councils are responsible for the administration of municipalities

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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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