2. Organization and governance
Chapter summary The Sri Lankan health system comprises western allopathic and other traditional systems, with the former serving the majority of the population. Government health services commenced with the initiation of a civil medical department in 1858. In 1926, the preventive services were reorganized with the creation of the health unit system. Curative services are provided by a network of tertiary- and secondary-care institutions, divisional hospitals (outpatient and inward care) and primary medical care units offering outpatient care. The medical officer of health (MOH) and his team provide preventive services through health units that cover the whole island. All state sector services, both curative and preventive, are free of charge at the point of delivery. In addition, separate service facilities are available for the armed forces, police and prisons. The public sector provides nearly 95% of inpatient care and around 50% of outpatient care. Although the private sector is becoming a growing presence, their services are available to only a fraction of the population due to the high costs involved. Furthermore, patient-related statistics from the private sector are limited since the national Health Information System (HIS) includes only the state sector. The state health services function under a cabinet minister. Following the Thirteenth amendment to the Constitution, health became a partially devolved subject. The Ministry of Health (MoH) is responsible for stewardship functions such as policy formulation and health legislation, programme monitoring and technical oversight, management of health technologies, human resources, and tertiary and other selected hospitals. The primary and secondary levels of curative care and preventive services function under the nine provincial ministries. The first comprehensive national health policy based on primary health care (PHC) was prepared in 1992 and later revised with a focus on universal health coverage (UHC) (2014–2016). The current policy (2016–2025) addresses emerging health issues, quality and safety, and the expectations of the people.
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