2.1 Historical background

The legal framework for health services of the country is the Sri Lanka Health Services Act 12 of 1952, with revisions in 1956 and 1962. The Medical Service Minute of Sri Lanka No. 662/11 gazetted in 1991 and amended in 2001 and 2014 is applicable to medical personnel employed in the health services of the country (Parliament of the Democratic Socialist Republic of Sri Lanka, 2015a).

2.1 Historical background

From the time of the ancient kings, the State has assumed responsibility for the protection and promotion of the health of the people. There is archaeological and literary evidence that the State provided hospitals, “houses of delivery”, convalescent homes, institutions for the crippled and hospitals for the blind (Uragoda, 1987). The indigenous system of medicine is called deshiya chikithsa. Legend suggests that Ravana, the prehistoric king of Lanka, was a physician. The authorship of several books on medicine, namely Arkaprakasaya, Kumarathanthraya and Udishasasthraya, is attributed to him (Uragoda, 1987).

The indigenous system of medicine of the country is a confluence of the Ayurvedic system of medicine from north India, the Siddha system from southern India, the Arabic Unani system and the traditional deshiya chikitsa.5 The western allopathic system of medicine that predominates current service provision was introduced in the country by the Portuguese and the Dutch, but they provided services mainly for their military units and colonial staff. The foundations of the present health-care system were laid down during the British colonial period with the creation of a civil medical department in 1858 and a sanitary branch in 1913 (Medcalf A et al., 2015). The civil medical department and its sanitary branch functioned independently (although the sanitary branch was organizationally placed within the civil medical department) until they were brought under one office, that of the Director of Medical and Sanitary services. To date, the government health service displays this dichotomy as two functional arms, preventive and curative, albeit with different nomenclature and few cross-links, under a single Director General of Health Services (DGHS) and served by two hierarchical structures.

5 Sri Lanka has its own indigenous scheme of traditional medicine, which is called “Hela wedakama of Deshiya Chikitsa”. It is a traditional system of medicine mainly in the form of manuscripts. Hela wedakama considers the body as a whole ailment and sees health and disease in holistic terms. It emphasizes on the harmony of mind, body and spirit to cure diseases. This system has been practiced for many centuries.