developments in Sri Lanka

6.1 Analysis of the significant health reforms that affected health developments in Sri Lanka

The reforms date back to 1926 when the MOH system was established. The principal reforms in Sri Lanka are described in Table 6.1 and can be categorized with reference to the six health systems building blocks. Although almost all these policies change the impact of multiple building blocks of the system, each is seen to have an impact on one component more than the rest. These reforms include the following:

a. governance: legislation of the Health Service Act 1952; regulation of the private sector in 2006; addressing health risks such as the tobacco and alcohol policy in 2006; and establishing the framework for prevention and control of NCDs in 2009; b. medicines and medical products: establishment of the NMRA in 2015; c. health workforce: dual practice policy in 1977; establishment of HR coordinating division in 2016; d. health delivery systems: decentralization of health services to the provincial health departments in 1987; establishment of a DGH in each district in 2000; and policy towards health service delivery for

UHC in 2018; and e. HIS strengthening in 2016.

Table 6.1 Major health-care reforms and policy measures

Year Reform

1926 Establishment of health unit (Medical Officer of Health) system 1952 Health Services Act (No. 12 of 1952) 1977 Dual practice* 1987 Decentralization of health services and establishment of provincial health departments 1991 Management reform to amalgamate preventive and curative care services in keeping with local administrative boundaries 2000 Development of one hospital to the level of a district general hospital for each district 2005 National Medicinal Drug Policy 2006 Private Health Sector Regulation Act 2006 National Authority on Tobacco and Alcohol 2009 National Policy and Strategic Framework for Prevention and Control of Chronic NonCommunicable Diseases 2013 National Migration Health Policy 2016 Establishment of National Human Resource Coordinating Division 2017 National Policy on Health Information 2018 Policy on Health Service Delivery for UHC

* Government health professionals are allowed to engage in private practice during off hours. Source: Compiled by the authors