2019 Dec 12
As the world commemorates Universal Health Coverage Day on December 12th every year, we reflect on the progress Sri Lanka has made in achieving universal healthcare as well as prospects for improvement. The idea behind Universal Health Coverage (or UHC) is that every human being has a right to quality and affordable basic health services. The United Nations passed a resolution on global health and foreign policy that recommended universal health coverage as a top priority in the post-2015 development agenda. Sri Lanka, along with other member states not only made it a point to recognise the importance of universal healthcare in national health systems but also reaffirmed their commitment to promote physical and mental wellbeing and extend life expectancy for all with the aim of “leaving no one behind.”
The Sri Lankan Healthcare Policy
Sri Lanka adopted a free healthcare policy in 1951, shortly after gaining Independence. In addition to readily available OPD services in public hospitals located in major towns, treatment options that cover a large number of illnesses and highly trained doctors and nursing staff, Sri Lanka also frequently states that free and universal healthcare to all citizens is and always will be a top national priority.
Sri Lanka’s health indicators too are higher and much more impressive than those in the region, despite our relatively low levels of health expenditure. This also places a small state like Sri Lanka on an equal footing with developed countries. The life expectancy of males and females stand at 72 years and 80 years respectively. An expansion of preventive and curative services in the national health delivery system has resulted in a significant number of other achievements within the past few years. For instance, low rates of both maternal and infant death, comprehensive vaccination coverage and the elimination of Malaria, Lymphatic Filariasis, Neonatal Tetanus and Measles are some significant achievements of our healthcare system.
Primary Healthcare in Sri Lanka
Sri Lanka is also on a good trajectory towards achieving universal healthcare coverage owing to the country’s investment in primary healthcare (or PHC). Primary healthcare in Sri Lanka aligned with two central services at the onset; community services such as maternal and child health and curative services such as improving hospitalization and ambulance services. Thereby, PHC not only ensures a continuing state-sponsored commitment to quality healthcare delivery but also provides a firm base for the achievement of universal and affordable healthcare to all its citizens. Further, proactive steps taken to ensure female education as well as a commitment to improving mother and child care have had a positive impact on recent health sector indicators as well.
Room to Improve
However, despite some major achievements our healthcare delivery system has a long way to go in addressing an array of shortcomings, ranging from chronic malnutrition in children to an increased rate of deaths caused by non-communicable diseases. The latter comes as a new challenge following a significant lowering in infectious diseases that greatly improved healthcare. However, conditions such as diabetes, ischaemic heart disease and strokes have become the top three health problems that most patients face. Sri Lanka also faces a significant demographic shift reflected by a rising ageing population; the fastest in South Asia, according to recent studies. Figures show that 20.8% of the country’s population will be over 60 by 2031, according to Dr Palitha Abeykoon who serves as Chairman of the Sri Lanka Medical Council. At an event held last year to commemorate Universal Healthcare Coverage Day, Dr Ruvaiz Haniffa, President of the Sri Lanka Medical Association stressed on the importance of creating a culture of people-centred healthcare services instead of hospital-based or illness-based treatment procedures, which is arguably the norm at present; further stating that “the goal is to live well, not to live more.”
Tackling the rising trend of cigarette consumption is another concern expressed by the health sector in order to reduce the number of drug-related deaths that occur annually. Cigarette consumption among adult males has supposedly decreased from around 29% in 2011 to around 24% in 2015.
Complications in Retaining Talent
With regard to human resources, issues such as brain drain undoubtedly play a role in the palpable shortage of doctors and other medical professionals in the public health sector. Most medical officers see a lot more incentive in either moving to private hospitals or migrating overseas due to better salary prospects and living standards. The same applies to those in the nursing profession, who see better prospects working in the private sector or by working abroad. A sustainable solution to Sri Lanka’s problem of ‘brain drain’ is yet to be found.
While appreciating the significant achievements of Sri Lanka’s healthcare system and acknowledging that we have a long way to go, let the International Day for Universal Healthcare Coverage serve as a reminder of our collective responsibility to advocate for a future where each and every citizen has access to quality and affordable healthcare.