health scenario in sri lanka dr.sarath samaraga deputy director general (planning)
TRANSCRIPT
Health Scenario in Sri Lanka
Dr.Sarath Samaraga
Deputy Director General (Planning)
Sri Lanka
Total Population 20.064 m (2004)
GDP per capita 947 USD (2003)
GDP per capita (PPP US$) 4,300
Human Development Index (HDI) 0.751 (2005)
Sri Lanka is ranked 93rd in the 2005 Human Development Report, with an HDI value of 0.751.
• Life expectancy at birth (years) 73• Adult literacy rate 92.3• Infant Mortality Rate 14.35 / 1000 LB• Hospital beds: 3.6 per 1,000 persons• Doctors: 2,300 persons per doctor• Nurses: 826 persons per staff
nurse
Sri Lanka
Problems• Malnutrition
• rapid increase in noncommunicable diseases
• violence and injuries (intentional and unintentional)
• malaria, TB, dengue and filariasis
• the above-mentioned problems are compounded for the poor population, with an estimated 25% of the population below the ‘national’ poverty line and 7% on less than one dollar/day.
Health Sector as an organic system
Management
Resource Inputs Organisation
Financial Support
Service Provision
SECTORS
+Others
++Indigenous
++Western
PrivateGovernment
Ampara
Anuradhapura
Moneragala
Kurunegala
Badulla
Puttalam
Ratnapura
Matale
Galle
Kandy
Polonnaruwa
Mullaitivu
Mannar
Batticaloa
Kegalle
Vavuniya
Hambantota
Trincomalee
Kalutara
Matara
GampahaNuwara
Eliya
Kilinochchi
Jaffna
Colombo
53.2
26.9
30.1
19.0
53.7
32.9
30.6
38.0
26.3
23.6
21.3
45.8
25.3
95.1
13.3
17.7
30.9
38.5
57.1
33.8
35.5
2.2
113.1
23.5
Medical Offcers
0
1 - 25
25 - 35
35 - 55
55 - 115
Legend
Distribution of Medical Officers - 2002
Note : The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptanceby the United Nations.
Source : Annual Health Bulletin 2002 Department of Health Services - Sri Lanka
Ampara
Anuradhapura
Moneragala
Kurunegala
Badulla
Puttalam
Ratnapura
Galle
Matale
Kandy
Mullaitivu
Polonnaruwa
Mannar
Batticaloa
Kegalle
Vavuniya
Hambantota
Trincomalee
Kalutara
Matara
Gampaha
Nuwara Eliya
Kilinochchi
Jaffna
Colombo
128.4
47.9
81.5
34.2
55.1
68.0
45.0
80.6
38.8
44.4
65.9
66.1
49.337.8
28.4
151.8
66.7
55.5
109.4
54.2
68.6
8.2
172.1
60.7
Distribution of Nurses - 2002
Nurses per 100,000 population
0
1 - 50
50 - 100
100 - 150
150 - 200
Legend
Source : Annual Health Bulletin 2002 Department of Health Services - Sri Lanka
Note : The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptanceby the United Nations.
0
5000
10000
15000
20000
25000
1980 1985 1990 1995 2000 2005 2006
MO
SNN
Doctors and Nurses in the Health Sector over the years.
Public Resource Mobilization and Resource Allocation:
Issues Facing the Health Sector in Sri Lanka
MINIMUM FINANCING NEED $ 30-40 PER PERSON PER YEAR TO COVER ESSENTIAL INTERVENTIONS
Sri Lanka currently spending about $ 29 per capita50% by the state 50% Private
Only 1% Private Health Insurance
Per capita health expenditure 3.2% of GDP
49%44%
4%
1% 2%
Taxes
Employers
Out of pocket
Insurance
NGOs
Who Pays?
Source: Annual Health Accounts, Ministry of Health 2002
IS SRI LANKA INVESTING ENOUGH IN HEALTH?
NOT BY INTERNATIONAL STANDARDS
NHE/GDP% NHE/GDP%
Sri Lanka 3.2% UK 6.8%
Philippines 3.6% Canada 9.2%
Thailand 3.7% Australia 8.3%
Bangladesh 3.9% Japan 7.5%
Myanmar ?
Source: IPS-NHA 2002
0
0.5
1
1.5
2
2.5
1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000
Year
% S
har
e o
f G
DP
MOH Health Share of GDP Nominal (R+C) Exp.
* MOH Health Expenditure combines Recurrent & Capital Expenditures , 2003 is based on Estimates
Figure 01
Sri Lanka MOH Health Expenditure Share of GDP, 1939 to 2003
0.00
1.00
2.00
3.00
4.00
5.00
6.0019
73
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
YearHealth Share of Nominal GDP Education Share of Nominal GDPDefense Share of Nominal GDP
Trends in Sri Lanka Public Expenditure Shares of GDP for Health, Education and Defence, 1972-2003
Figure 02
Scenario A = GDP share growing to 1.49
0
20
40
60
80
100
120
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Year
Bil
lio
ns
of
Rp
s
Low GDP Growth
Medium GDP Growth
High GDP Growth
Estimated Growth of Health Expenditure by Government of Sri Lanka 2001-2015
Source: Health sector master plan study 2003
8.0 6.0 4.0 2.0 0.0 2.0 4.0 6.0 8.0
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
Over 75
Age
grou
p (y
ears
)
Percentage of population
Male Female
Age Pyramid 1981 and 2001
8.0 6.0 4.0 2.0 0.0 2.0 4.0 6.0 8.0
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
Over 75
Age
grou
p (y
ears
)
Percentage of population
Male Female
Planning Issues & Challenges
1: Responding to Epidemiology (Service and System) In order to meet the epidemiological changes, reorientation
of the health care services and their delivery system is a must. This can be derived from the following three principles:
• Principle 1: Prioritisation and Characterisation of Disease (Communicable/Non Communicable)
• Principle 2: Exploration and Development of New Strategy• Principle 3: Linking and Integrating Services and Systems
Required Policy Framework and Guiding Principles
Planning Issues & Challenges
Required Policy Framework and Guiding Principles
2: Responding to Patients’ Expectation (Culture and Care)Not only through the global awakening of patient’s right and equity, but also by looking at the characteristics of the disease itself, patient participation and satisfaction bears greater importance in the success of treatment. Greater efforts are needed in educating patients as well as health service providers to make better choices. This calls for reorientation of people’s cultural norm on the health care in association with the following principles:
Principle 1: Improvement of “Quality and Safety”Principle 2: Securing of “Patient Right”Principle 3: Enhancement of “Client Satisfaction”
Planning Issues & Challenges
Required Policy Framework and Guiding Principles
3: Responding to Efficacy of the System (Mission and Management)
Reorientation of the health sector organisation, management and information systems is required to respond to efficacy of the system. In the changing situation, it must reframe the entire management system to:
Principle 1: Be Accountable Principle 2: Be Flexible Principle 3: Be Efficient