Healthcare Scenario in Sri Lanka

Healthcare Scenario in Sri Lanka  

Sri Lanka, historically known as Ceylon, and officially known as the Democratic Socialist Republic of Sri Lanka, is a South Asian Island republic. It is located in the Indian Ocean, southwest of the Bay of Bengal and southeast of the Arabian Sea; the Gulf of Mannar and the Palk Strait separate it from the Indian subcontinent.  

Sri Lanka has a free and universal health care system. It scores higher than the regional average in healthcare having a high Life expectancy and a lower maternal and infant death rate than its neighbours.  

Healthcare Overview 

The health system in Sri Lanka has a mix of Allopathic, Ayurvedic, Unani and several other systems of medicine that exist together. Like other countries, the Sri Lankan health system consists of both public and the private sector. The Health Ministry and the Provincial Health Services provide a wide range of promotive, preventive, curative and rehabilitative health care with an extensive network of health care institutions.   

Health Indicators 

Sri Lanka has a population of 2.1 Crore and a growth rate of 0.63% according to 2022 estimates. It has a birth rate of 14.01 births per 1000 population, a death rate of 6.45 deaths per 1000 population, and average life expectancy of 77.75 years. The sex ratio is 0.95 males to 1 female.   

Maternal Health Indicators 

The fertility rate in Sri Lanka is 2.1 children per woman. Maternal mortality rate in Sri Lanka is 36 deaths per 100,000 live births, and contraceptive prevalence is 64.6%.  

Child Health Indicators 

Neonatal mortality rate is 4 per 1000 live births. Infant mortality rate in Sri Lanka is 8.36 deaths per 1,000 live births which is much less than the global average of 29 deaths per 1000 live births. Under-five mortality rate (probability of dying by age 5) is a staggering 7.1 per 1000 live births.  

Health Care System in Sri Lanka  

Sri Lankan primary healthcare is delivered through two distinctive modalities; curative and preventive. However, most primary healthcare systems in the world are limited only to ambulatory care.  

• Preventive care: The preventive care system of Sri Lanka is separated into geographic subdivisions known as Medical Officer of Health (MOH) Units that cater to 60,000 to 100,000 people. Established first in Kalutara in the Western Province in 1926, the system has now expanded to cover the whole island. MOH area can be described as the smallest administrative division in public health in Sri Lanka. Internationally, only a handful of countries share a unit based preventive health system similar to Sri Lanka. 

These health units in Sri Lanka undertook the usual duties of a public health department, including health education, general sanitation, vital statistics, prevention and control of communicable diseases, maternal and infant welfare, and school inspection. The MOH unit consists of a medical officer of health, public health inspector and public health nurses and midwives. Currently, there are 346 MOH offices in Sri Lanka. 

• Curative care: Curative services are provided by a network of hospitals, including primary care units, under the main ministry and provincial governments. In 1951, access to health services was further extended, by abolishing all user charges for government medical services. By the year 2007, there were 615 health institutions providing inpatient care in the country, along with 441 primary medical care units (PMCUs) and 291 MOH areas engaged in providing preventive health care. 

Public Sector 

Sri Lanka has an extensive public health care system. There were a total of 1,067 public hospitals and outpatient facilities in 2011: 592 hospitals with inpatient facilities providing various levels of inpatient and outpatient care, and 475 central dispensaries providing only outpatient care. The government employs more than 90 percent of all practising doctors and nurses in the country, and operates more than 90 percent of the hospital beds. The majority of the population has reasonable access to a public health care facility (with the private sector playing a supportive role). On average, Sri Lankans are within 1.4 kilometres of a basic health clinic and 4.8 kilometres from a free government-sponsored Western-type health care facility. It is also important to note that most healthcare facilities are small; fewer than 10 percent have 100 or more beds.   

Private Sector 

There has been a surge in private sector capacity since the 1980s, but the rate of growth of the sector has slowed more recently. Private health sector facilities in Sri Lanka saw a rapid growth during the period 1981 to 2000, with an expansion of services through hospitals, laboratories, and clinics. This growth has continued in recent years, but the rate of growth since 2000 has slowed and, in the case of smaller clinics and laboratories, has declined.  

The private health sector provides both outpatient and inpatient curative care in urban and semi urban areas of the country. The focus on curative services most likely stems from the higher demand for these services compared for preventive services (which the public system ensures easy access to) and the greater profit margins that curative services yield. 

Private hospitals provide inpatient care, with an estimated 4,210 beds in the private sector. Of these, approximately 50 percent are in Colombo, and the rest are distributed across a few districts (for example, Kandy, Galle, Kurunegala, and Anuradhapura) in small hospitals or clinics with approximately 20 to 30 beds each. The pharmacies, laboratories, imaging facilities, and individual medical practitioners provide ambulatory care. 

Healthcare Market Value  

The Healthcare Market of Sri Lanka is projected to reach US$2.25m in 2022. It is expected to grow at an annual rate of (CAGR 2022-2025) of 15.81%, resulting in a projected market volume of US$3.50m by 2025.  

Healthcare Financing 

The total current health expenditure in Sri Lanka for the years 2014, 2015 and 2016 amounted to be 374, 426 and 463 billion Sri Lankan rupees, respectively. The current health expenditure (CHE) was approximately 4% of the GDP in 2014, 2015 and 2016. Per capita CHE in 2014 was Rs 18, 119, Rs 20, 564 in 2015 and Rs 22, 268 in 2016.  

Analysis of CHE by districts indicated that the highest average per capita CHE was from the Colombo district. This may partially reflect the presence of a relatively larger number of specialist hospitals in the district. National per capita CHE was around Rs 20, 225. Assessment of CHE by sources of funds revealed that households and government sources have been the main sources of revenue in all three years. Out-of-pocket expenditure accounted for 50% of CHE in 2014 and 2015, which increased to 53% of CHE in 2016. 

Disease Burden 

Sri Lanka outperforms income and regional peers with regard to most health outcomes, including child and maternal mortality, and life expectancy. There has been considerable progress in eliminating several communicable diseases, including malaria, tuberculosis and measles. Nonetheless, challenges remain with regard to regional disparities in health outcomes, rising non-communicable diseases (NCDs) associated with an ageing population, and child malnutrition. The leading risk factor in Sri Lanka is dietary risks. Overall, the three risk factors that account for the most disease burden in Sri Lanka are dietary risks, high blood pressure, and household air pollution from solid fuels. The leading risk factors for children under 5 and adults aged 15-49 years were childhood underweight and dietary risks, respectively. These chronic diseases become more prevalent as Sri Lanka’s population rises. The limited supply of medications and medical specialists to address these diseases reduce the chances of patients receiving the care that they need. Sri Lanka frequently suffers from dengue outbreaks due to its tropical climate. Risk of dengue peaks from October to December and from May to July. In February 2020, the country’s Epidemiology Unit reported 11,352 cases, double the number of cases in 2019.  

Physician and Hospital Bed Density 

Physicians (per 1,000 people) in Sri Lanka was reported at 1.1 in 2019, according to the World Bank collection of development indicators, compiled from officially recognized sources. The physician density is just equal to the WHO recommended 1 physician per 1000 population. 

 There are 4.2 hospital beds per 1000 population which is a little more than WHO’s recommended standard of beds which is 3 beds per 1000. The Nurses and midwives (per 1,000 people) are 2.3, falling short of the WHO recommended rate of 3 nurses per 1,000 population. 

 Hospitals 

There are 555 government hospitals in Sri Lanka, in addition to several other government hospitals treating according to the Ayurvedic System. One hundred and forty-one (141) private hospitals provide inward patient care services in Sri Lanka. A large number of private hospitals have appeared in Sri Lanka, due to the rising income of people and demand for private healthcare services. 

Few major Public Hospitals in Sri Lanka are: 

1. The National Hospital of Sri Lanka: The National Hospital of Sri Lanka is a government hospital in Colombo, Sri Lanka. Founded in 1864 as the General Hospital, it is the leading hospital in Sri Lanka and is controlled by the central government. The hospital has 18 intensive care units and 21 operating theatres and 3,404 beds. 

1. Teaching Hospital, Peradeniya: This is one of the three hospitals in Peradeniya, Sri Lanka. It is one of the leading community teaching hospitals in Sri Lanka, affiliated with the University of Peradeniya. In addition to delivering medical care to patients, it facilitates undergraduate training programmes for the university students studying in the faculties of Medicine, Dental Sciences and Allied Health Sciences. It was established in 1980 and has 960 beds. 

1. National Cancer Institute, Maharagama: National Cancer Institute (sometimes Apeksha Hospital), widely known as the “Maharagama Cancer Hospital” is a government hospital in Maharagama, Sri Lanka. It is the main hospital which is dedicated for treating cancer which is under the control of the Department of Health, provides all its services free of charge. In 2016 the hospital opened a Haematopoietic Stem Cell Transplant (HSCT) unit. It is valued at Rs. 1.2 billion. Present day Sri Lanka has more than 50,000 cancer patients.  

1. Provincial General Hospital, Badulla: Provincial General Hospital- Badulla is a compassionate provider of patient-centred health services with an emphasis on tertiary-level specialty care, primarily for residents of Uva province. As the premier healthcare provider (1541 bedded) in the region, it is the only tertiary-care hospital in the Uva province and works actively to develop partnerships with other health care organisations.

Few major Private Hospitals in Sri Lanka are:

Lanka Hospital: Lanka Hospital (formerly Apollo Hospital Sri Lanka) is a multi-specialty tertiary care hospital in Sri Lanka and is one of the largest private hospitals in the country. It is a subsidiary of Sri Lanka Insurance Corporation. The company was previously owned by Apollo Hospitals. There are approximately 350 beds at the hospital including four intensive care units (medical, cardiothoracic, renal and neonatal). The wards are divided into either individual rooms or cubicles with six beds each, depending on the patients’ choice.  

1. Durdans Hospital, Colombo: A trusted name in Sri Lankan healthcare for over seven decades, the hospital has built a huge reputation, for its regional leadership in medical excellence as well as innovation. With 260 beds, including 60 in the critical care department, across spacious modern rooms. The hospital is also known for offering the best consultants, specialists, and employees. The hospital’s specialties are general surgery, cardiology, neurology, orthopaedics, oncology, gynaecology, dermatology, etc.

1. Nawaloka Hospitals, Colombo: The entry of Nawaloka Hospitals into the state-dominated healthcare sector in 1985, saw a growth in the private health care system take root in Sri Lanka. The hospital’s launch has seen an overwhelming response from the people during its high-quality healthcare. The hospital has several departments and some of them include ophthalmology, oncology, hematology, cardiology, and neurology.

1. Asiri Hospital, Sri Lanka: Known as one of the leading private healthcare brands of the country, the hospital is staffed with most dedicated, skilled, and experienced healthcare providers, as well as medical experts. Preferred by patients for its safe and healthy environment, the hospital’s specialties are general surgery, ophthalmology, oncology, neurology, audiology, radiology, etc.

Conclusion 

Sri Lanka holds a unique position in South Asia as one of the first of the less developed nations to provide universal health, free education, strong gender equality, and better opportunity to social mobility. Since its independence, successive governments have implemented welfare-oriented policies and programs which have allowed Sri Lanka to achieve relatively high standards of social and health development in comparison with countries of similar levels of economic development. As a result of this, the country has made significant improvements in social welfare, both in the development of public health care and education systems  

However, the quality of Sri Lanka’s public healthcare still needs improvement. The situation is particularly challenging in the estate sector, where the population has lower access to healthcare and lower levels of nutrition, compared to their counterparts in urban and rural areas. Further, the absence of a proper referral system and the shortage of primary healthcare facilities lead to overcrowding of secondary and tertiary healthcare units, prompting people to seek healthcare with private institutions, thereby increasing their out-of-pocket expenditure. 

For more information about the Country and Healthcare opportunities in Sri Lanka, you can visit the company website on www.hospaccxconsulting.com or contact us directly. 

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