Background:

Sri Lanka was and remains a high performer in health status terms, with better health indicators than other low income and low middle income countries. . Mortality rates are low and continue to decline at above average rates in the comparison with other comparable countries. With life expectancy projected to reach current US levels by 2020, the country faces a rapid aging process with an increasing portion of the population suffering from chronic diseases. The number of elderly is expected to increase rapidly after 2010.

The total midyear population (2005) is 19.6 million. The island has a land area – Sq Km 62,705. The per capita GNP was Rs 119,413 (USD 1,188) with a GDP growth rate of 6% (2005)

Sri Lankans enjoy a long life expectancy and in 2006 for male life expectancy was 71.7 yrs, and for female 76.4yrs. In the recent years the male to female difference has been widening.

Health system

The Key provider of health care is through the Government health care system. Western and Ayurvedhic systems are practiced. The Western system of medicine is more popular at present; however significant interest in the Ayurvedhic systems is seen.

The Government health care is totally free of charge to the patient. However out of pocket spending is incurred for transport and sometimes for drugs and investigations that may not be available at the time of seeking care.

The Government health system has a wide coverage that provides accessible care throughout the country. The Health system is hospital based, and preventive and preventive health care being provided through the community health care system.

International comparisons:

Sri Lanka’s per capita income in 2008 is USD 1600 (source – Central Bank, Sri Lanka ) The per capita expenditure on health is USD 31 ( 2003) When compared with other countries that have achieved similar life expectancy and % population above 60yrs Sri Lanka has been able to do this with lesser expenditure on health care.

Table 2. International comparison of health outcomes and expenditures

Source World Health Organization 2006 Countries are ranked in order of increasing GDP per capita

Sri Lanka’s Health sector performance as reflected through selected health indicators (maternal and infant mortality, life expectancy)are far ahead of the averages for countries at comparable levels of income. These health indices however correctly reflect non communicable diseases which have posed a significant health burden affecting all demographic strata and are seen to affect out of pocket health care expenditure. NCDs contribute to 65% of all cause mortality. This is a high rate where the WHO – SEARO region rate is 50% and WHO – EURO regions rate is 85%. (page 68, Sri Lanka: Addressing the needs of an aging population – The WB , Human development division South Asian region, 2008) The cost of addressing non communicable diseases is high in a situation where there is already significant prevalence (Diabetes mellitus 14.2% men and 13.5% women (Wijewardene et al. 2005).

Early diagnosis and long term treatment to prevent adverse outcomes is vital. The management of adverse clinical outcomes of these NCDs becomes costly and hence more emphasis needs to be placed on earlier diagnosis and treatment (secondary prevention). Recent analysis of Sri Lanka’s mortality data (Institute of Policy studies, Sri Lanka) shows that the age adjusted mortality rates are 20-30% higher in Sri Lanka than in the developed countries.