Sri Lanka has embarked on strengthening Primary Health Care as a means towards universal health coverage and SDG3. The health system has achieved good health outcomes in communicable diseases and RMNACH through its extensive network of public health units and hospitals throughout the island. Hospitals in urban areas are well staffed and equipped to meet the growing curative health demands of the community and the government contributes more than 55% of the total health expenditure for the country. However, the high burden of Non-communicable diseases (NCDs), particularly cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, which account for over 75% of deaths in the country, needs to be addressed within a systems approach. This frame is supported by the Cabinet approval of the policy on health care delivery for Universal Health Coverage in 2018, which aims to “ensure universal health coverage to all citizens, relevant to the disease burden experienced in the country through a well-integrated, comprehensive and efficient health service.”
The country’s health sector has delivered exceptionally well without an explicit package, no strategic purchasing and little managerial autonomy. However, as an answer to future challenges, the government is looking to strengthen the system accountability mechanism and responsiveness by developing and ensuring the implementation of a benefit package. Thus, the MoH together with WHO has initiated the development of an essential service package (ESP) which consists of guaranteed services including most NCD and chronic care (elderly, palliative), as well as gradual integration of services delivered vertically in all PHC facilities. In addition, several catalytic technical work such as the strategic roadmap for human resources for health, health financing strategy, cross-programmatic efficiency analysis and general review of the health system (HiT) are currently undertaken. The ESP is at the center of health system strengthening efforts.
With the benefit package developed (ESP), the challenge is to effectively implement it across the PHC facilities. This will require good understanding of stakeholders on why Sri Lanka needs a package, what are the guaranteed essential services, how are these delivered and what needs to change in the system.