Transcript Health Scenario in Sri Lanka

Health Scenario in Sri Lanka
Dr.Sarath Samaraga
Deputy Director General (Planning)
Sri Lanka
Total Population
GDP per capita
GDP per capita (PPP US$)
20.064 m
947 USD
(2004)
(2003)
4,300
Human Development Index (HDI) 0.751
Sri Lanka is ranked 93rd in the 2005 Human Development Report,
with an HDI value of 0.751.
(2005)
Sri Lanka
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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
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
Government
Private
Western
+
+
Indigenous
+
+
Others
+
Distribution of Nurses - 2002
Distribution of Medical Officers - 2002
Jaffna
23.5
Jaffna
60.7
Legend
Legend
Nurses per 100 ,0 00 po pu lation
Kilinochchi
2.2
Kilinochchi
8.2
Medical Of fcers
0
0
1 - 50
Mullaitivu
1 - 25
Mullaitivu
50 - 1 0 0
10 0 - 1 5 0
25 - 35
15 0 - 2 0 0
35 - 55
Vavuniya
25.3
Mannar
13.3
Anuradhapura
53.2
Puttalam
30.6
Anuradhapura
128.4
Trincomalee
26.3
Puttalam
45.0
Polonnaruwa
53.7
Nuwara
Eliya
17.7
Gampaha
Kegalle
54.2
66.7
Badulla
38.0
Colombo
172.1
Ratnapura
32.9
Hambantota
23.6
Galle
109.4
Matara
35.5
Note : The boundaries and names shown
and the designations used on this map do
not imply official endorsement or acceptance
by the United Nations.
Nuwara
Eliya
28.4
Ampara
34.2
Badulla
80.6
Moneragala
47.9
Kalutara
55.5
Sou rce : Ann ual He alth Bu lle tin 2 00 2
D ep artm en t o f H ea lth S ervices - S ri Lan ka
Matale
66.1
Kandy
151.8
Ampara
19.0
Moneragala
26.9
Galle
57.1
Note : The boundaries and names shown
and the designations used on this map do
not imply official endorsement or acceptance
by the United Nations.
Batticaloa
65.9
Matale
45.8
Kegalle
30.9
Kalutara
38.5
Polonnaruwa
55.1
Kurunegala
81.5
Kandy
95.1
Colombo
113.1
Trincomalee
38.8
Batticaloa
21.3
Kurunegala
30.1
Gampaha
33.8
Vavuniya
49.3
Mannar
37.8
55 - 115
Ratnapura
68.0
Hambantota
44.4
Matara
68.6
Sou rce : Ann ual He alth Bu lle tin 2 00 2
D ep artm en t o f H ea lth S ervices - S ri Lan ka
Doctors and Nurses in the
Health Sector over the years.
25000
20000
15000
MO
SNN
10000
5000
0
1980
1985
1990
1995
2000
2005
2006
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
Per capita health expenditure
3.2% of GDP
Sri Lanka currently spending about
$ 29 per capita
50% by the state
50% Private
Only 1% Private Health Insurance
Who Pays?
1% 2%
Taxes
44%
49%
Employers
Out of pocket
Insurance
NGOs
4%
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
Sri Lanka MOH Health Expenditure Share of GDP, 1939 to 2003
Figure 01
% Share of GDP
2. 5
2
1. 5
1
0. 5
0
1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000
Year
M OH Health Share of GDP Nominal (R+C) Exp.
* MOH Health Expenditure combines Recurrent & Capital Expenditures , 2003 is based on
Estimates
Trends in Sri Lanka Public Expenditure Shares of GDP
for Health, Education and Defence, 1972-2003
Figure 02
Estimated Growth of Health Expenditure by
Government of Sri Lanka 2001-2015
Scenario A = GDP share growing to 1.49
120
Billions of Rps
100
80
60
40
20
Low GDP Growth
0
Medium GDP Growth
High GDP Growth
Year
Source: Health sector master plan study 2003
Age Pyramid 1981 and 2001
Over 75
Over 75
70-74
70-74
65-69
65-69
60-64
60-64
55-59
55-59
50-54
50-54
Age group (years)
Age group (years)
Male Female
Female
Male
45-49
40-44
35-39
30-34
45-49
40-44
35-39
30-34
25-29
25-29
20-24
20-24
15-19
15-19
10-14
10-14
5-9
5-9
0-4
0-4
8.0
6.0
4.0
2.0
0.0
Percentage of population
2.0
4.0
6.0
8.0
8.0
6.0
4.0
2.0
0.0
Percentage of population
2.0
4.0
6.0
8.0
Planning Issues & Challenges
Required Policy Framework and Guiding Principles
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
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