Sri Lanka Human Development Report 2012.pdf

Agenda for Action
Develop health policies to reduce the
vulnerability of the very poor
Of the three dimensions of the Human Development
Index, Sri Lanka scores highest on health. For some basic
indicators, however, such as infant nutrition and maternal
mortality, there are sizeable disparities in outcomes.
According to multidimensional poverty analysis, poor
health is the biggest contributor to poverty.
At the national level, just over one in five children is
underweight, and nearly one in six is stunted. In districts
with large estate populations, such as Nuwara Eliya and
Badulla, the picture worsens: almost one in three children
is underweight and just above one in three is stunted.
Women on the estates are underweight for their height,
which predisposes them to illness. Stunting and wasting
due to malnutrition are worst in some conflict-affected
districts, such as Trincomalee and Batticaloa. Some rural
districts, such as Moneragala and Hambantota, also have
high levels.
While the infant mortality rate has declined from 19.8
per 1,000 live births in 1990 to 8.5 per 1,000 live births
in 2007, there are considerable disparities across regions.
It is particularly high on estates, as well as in Batticaloa,
Colombo, Nuwara Eliya and Kandy, although the high
rates in Colombo and Kandy could be due to errors in data
collection. 329 Compared to the national average, maternal
mortality is considerably higher in some conflict-affected
districts, such as Killinochchi, Batticaloa and Ampara; in
some districts with a high concentration of estate workers,
such as Nuwara Eliya; and in some rural districts such as
Moneragala.
The Ministry of Health and other relevant national
entities need to target more health resources to deprived
and conflict-affected areas for a number of reasons.
First, health outcomes are influenced not only by healthrelated
services, but also by a variety of factors such as
environment, income, working conditions, safety, etc.. An
integrated approach is required.
Second, especially in conflict-affected areas, medical
facilities have been destroyed, the quality of remaining
services is low, and there are few adequately qualified and
experienced personnel. Both physical and human health
infrastructure require attention, and could be integrated
more seamlessly into the national health system.
Third, more resources are needed to take on emerging
health issues and upgrade health facilities throughout the
country. A larger role for the private sector could bring
in the much-needed resources. It already has a presence
in the health sector, which helps to reduce congestion in
public hospitals in urban centres and to provide specialized
services. An expanded role would, however, require greater
safeguards and closer monitoring.
At the same time, the public sector will need to continue
to operate in key areas to provide preventive programmes,
and ensure equitable access to quality health care for all.
The management of health care under the public system
could be streamlined and made more efficient to increase
returns. Timely collection and analysis to inform policy
makers on operations and outcomes across the sector
could improve monitoring and service delivery.
Design and implement policies to address
emerging and non-communicable diseases
Lifestyle changes from rising incomes, cultural trends,
technology and demography are altering the pattern of
disease in Sri Lanka. Emerging health issues that require
greater attention include communicable diseases such as
dengue and leptospirosis; non-communicable diseases
such as diabetes, hypertension and cardiovascular illnesses;
mental health problems; and accidents and injuries. Noncommunicable
diseases have a higher prevalence rate in
more affluent districts, such as Colombo, Gampaha and
Kalutara, and in urban centers such as Jaffna and Kandy.
The concern about them is that they may be life-long,
debilitating illnesses that reduce productivity and burden
families, even as they require increasing amounts of public
resources. Unless measures are taken to contain them and
the other emerging health concerns, it will be difficult to
sustain achievements in human development.
Chapter 7
Building on Peace, Progress and Security 121