Sri Lanka Human Development Report 2012.pdf

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Box 1.2: Development of Health Care Facilities on the Estates Morbidity and mortality rates were very high on the estates from the beginning. Around the 1850s, the British colonial Government recognized the economic value of the estate population and enacted several laws to improve health care. The Master Servant Law of 1865, for example, required colonial planters to provide some medical relief to sick workers. Since 1930, there have been more concerted efforts to improve maternal and infant health care through establishing maternity facilities on estates and increasing the number of registered estate midwives. Unfortunately, morbidity and mortality rates remained high into the early 1970s - infant mortality rates were above 100 per 1,000 live births, for example. The Land Reform Law in the early 1970s nationalized the estates and handed their management over to two government agencies: the Janatha Estates Development Board (JEBD) and the Sri Lanka Plantations Corporation (SLSPC). Health services subsequently increased and became more comprehensive. In 1978, the Social Development Division (SDD) was established to manage the welfare facilities of estate populations, with guidance from the Ministry of Health. In 1992, the estates were restructured and divided into 23 regional plantation companies, with management contracted to private sector companies. The Plantation Housing and Social Welfare Trust (PHSWT) was established under the Companies Act to provide social welfare services. Its operational expenditures were covered through a levy paid by private companies and funding from donors. Unlike the SDD, the PHSWT did not have direct authority over the provision of health care and welfare on the estates. Instead, it had to work through different management companies to operationalize their welfare programmes. Its main function was to monitor health and welfare standards, implement national health programmes and introduce special initiatives to address health needs. There was also an emphasis on developing housing, and water supply and sanitation facilities, with funding from both the Government and development partners. These efforts have led to a fall in infant mortality and low birth weight rates, as shown by the data below. The former declined from 49.6 per 1,000 live births in 1985 to 19.1 in 2000, an improvement of over 60 percent in 15 years. For the same period, the share of babies born at a weight under 2.5 kilogrammes declined from 42 percent to 14.5 percent. Plantation Sector Health Data, 1985-2000 Year Agency Population Infant mortality Maternal Institutional Low rate mortality rate births (%) birth weight 1985 JEBD/SLSPC 738,025 49.6 1.2 60.8 42.0 1992 JEBD/SLSPC 809,096 27.9 1.2 85.5 19.4 1995 PHSWT 849,646 28.5 1.5 90.3 17.2 2000 PHSWT 886,936 19.1 1.8 96.0 14.5 According to the latest data, there are indications that while health outcomes on estates still lag behind those in urban and rural areas, they have improved significantly. The infant mortality rate on estates was 16.9 per 1,000 live births in 2007 25 (compared to 10.7 and 3.7 per 1,000 live births in the urban and rural sectors, respectively). For childbirth deliveries, 97.2 percent took place in institutions, compared to 98.6 percent and 98.2 percent in urban and rural areas, respectively. Low birth weight was 31 percent, compared to 12.8 percent and 16.4 percent for urban and rural areas, respectively. 26 The availability of medical personnel remains a major issue on the estates. Earlier, registered assistant medical officers, estate medical assistants and registered estate midwives were the main providers of health care. In the 1990s, on the insistence of trade unions and politicians, there was an attempt to take over the estate hospitals and upgrade them to the status of rural hospitals. But upgrading and staffing them with qualified medical doctors did not result in the desired improvements, as the monitoring of doctors was difficult, and many hospitals are located in geographically isolated areas. Given the high costs, changes are taking place slowly. An additional factor is that some estate hospitals are located near rural hospitals, leading to questions about the rationale for upgrading. Source: Vidyasagara 2001. Chapter 1 WHY REVISIT REGIONAL DIMENSIONS OF HUMAN DEVELOPMENT 7
Other Vulnerable Groups A number of other groups in Sri Lanka face specific vulnerabilities, including the significant share of the population affected by yearly environmental disasters-such as droughts, floods and cyclones. The tsunami of December 2004 was the most devastating natural disaster ever to strike Sri Lanka, directly affecting close to five percent of the population. Disaster-impacted people are at high risk of poverty. Their vulnerability increases through their displacement and separation from social and administrative networks providing social protection. The proportion of households affected by disaster is particularly high in the Eastern, North Western and North Central provinces; in 2009-2010, households affected by at least one disaster comprised 10.7 percent, 9.8 percent and 7.3 percent of the populations of the three provinces, respectively. 27 Another vulnerable group comprises elderly people, especially given the country’s rapidly ageing population. They are at a high risk of poverty because most are not covered by social security support. Declining fertility rates and increasing life expectancy will likely continue expanding the elderly population in the next 40 years, 28 with the proportion of people aged 60 and above projected to rise from its current level of 11 percent to 16 percent in 2020 and 29 percent by 2050. The country will have to find ways and means of coping with the economic burden of this demographic trend. Resources are an issue, but people should be able to remain healthy and productive in their older years. People with disabilities also need attention to ensure that they have equitable access to health, education and employment services. There were 274,711 disabled persons - including seeing, hearing, speaking, or other mental or physical disabilities - in the 18 districts covered by the 2001 Census of Population and Housing. 29 Only a very small proportion are employed, making most highly economically dependent on their families. Many require better social protection and access to education and health care. For some Sri Lankans, vulnerability comes in the quest for employment in foreign jobs. Estimates by the Sri Lanka Bureau of Foreign Employment reveal that around 250,000 Sri Lankans emigrate per year for foreign employment. 30 The majority comprises young, low-skilled female workers who go to Middle Eastern countries as housemaids. Successive governments have encouraged migration for employment, but also for foreign remittances, now a major source of foreign exchange. 31 The effects of foreign employment on household welfare are mixed. Around 10 percent of all households receive remittances, amounting to a significant proportion of their income. These households invest more in health, education and productive assets, which, in turn, produces an increase in incomes. But the lack of protection for migrant workers, especially unskilled female workers, and the welfare of the children and families left behind are major concerns. 32 As a group, women in Sri Lanka fare well compared to those in similar developing countries, but are still marginalized in some areas. Educational outcomes are at par with or better than those of men, and life expectancy is also considerably higher for women. Currently, however, women hold only a handful of parliamentary seats. In all countries considered in South and South-East and East Asia, women’s labour market activity was higher than in Sri Lanka, with the exception of predominantly Muslim countries that have poor overall records on gender equality (Table 1.2). These issues will be discussed in greater detail in subsequent chapters. 8 sri lanka Human Development report 2012
Page 1 and 2: SriLankaHumanDevelopmentReport 2012
Page 3 and 4: Sri Lanka Human Development Report
Page 5 and 6: Acknowledgements This report would
Page 7 and 8: sri lanka Human Development report
Page 9 and 10: Access to water 89 Accessibility to
Page 11 and 12: Figure 1.1: Share of GDP by Provinc
Page 13 and 14: Table 2.1 Table 2.2: Table 2.3: Tab
Page 15 and 16: CHAPTER 1 Why Revisit Regional Dime
Page 17 and 18: spreading its fruits more equitably
Page 19 and 20: Negotiations are still ongoing to f
Page 21: Box 1.1 A Selected Summary of Damag
Page 25 and 26: education financing and the distrib
Page 27 and 28: CHAPTER 2 Patterns of Human Develop
Page 29 and 30: population. It accounts for inequal
Page 31 and 32: Regional Variations in the Human De
Page 33 and 34: Map 2.1: Human Development Index 20
Page 35 and 36: Gender Inequality Index Among distr
Page 37 and 38: Comparing Districts Across Indices
Page 39 and 40: 14.5 percent in 2009-2010. As seen
Page 41 and 42: Economic Growth and Inequality Alth
Page 43 and 44: The poverty gap index, which measur
Page 45 and 46: half the headcount index. For the e
Page 47 and 48: What are the factors that push peop
Page 49 and 50: lowest incidence of both income and
Page 51 and 52: CHAPTER 3 Bridging Human Developmen
Page 53 and 54: disability of the heads of poor hou
Page 55 and 56: Infant Mortality and Under-five Mor
Page 57 and 58: and given three doses each of polio
Page 59 and 60: as the absence of illness, but also
Page 61 and 62: Box 3.2: Gender-based Violence The
Page 63 and 64: Figure 3.7: Distribution of Governm
Page 65 and 66: Figure 3.10: Medical Officers per 1
Page 67 and 68: While access to public health care
Page 69 and 70: Data on access in the Northern and
Page 71 and 72: People in Conflict-affected Areas F
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CHAPTER 4 Bridging Human Developmen
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Levels)—mark the end of the senio
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Funding Education Public investment
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Figure 4.2: Distribution of Out-of-
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Male children are generally less li
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Deficits in information technology
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supports displaced children who ret
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Educational Performance: Senior Sec
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Building a Knowledge Economy Sri La
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Figure 4.10: Distribution of Univer
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offered by private institutions. 18
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CHAPTER 5 Bridging Human Developmen
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twice the rate for the economy as a
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across geographic locations and by
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Box 5.1 Programmes to Improve Infra
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Figure 5.5: Extent (Ac) of Agricult
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towards constructing multipurpose r
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The length of national, provincial
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performs better in terms of mobile
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Technological advancements and tran
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Figure 5.12: Number of Fishers and
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CHAPTER 6 Bridging Governance Gaps:
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Figure 6.1: Sri Lanka’s Tax Reven
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When taxation becomes more visible,
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Table 6.2: The CPI: Comparing Count
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While the objective is laudable, it
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There has been progress on some ind
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to collect their own revenue throug
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the public sector in policy reform
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Table 6.6: Women in Elected Politic
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CHAPTER 7 Building on Peace, Progre
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This is a considerable task, but it
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The Ministry of Health in associati
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nationally and locally. The decline
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Notes sri lanka Human Development r
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54 World Health Organization 2001.
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amount equivalent to 8 percent of G
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Bibliography sri lanka Human Develo
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———. 2009e. Statistics databa
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Draft-13%2006%202010.pdf]. Last acc
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———. 2008c. Land Reforms in S
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Table A2: Human Development Index a
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Table A4: Income Poverty, Multidime
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Table A6: Income Poverty and Measur
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Table A8: Demography, Land and Hous
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Table A10: Infant Mortality, Under-
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Table A12: Maternal Nutrition, Tota
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Table A14: Health Awareness Percent
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Table A16: Primary Gross Enrolment
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Table A18: Government Schools and S
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Table A20: Labour Force Labour forc
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Table A22: Unemployed Population Un
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Table A24: Household Possessions Co
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Table A26: Average Distance and Tim
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Technical Note sri lanka Human Deve
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HDI= (I Life Expectancy ) 1 / 3 ×
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where MMR=maternal mortality rate;
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Multidimensional poverty headcount(
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Figure T.2: Intensity of Poverty an
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of the total deprivations of poor p
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178 sri lanka Human Development rep
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