Sri Lanka Human Development Report 2012.pdf

Box 3.2 .....Continued
What has been done so far
Sri Lanka has taken initiatives to stop violence
against women, such as the Domestic Violence
Act of 2005. It has ratified all key international
mechanisms on human rights, including four major
instruments relevant to rape and other forms of
gender-based violence.
Following the passage of the Domestic Violence
Act, the Forum against Gender-Based Violence
was set up. Programmes help raise awareness
among women and extend assistance through both
government and non-governmental organizations.
One-stop crisis centers are in place in government
hospitals, and there are women’s desks at police
stations.
1
United States Agency for International Development 2009b.
2
World Health Organization 2005.
3
Department of Census and Statistics of Sri Lanka 2011e.
Health Care Services
Decades of health investment have enabled Sri Lanka to
achieve commendable health outcomes. Today, public
health care is provided free of charge at government
hospitals and dispensaries to all citizens, although the
supply is unable to meet the demand. While the public
health sector serves nearly 60 percent of the population,
out-of-pocket health expenditure is very high, as will be
discussed later in this chapter. 79
Responsibility for the public health service devolved
from the central Government to the provincial councils
with Provincial Council Act No. 42 of 1987. As a result,
apart from the Health Ministry at the national level, there
are nine provincial ministries of health. The Ministry of
Indigenous Medicine promotes ayurvedic medicine.
Compared to the public sector, the role of the private
sector in health care is smaller, but has increased over time.
Only 46 private hospitals operated in 1990; by 2000, their
number grew to 65, and by 2008 to 90. 80 Private hospitals
are largely concentrated in the Western Province, which in
2008 had 60 percent of them and 75 percent of all private
hospital beds. 81
Health Facilities
Access to health care is a complex process, encompassing
service availability, the adequate supply of services and the
opportunity to obtain health care. 82 The extent to which a
population gains access depends on a variety of financial,
organizational, social and cultural factors. 83
According to the Ministry of Health, by the end of 2007,
Sri Lanka had 608 hospitals and 68,694 patient beds,
including maternity homes and central dispensaries, and
72 government medical institutes, including teaching,
provincial and base hospitals. 84 There were 62 ayurvedic
hospitals and 208 central ayurvedic dispensaries, with
1,424 physicians serving public ayurvedic hospitals. 85
The number of government hospitals increased from 558
in 2000 to 615 in 2007. On average, a free Western-type
government health care service can be found within 4.8
kilometres of any home. 86
In 2011, 11,023 medical officers and 31,466 nurses worked
in the public hospital system. The number of medical
officers and nurses per 100,000 people increased from
41.1 to 55.1, and 76 to 157.3, respectively, from 2000 to
2007. 87
This enormous health infrastructure is not equitably
distributed. There are fewer government hospitals in the
Northern and Eastern provinces (i.e. Jaffna, Killinochchi,
Mannar, Vavuniya, Mullaitivu, Batticaloa, Ampara and
Trincomalee), although the situation improved markedly
from 2000 to 2007 (Figure 3.7).
Chapter 3 Bridging Human Development Gaps: Health 47