National Report on Violence and Health in Sri Lanka

The occurrence and recognition of violence in a country is dependant on a number of issues at macro and micro levels. The epidemiological dimensions are not well known or not often discussed openly. Many issues involving violence in Sri Lanka are not understood completely as violence has always been considered a police, legal, personal or family problem and not as a health problem that needs detailed epidemiological analysis. This Report on Violence and Health is the first national report ever published on this important problem. This report analyses available data to understand violence in the local context and its impact on the country. It attempts to assess the magnitude of the problem and describes different aspects of violence in Sri Lanka. This report too confirms the fact that violence should be considered as multifactorial in its origin and identifies the ways for the collaboration among different stakeholders in the prevention of violence. The lead role that the  Ministry of Health should take , as the organization carrying the burden due to morbidity and mortality attributable to violence is highlighted in the report.

External Review of the Maternal & Newborn Health Programme

Although Sri Lanka has made remarkable progress in the last few decades in lowering infant, child and maternal mortality due to a number of factors, yet wide disparities in maternal mortality rates exist between geographic regions as well as population groups. The Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NNMR) have been stagnant over the past decade. There is also concern regarding inequitable distribution of services, deficiencies in quality of care, competing interests for health resources, increasing costs in health care and constraints faced by the Ministry of Health (MoH). This publication gives in detail the outline of the external review which was commissioned by the MoH to examine the MNH components of the current national Maternal and Child Health (MCH) Programme and to identify achievements, gaps and challenges faced by the programme, with the recommendations made by the national and international review team to help in the development of a new strategic plan for the period 2008- 2012 and beyond.

Sri Lanka Health Atlas

Compared to its neighbouring countries, Sri Lanka has achieved much in health. The indicators pertaining to maternal health, infant health, several communicable diseases such as polio and other vaccine preventable diseases, and in malaria have  shown considerable improvement. However disaggregated figures show significantly high disease prevalence in several districts. With more focused interventions, the disease burden could be reduced in these districts. With a view to highlight the need for focused interventions in districts, WHO and the Ministry of Health jointly published the Sri Lanka Health Atlas based on data available with the ministry for 2001 and 2002. 

This publication contains basic health-related statistics for the 25 administrative districts of Sri Lanka. The disaggregated data cover the main aspects of health and its determinants covered under six topics namely: Demography, Economy, Health Resources, Health Service Utilization, Morbidity, and Mortality.

Throughout the atlas data is represented by horizontal and vertical bar graphs, line graphs, and maps.

Maternal Mortality Reduction in Sri Lanka

As a low income country, Sri Lanka has made significant progress in reducing  maternal mortality compared to other countries in the developing world. The factors related to the reduction of maternal mortality are well worth examining as they analyze the success story that could be used by other countries. These factors also provide the foundation to further reduce maternal deaths. In spite of the decline in maternal mortality there is a realization that the majority of deaths are preventable. The publication examines the reproductive health factors, socio-economic factors and the service factors that need to be taken into account to further reduce maternal mortality. The emphasis that needs to be made in future activities in this regard are well illustrated. It stresses the fact that there is a need to go beyond the pregnant state and to introduce an effective programme of pregnancy education and counseling, as a part of pregnancy preparedness.

Profile of Health Related NGOs

The Non Governmental Organizations play an important role in the delivery of Health services at grass root levels. While the Ministry of Health is responsible in providing the institutional based health services, through its wide spread net work of curative and preventive institutions, the Non Governmental Sector too plays an important role in providing community based health services through hundreds of Non Governmental organizations.

The coordination through the Non Governmental Sector was indeed a problem as a comprehensive inventory was not available. This deficiency was fulfilled with the WHO initiative of publishing the ‘Profile of Health Related NGO’. This is the only up-to-date inventory of Health Related NGOs in Sri Lanka and has assisted health care providers in coordinating their activities with maximum non governmental sector collaboration and partnership.

Potential for Government / NGO Partnership in Health Care

A study of the potential for Government – NGO partnerships in health care consists of three components.

The first component covers the national policy framework for NGOs, the political and social context, legal and administrative framework and the organizational arrangements in the health sector related to NGOs.

The second component addresses the potential of NGOs as partners in health care and analyses the strategic areas of coverage, geographical distribution of the non-governmental sector, professional capacity, their financial management, strengths and weaknesses.

The third component comprises a directory of NGOs working in the health sector with information pertaining to their activities. The information facilitates understand the complex NGO involvement in health related areas. 

Proposal for Recovery of the Health System of North & East Sri Lanka

Based on the Health System and Health Needs of the North-East Sri Lanka  the efforts made by the WHO country office to develop an immediate health system recovery plan in the North and the East  is well reflected by this publication. The publication explicitly highlights the areas of the North East health system that need urgent recovery. The proposal uses a sector-wide approach to analyze the needs of the entire health system in the North-East and employs the logical framework approach to develop the proposal for recovery of the health system as a whole and provides a clear outline of a short-term plan to recover the health system in the North-East. This document was instrumental in seeking a sum of US $ 8.2 million as a grant for the Health System recovery in the North and the East.

Health System and Health Needs of the North-East Sri Lanka

The signing of the memorandum of understanding between the Government of Sri Lanka and the LTTE in February 2002 enabled mutual halting of all armed hostilities in the conflict affected areas enabling the provision of health services for those that were battered by the war. This was followed by the gush of technical and financial assistance committed by donors for those areas that were affected by the conflict. The most pressing need during this phase was the lack of adequate health related data from the North and the East. This publication which was based on an onsite health situational analysis enabled all development partners to base their assistance on the true needs of the North East Province. It describe the health needs of district health systems in the cleared and un-cleared areas in the North and East. This document published by the WHO has assisted the UN country team, Ministry of Health, World Bank and many other development partners to mobilize funds for the restoration of North East Health Sector Development.

Macroeconomics and Health Initiatives – Sri Lanka

The Millennium Development Goals have set the agenda for social development in the 21st century. The WHO through its commission on Macroeconomics and Health has provided a framework for relating macroeconomic policy and improved health status focusing primarily on the poor. The publication examines the relationship between macro-economics, poverty and health, in the context of international and national interest. The document attempts to provide a critical review on focusing the health services on the poor and the need to scale up the pro-poor health interventions. It provides guidance to the health sector regarding the feasibility of harnessing greater domestic resources and emphasize on the need for strategic planning of health expenditure in Sri Lanka.

Poverty, Transition and Health: A Rapid Health System Analysis

As a fulfillment of an request made by the Ministry of Health the WHO took the initiative of carrying out a rapid appraisal of the health system in Sri Lanka, focusing particularly on the issues of poverty reduction and the challenges of the demographic and epidemiological transition. The document analyses the present health care system by identifying the most salient problems of the system: malnutrition, mal-distribution of resources and structural deficiencies in health care provision that result simultaneously in under-utilization and overcrowding at different levels of hospital. The document describes the performance of the health system and emphasise on the equity in the health system. It also propose the shift to a new health delivery model along the lines of development in the public health sphere, which has shifted its emphasis from damage reduction and risk control to proactive health promotion.

WHO Country Cooperation Strategy 2006 – 2011

The WHO Country Cooperation Strategy 2006 – 2011 is a medium-term strategic framework for cooperation between the Government of Sri Lanka and WHO, focusing on six strategic areas of intervention which are consistent with the needs of the country and will support the Government to adapt and strengthen the health system. Further more the CCS spells out the principles and core functions of WHO and serves as the fundamental guiding document for developing all the technical programs of the organization in the country during this period. 

Sri Lanka Tsunami Response: six months and beyond

In the aftermath of the tsunami, the WHO Country Office began to collect information on the extent of the disaster and the acute needs in the affected areas. This publication takes into account the strategies that were implemented and the responses of these programmes of work which covered a wide range of health services from ‘strengthening the management information system’ to ‘disease surveillance and Control’ as well as the ‘control of vector borne disease’ and ‘water and sanitation’ among other areas. It also illustrates some of the achievements made during this period.