Health in South Asia

Editor—Bhutta et al and the World Bank highlight Sri Lanka as a model in achieving exceptional health status with comparatively low investments.¹,² However, recent data show a stagnation of gains (such as an increase in infant mortality from 15.9/1000 in 1998 to 17/1000 in 2001) and emerging challenges.¹,³ This requires the model to be suitably modified to lower the preventable morbidity and mortality, while responding to the emerging challenges. The following examples show that Sri Lanka is deviating in an ad hoc manner from the successful model of preventive programmes at a relatively equitable grassroots level.

The preventive sector is progressively underfunded, rather than strengthened to meet the epidemic of non-communicable diseases. From 1993 to 1999 expenditure on preventive and public health declined from 10% (of total health expenditures) to 6%, and expenditure dedicated to the curative sector has been maintained around 44% to 47%.⁴

Human resource development is heavily biased towards medical officers in the curative sector rather than staff in the preventive sector, personnel, and support functions. From 1996 to 2001 the proportion of medical officers in the curative sector increased by 71% compared with a 33% increase in medical officers working in the community and a 6.5% increase in family health workers.⁵

Sri Lanka therefore requires urgent corrective action to build on its strengths and gains. Otherwise it may end up as an example of a country that dismantled its own pioneering model in an ad hoc manner.