The proposed assistance will help enhance Sri Lanka''s health system to adapt to emerging challenges and deal with shifting disease burdens. The proposal is aligned with the government priorities identified in the Public Investment Program (2017 -2020), as well as with the Health Master Plan''s National Strategic Framework for Development of Health Services (2016 -2025). It is also included in Asian Development Bank (ADB)''s Sri Lanka Country Partnership Strategy (2018- 2022), and reinforces ADB''s inclusive growth agenda in the Midterm Review of Strategy 2020.
|Project Name||Health System Enhancement Project|
|Project Type / Modality of Assistance||Grant
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change||Gender Equity and Mainstreaming
Governance and capacity development
|Sector / Subsector||
Health / Disease control of communicable disease - Health sector development and reform
|Gender Equity and Mainstreaming||Effective gender mainstreaming|
|Description||The proposed assistance will help enhance Sri Lanka''s health system to adapt to emerging challenges and deal with shifting disease burdens. The proposal is aligned with the government priorities identified in the Public Investment Program (2017 -2020), as well as with the Health Master Plan''s National Strategic Framework for Development of Health Services (2016 -2025). It is also included in Asian Development Bank (ADB)''s Sri Lanka Country Partnership Strategy (2018- 2022), and reinforces ADB''s inclusive growth agenda in the Midterm Review of Strategy 2020.|
|Project Rationale and Linkage to Country/Regional Strategy||
Sri Lanka''s health indicators are generally well-performing, and the sector is known for achieving good health at relatively low cost. Government spending on health as share of the gross domestic product is comparably low in the region, yet the sector has achieved outcomes on a par with developed countries, including a life expectancy of 75 years and nearly 100% institutional delivery and immunization coverage. Sri Lanka has also done well to control infectious diseases, being the first in the region to eliminate diseases such as smallpox, polio, diphtheria, pertussis, and tetanus, and more recently filariasis and malaria through focused campaigns. This indicates hitherto effectiveness of the country''s health system, with contributing factors including dedicated delivery of preventive health services at the community-level and an extensive public hospital system throughout the island.
Despite its achievements, Sri Lanka''s health system today is facing challenges to sustain its performance due to rapidly changing demographic and epidemiological transitions. The cost of health care has been increasing due to the sharp rise in noncommunicable diseases linked to lifestyles and a rapidly aging population. The national health system also needs to further strengthen expanding services to vulnerable populations with lagging health indicators. In addition, there is increased threat of emerging and resurging infectious diseases linked to environmental factors and increased cross-border migration. The status quo of the health system is inadequately prepared to deal with these evolving challenges without significant reorientation and further improvements.
Primary health care. Primary health care (PHC), including both primary care and preventive health services, in Sri Lanka needs significant strengthening to tackle the rising costs of health care, as well as to improve basic health services to lagging populations. The current health system underinvests in primary care, and limited government funds largely cater to higher level hospital services. The underinvestment at the primary care level has led to inadequate facilities and generally poor utilization of primary care level institutions and increased burden on higher-level health care facilities. As hospital care is costly, overuse of hospital services also creates an inefficiency in the use of government health expenditures. The cost pressures arising from increased noncommunicable diseases and population aging, however, have catalyzed the beginning of government reforms to rationalize health care utilization with increased focus and orientation towards PHC. Still, the actual reform model is still evolving, and there is a need for external assistance to further inform and help operationalize PHC reform initiatives.
Lagging populations. Preventive health services, which are organized separately from curative medical services in Sri Lanka, also need enhancement to bridge in-country disparities in health status and expand basic health access to lagging communities. While Sri Lanka''s dedicated preventive health services has significantly contributed to the country''s past performance in health indicators, actual government spending in this area has been decreasing from 10% of current health expenditure in 1990 to about 5% in 2013. This is impacting the further reach of basic health services to vulnerable populations, such as in the estates, which have lagged behind in health and nutrition status. Although the Government made the decision to integrate estate health services into the national health system since the 1990's, the implementation progress has been slow, largely owing to limited resources and capacity of the health system to further extend, and lack of effective coordination with estate management. Moreover, strengthened PHC is needed in rural, remote areas affected by prevalence of chronic kidney disease of unknown etiology (CKDu), especially to improve the communities' access to early detection and management of the disease. Inadequate facilities, lack of mobility and transport, shortages of staff, and staff accommodation are some of the notable barriers to providing adequate preventive health services to these lagging communities.
Disease prevention. While Sri Lanka made significant achievements regarding control and elimination of communicable diseases, there is a need to further improve the health system's capacity to detect and respond to emerging and resurging infectious disease threats. The communicable disease surveillance system, while effective and comprehensive, is still largely paper-based and needs to leverage modern technology to further improve efficiency and timeliness and accuracy of data capture, reporting, feedback, and analysis. There are also increasing threats of disease spread from more in-flow of migrants and cross-border activities, with corresponding need to step up monitoring and surveillance at points-of-entry and health screening procedures of in-bound migrants. There is also need to sustain hard-won gains such as with malaria elimination, while stepping up prevention and control of pressing issues like dengue, which requires cross-agency collaboration, better environmental management, effective vector control, and more community outreach.
|Impact||A healthy nation ensured|
|Outcome||Sustainability and responsiveness of the health system, especially in lagging areas, enhanced|
Primary health care strengthened, especially in lagging areas
Health and disease surveillance capacity improved
Policy development supported
|Summary of Environmental and Social Aspects|
|Involuntary Resettlement||There will be no new constructions, and no land acquisition. Infrastructure support will be limited to some renovation and _face-lifting_ of existing primary health facilities. No involuntary resettlement impact is expected.|
|Indigenous Peoples||In the project area, there are no indigenous people who fall within the purview of ADB Safeguard Policy Statement.|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design||Primary stakeholders are Ministry of Health, Nutrition, and Indigenous Medicine; provincial health departments of Uva, Sabaragamuwa, Central, and North Central provinces; Ministry of Provincial Councils and Local Government and estate management of regional plantation companies, health workers, and project beneficiaries. During PPTA, stakeholder consultations will be held and their views and recommendations will be incorporated when and where possible. The team will organize consultations and workshops with communities, nongovernment organizations, and other relevant stakeholders when and as needed.|
|During Project Implementation|
|Consulting Services||A total of 37 person-months (14.5 international and 22.5 national) of consulting inputs will be provided under the TA. ADB will engage a firm (a total of 32 person-months) as well as two individual consultants (a total of 5 person-months).|
|Procurement||Procurement items include small works, medical equipment, vehicles, information technology equipment and consulting services.|
|Responsible ADB Officer||Chin, Brian|
|Responsible ADB Department||South Asia Department|
|Responsible ADB Division||Human and Social Development Division, SARD|
Ministry of Health, Nutrition and Indigenous Medicine
385 Baddegama Wimalavansha Mawata
|Concept Clearance||05 Oct 2017|
|Fact Finding||23 Apr 2018 to 04 May 2018|
|MRM||20 Jul 2018|
|Last Review Mission||-|
|Last PDS Update||23 Mar 2018|
Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.
The Public Communications Policy (PCP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.
The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.
In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.
|Title||Document Type||Document Date|
|Preparing the Health System Enhancement Project: Technical Assistance Report||Technical Assistance Reports||Oct 2017|
|Health System Enhancement Project: Initial Poverty and Social Analysis||Initial Poverty and Social Analysis||Oct 2017|
Safeguard Documents See also: Safeguards
Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.
None currently available.
Evaluation Documents See also: Independent Evaluation
None currently available.
None currently available.
The Public Communications Policy (PCP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.
Requests for information may also be directed to the InfoUnit.