51107-002: Health System Enhancement Project | Asian Development Bank

Sri Lanka: Health System Enhancement Project

Sovereign (Public) Project | 51107-002 Status: Approved

The project will contribute to the government''s development objective to ensure a healthier nation by supporting the development of a more responsive and comprehensive primary health care (PHC) system in Sri Lanka. It will enhance planning and delivering of essential PHC to geographically and socioeconomically deprived populations of Central, North Central, Sabaragamuwa, and Uva provinces. The project will (i) inform and operationalize government PHC reform initiatives, (ii) improve underserved communities'' access to primary health services, and (iii) address selected gaps in core public health capacities in line with the International Health Regulations (IHR).

Project Details

Project Officer
Chin, Brian South Asia Department Request for information
Country
  • Sri Lanka
Sector
  • Health
 
Project Name Health System Enhancement Project
Project Number 51107-002
Country Sri Lanka
Project Status Approved
Project Type / Modality of Assistance Grant
Loan
Source of Funding / Amount
Grant 0618-SRI: Health System Enhancement Project
concessional ordinary capital resources lending / Asian Development Fund US$ 12.50 million
Loan 3727-SRI: Health System Enhancement Project
concessional ordinary capital resources lending / Asian Development Fund US$ 37.50 million
Strategic Agendas Environmentally sustainable growth
Inclusive economic growth
Regional integration
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Partnerships
Sector / Subsector

Health / Disease control of communicable disease - Health sector development and reform

Gender Equity and Mainstreaming Effective gender mainstreaming
Description The project will contribute to the government''s development objective to ensure a healthier nation by supporting the development of a more responsive and comprehensive primary health care (PHC) system in Sri Lanka. It will enhance planning and delivering of essential PHC to geographically and socioeconomically deprived populations of Central, North Central, Sabaragamuwa, and Uva provinces. The project will (i) inform and operationalize government PHC reform initiatives, (ii) improve underserved communities'' access to primary health services, and (iii) address selected gaps in core public health capacities in line with the International Health Regulations (IHR).
Project Rationale and Linkage to Country/Regional Strategy

Sri Lanka has made impressive gains in ensuring access and quality to health services for all. Life expectancy at birth increased to 75 years in 2015 from 70 in 1990. Maternal mortality reduced from 75 to 30 per 100,000 live births and infant mortality from 17.9 to 8.0 per 1,000 live births during the same period. Sri Lanka has achieved these efficiently with low overall health spending at 3.0% of gross domestic product (GDP). Most vaccine preventable diseases are at near elimination stage with immunization coverage at about 99%. Sri Lanka has been polio-free since 1994, and malaria- and filariasis-free since 2016.

While Sri Lanka has benefited greatly from improvements in health outcomes during the Millennium Development Goals period (1990 to 2015), it is facing new health challenges related to population aging, changing disease pattern, economic and social changes, and changing lifestyles. These dynamics have resulted in a dramatic increase in noncommunicable diseases (NCDs), which are causing a surge in demand for health services and an increase in health care costs while reemerging and emerging communicable diseases remain a threat. Disparities in health outcomes, health-seeking behavior, life expectancy, and disease burden remain in lagging geographic areas especially in rural and estate sector populations, e.g., malnutrition in mothers and children is a persistent health issue and more acutely seen in the estate sector. The country is now more exposed to communicable diseases because of increased labor mobility and connectivity. Sustaining control of vaccine preventable diseases, malaria elimination efforts, and containment of global diseases will require continuous investments in the prevention and control of communicable diseases and disease surveillance in Sri Lanka.

Primary health care delivery system. The public PHC system in Sri Lanka has been instrumental in providing universal comprehensive care at no cost to the population at the point of service delivery. One of the most characteristic features of the system is preventive health care services focusing on communicable diseases control and maternal and child care. The system covers 341 geographic areas, each with a population of about 80,000. Each area is managed by a medical officer of health and served by 5 -10 field health centers with midwives, public health inspectors, and preventive health care staff. In parallel, there is an extensive network of curative services in three tiers of care (955 PHC hospitals and dispensaries, and 149 secondary and tertiary health care hospitals). The government health sector provides as much as 90% of inpatient care, nearly 100% of preventive care, and 50% of outpatient care. At present, the health system planning, policy, and stewardship functions are centrally managed while management of primary and most secondary health care services is decentralized to provincial governments.

Constraints. Since 1990, changing health challenges and population aging led to secondary and tertiary health care services being prioritized for investments at the expense of investments for primary curative and preventive care services. Deterioration of PHC facilities led to bypassing of primary curative care services for secondary and tertiary care for most health problems faced by the population. For example, secondary and tertiary health care today manage as much as 93% of childbirths, 75% of NCD patients, and 50% of outpatient services. On the preventive side, the medical officers of health continue to provide antenatal care, nutrition, and immunization services. However, the quality of services decreased because of lower investments (about 4.5% of public health spending), inadequate staffing, and other resource constraints. Expanded outreach and interventions for populations living in vulnerable and lagging areas are also hampered. Preventive health care services are limited to mothers and children and village environments. There is a need to expand the target group to include the total population (children, youth, adult men and women, and elderly) and expand coverage of NCDs.

Government initiatives. The Government of Sri Lanka is reprioritizing PHC in line with its national health policy and strategic master plan. Sector reforms aim to establish a more responsive, patient-centered, and person-focused health care system. The system will enable health seekers to access a comprehensive package of essential health services including financial risk protection. The government's most recent policy on rational health care delivery for universal health coverage provides the guiding framework to reform the existing PHC system.

The government is committed to develop a more comprehensive, accessible, and higher-quality PHC package to strengthen PHC services, reduce bypassing, and reach vulnerable groups. It is also committed to implement e-health to strengthen evidence-based health services. This includes scaling up the introduction of a patient e-health card, connecting health services for referral and better patient care, and improving information on diseases and health-seeking behavior using a geographical information system (GIS). The system will be linked to disease surveillance for national health security. To comply with International Health Regulations standards, the government aims to strengthen the health assessment of migrants and quarantine services at ports of entry (POEs). In support of efforts to strengthen PHC and the digital health information system, policy developments are in preparation for the essential services package, health human resources, family medicine, facility norms, and testing innovative approaches to strengthen PHC. Capacity building will also be implemented in management, e-health, quarantine and health security, procurement, accounting, gender, nutrition, and health care waste management.

Value added by ADB assistance. Asian Development Bank (ADB) assistance brings value by (i) supporting equity-focused health care delivery reform especially in lagging and rural areas such as the plantation and estate sectors; (ii) adopting evidence-based planning based on GIS mapping and vulnerability index to identify and target underserved districts and populations; (iii) enhancing infrastructure design to address climate change and disaster risk resilience; (iv) scaling up e-health card and its integration with the government's web-based health information system to improve continuity of care and disease surveillance; (iv) supporting GIS units in central and district planning departments to improve disease surveillance and monitor health-seeking behavior; (v) institutionalizing distance learning for training PHC staff; and (vi) helping districts develop and implement innovative solutions to integrate and improve PHC services.

Link to national development strategy and ADB sector priority. The project aligns with the government''s priorities identified in the Public Investment Programme, 2017 -2020 and Vision 2025, and with the United Nation's Sustainable Development Goal 3 on universal health coverage. The project is in line with ADB''s country partnership strategy, 2018 -2022 for Sri Lanka and paves the way for a long-term programmatic approach consistent with ADB''s health operations plan.

ADB experience and lessons learned. The project is ADB''s reentry to the health sector in Sri Lanka after a gap of about 20 years. The prior project and other recently completed and ongoing ADB-financed projects in the social sectors have been implemented successfully. These past experiences and the project preparation process indicate strong commitment by the government at the national and regional levels. The leadership provided by the Ministry of Health, Nutrition and Indigenous Medicine (MOHNIM) and the four provincial administrations during the project preparation stage is expected to continue into project implementation.

Development coordination. MOHNIM convened the donor coordination committee to ensure collaboration with and among development partners. The World Health Organization (WHO) has a leading role in policy development and sector coordination. The project will collaborate with WHO in terms of technical assistance to support selected areas related to the essential services package, health system strengthening, human resource development, and health security. The project also intends to work with the United Nations Children's Fund (UNICEF) and the World Food Programme on nutrition, as well as the International Organization for Migration on migrant issues. ADB''s support will be coordinated with the World Bank program support to strengthen PHC, and regular discussions are held to prevent duplication of efforts and to synergize on the results and outcomes.

Impact A healthier nation is ensured with a more comprehensive PHC system
Project Outcome
Description of Outcome Efficiency, equity, and responsiveness of the PHC system improved
Progress Toward Outcome
Implementation Progress
Description of Project Outputs

Primary health care enhanced in Central, North Central, Sabaragamuwa, and Uva provinces

Health information and disease surveillance capacity strengthened

Policy development, capacity building, and project management supported

Status of Implementation Progress (Outputs, Activities, and Issues)
Geographical Location Central Province, North Central Province, Province of Sabaragamuwa, Province of Uva
Safeguard Categories
Environment B
Involuntary Resettlement C
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects The project will support minor renovations and expansion of PHC facilities as well as small repairs to field health centers. It is not expected to have any significant or irreversible adverse environmental impacts during either construction or operation.
Involuntary Resettlement

No involuntary resettlement impacts are identified in the proposed project activities or components.

All civil works are limited to reconstruction and refurbishment of existing government health facilities, which does not necessitate land acquisition and resettlement.

Indigenous Peoples The project does not have indigenous people impacts because no health facilities in Uva and North Central provinces with indigenous peoples have been selected.
Stakeholder Communication, Participation, and Consultation
During Project Design The Ministry of Health, Nutrition and Indigenous Medicine (MOHNIM) is the primary stakeholder together with the provincial directorates of health services in the provinces of Uva, Central, Sabaragamuwa, and North Central. The project will improve MOHNIM''s operational capacity and efficiency, and contribute to the achievement of SDG 3 indicator on health.
During Project Implementation
Business Opportunities
Consulting Services A design and supervision consultant for all civil works to be carried out under the project will be engaged using the quality- and cost-based selection (QCBS) method with a standard quality cost ratio of 90:10. All consulting services will be engaged in accordance with the ADB Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time).
Procurement Procurement items include civil works, medical equipment, computers, vehicles, and furniture.
Responsible ADB Officer Chin, Brian
Responsible ADB Department South Asia Department
Responsible ADB Division Human and Social Development Division, SARD
Executing Agencies
Ministry of Health, Nutrition and Indigenous Medicine
385 Baddegama Wimalavansha Mawata
Colombo 10
Sri Lanka
Timetable
Concept Clearance 05 Oct 2017
Fact Finding 23 Apr 2018 to 04 May 2018
MRM 07 Aug 2018
Approval 23 Oct 2018
Last Review Mission -
Last PDS Update 23 Oct 2018

Grant 0618-SRI

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
23 Oct 2018 26 Oct 2018 - 31 May 2024 - -
Financing Plan Grant Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 22.50 Cumulative Contract Awards
ADB 12.50 23 Oct 2018 0.00 0.00 0%
Counterpart 10.00 Cumulative Disbursements
Cofinancing 0.00 23 Oct 2018 0.00 0.00 0%

Loan 3727-SRI

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
23 Oct 2018 26 Oct 2018 - 31 May 2024 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 37.50 Cumulative Contract Awards
ADB 37.50 23 Oct 2018 0.00 0.00 0%
Counterpart 0.00 Cumulative Disbursements
Cofinancing 0.00 23 Oct 2018 0.00 0.00 0%

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.

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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.

Title Document Type Document Date
Health System Enhancement Project: Initial Environmental Examination Initial Environmental Examination Jul 2018
Health System Enhancement Project: Environmental Assessment and Review Framework Environmental Assessment and Review Framework Jul 2018

Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

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.

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan