Article 25(1) of the Universal Declaration of Human Rights says “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control”.

Universal healthcare is the means by which this right could be fully ensured. States Parties to the International Covenant on Economic, Social and Cultural Rights are obliged to take adequate measures to ensure this goal.

Sri Lanka has achieved considerable successes in healthcare. It has eradicated many diseases including Malaria, filariasis etc. World Health Organization (WHO) has commended Sri Lanka on its successes. But it has no universal healthcare. Though there is free healthcare it does not reach everyone.

In 2014 Sri Lanka’s health expenditure comprised 56 percent government health expenditure and 44 percent private health expenditure. Out of the private expenditure on health 96 percent was out-of-pocket expenditure. Thus the boast of politicians and bureaucrats about healthcare being totally free is a myth.

Resource mobilization

As regards reaching universal healthcare it is often said that we cannot afford it as we are a poor country. However, no attempt is made to achieve it even in the long term. However, it is a fallacy. Nobel Laureate and renowned economist Amartya Sen says it is an “affordable dream”. He further says: “a number of poor countries have shown, through their pioneering public policies, that basic healthcare for all can be provided at a remarkably good level at very low cost if the society, including the political and intellectual leadership, can get its act together. There are many examples of such success across the world.” They include Japan, South Korea, Thailand, Japan et al.

Institute of Policy Studies gives three critical gaps in our healthcare financing, viz., (i) inadequacy of resource mobilization, (ii) allocative inefficiency in the distribution of healthcare provision outcomes amongst the population and (iii) weakness in financial management (Sri Lanka State of the Economy 2016).

Health Master Plan (2006 – 17) pointed out that total health expenditure should increase when life expectancy at birth increases. Accordingly it should be at least 5.8 percent of the GDP. In 2012 it was 3.1 when the global average stood at 8.6 percent.

Politicians often quote selected absolute statistics and show selected visuals of isolated development projects to hide these deficiencies. It is in such instances that Mark Twain’s satirical comment “There are three kinds of lies: lies, damn lies and statistics” seems appropriate.

There is much to be desired in countrywide resource allocation – both manpower and material. For example, there is excess allocation in Colombo compared to the peripheries. Often newly acquired machinery and buildings lie idle due to lack of necessary staff.

In its development plans the government should take a more people-friendly strategy aimed at attaining universal healthcare in the short term. In this respect priority to preventive over curative medicine should be the state policy. It is by such a strategy that countries such as Cuba have overcome financial constraints and reached universal quality healthcare.


In its strategy for health sector development the Government seems to give priority to Public-Private-Partnerships (PPPs). No mention is made of developing the existing public health care facilities.

It should be stated that the State is responsible for providing total health care of adequate quality to all people. At present around 95 percent of inpatients are served by the public sector while only 45 percent of outpatients are served by the private sector. Hence, it is obligatory to develop this sector if equity in health care is to be maintained and developed.

Contrary to the claims of politicians and officials public perception of the health care system is poor. They complain of shortage of staff, medicines and laboratory facilities as well as in public relations.

Over the years budgetary allocation for healthcare has fallen behind even world average. In 2012 per capita government expenditure on health was US $ 34 while the world average was 615.

The inefficiency in administration and financial management worsens the situation. When millions are pilfered or wasted on worthless ego-building exercises it was found impossible to buy a pet scanner for the only Cancer Hospital in the country. So much for the “best health service in the world!”

Though PPP is not new to the health sector in Sri Lanka much care should be taken in deciding upon projects since Sri Lankan private sector is unwilling to take risks in unexplored areas and would like to depend on the State for many privileges. In every instance government should evaluate which is more profitable – spending on PPP or developing the State sector.

Incidentally the government’s liability is to assist all systems of medicine practiced in the country including Ayurveda and Yanani et al. The goal should be to develop an integrated healthcare system, affordable and accessible to all people irrespective of their financial potential. 



There is 1 Comment

Govt. to evaluate which is more profitable, PPP or develop State sector. After the robberies of previous govt. and bond scam of this govt. is it not obvious that healthcare must belong to state and not depend on rise and fall of human failure of integrity. I don't want my health to depend on the market forces and wealth redistribution. In disasters too, wealth help will come into govt. Private sector must be allowed to develop on their own as at present in private hospitals, and govt. too benefits as part of load is taken over. GMOA insane.


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