Ceylon Medical Journal最新文献

Elimination of malaria in 2012 was a major achievement in post-independent Sri Lanka. Sri Lanka missed a golden opportunity in 1963 when only 17 cases of malaria were reported in the country, but could not sustain the momentum resulting in a major resurgence in 1967/69. With the resurgence, the then malaria eradication programme was reverted back to a control programme that lasted for another 30 years. The WHO's Roll Back Malaria Initiative launched in 1998 provided a renewed interest in malaria control and subsequent elimination. With targeted control activities, the burden of malaria started to decrease since year 2000. Although Sri Lanka had reached pre-elimination status as early as 2004, the ongoing separatist war at that time prevented a country-wide elimination drive being implemented. With cessation of hostilities in 2009 and Global Fund financing, both of which were crucial inputs, an elimination drive was launched in September 2009 which eventually eliminated indigenous malaria in November 2012 with malaria-free certification by WHO being obtained in September 2016. Since malaria elimination, the country forged on to the prevention of re-establishment phase primarily focusing on good public practice that included intensified surveillance, both parasitological and entomological; quality assured diagnostic and treatment services; and advocacy at various level including doctors. Despite these measures, an introduced case and an induced case of malaria have been reported. A new vector of urban malaria, Anopheles stephensi, was reported in December 2016. Prevention of re-establishment of malaria should be kept in the radar of public health until malaria is eradicated.

The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka's aspirational goal of achieving Universal Health Coverage (UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level. By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries. The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974 ,which resulted in the total fertility rate coming down significantly. Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women's health.