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Sri Lanka

National Health Performance (LK0003)

Overview

At-a-Glance

Action Plan: Sri Lanka National Action Plan 2016-2018

Action Plan Cycle: 2016

Status: Inactive

Institutions

Lead Institution: Ministry of Health

Support Institution(s): Sarvodaya, Patient’s Rights Movement, People’s Health Movement (Civil Society)

Policy Areas

Capacity Building, Fiscal Transparency, Health, Public Participation, Public Service Delivery

IRM Review

IRM Report: Sri Lanka End-of-Term Report 2016-2018, Sri Lanka Mid-Term Report 2016-2018

Starred: No

Early Results: Marginal

Design i

Verifiable: Yes

Relevant to OGP Values: Access to Information Civic Participation , Technology

Potential Impact:

Implementation i

Completion:

Description

Sri Lanka's health sector is largely seen as successful due to its effective public delivery system, which provides both preventive and curative care at low cost. Public healthcare is free for all citizens and accounts for almost all preventive care and most in-patient treatment. However, the public health sector has inadequate capacity, limited access to specialist treatment and inconsistent service standards. To mitigate some of these challenges, the Health Strategic Master Plan developed by the Government of Sri Lanka has framed a National Health Performance Framework to provide citizens with information regarding health sector effectiveness, efficiency and equity, and empower civil society to play an active role in ensuring that these goals for national health are met at a grassroots level. Citizens would make use of health performance information in different ways to create a healthy dialogue and voice their interest for health development. Performance information will also be useful to create more awareness on the need for supporting change in health behavior/ supportive policies from other sectors. The availability of such information will be a positive trigger to create this dialogue. Issues to be Addressed: Since the disaggregated health budget is not known/available to the public, there is no oversight from civil society of national health performance measures. This policy will address this issue by ensuring public oversight in setting and achieving national health goals. Main Objective: Establish a national health performance framework.

IRM End of Term Status Summary

3. National Health Performance

Commitment Text:

National Health Performance

[…] the public health sector has inadequate capacity, limited access to specialist treatment and inconsistent service standards. [48]

To mitigate some of these challenges, the Health Strategic Master Plan developed by the Government of Sri Lanka has framed a National Health Performance Framework to provide citizens with information regarding health sector effectiveness, efficiency and equity, and empower civil society to play an active role in ensuring that these goals for national health are met at a grassroots level.

Citizens would make use of health performance information in different ways to create a healthy dialogue and voice their interest in health development. Performance information will also be useful to create more awareness on the need for supporting change in health behavior/ supportive policies from other sectors. The availability of such information will be a positive trigger to create this dialogue.

Milestones:

  • 1. Ministry of Health to publish detailed health budget and spending information.
  • 2. Raise awareness on the National Health Performance Framework (NHPF) through public consultations.
  • 3. Popularise the NHPF through the Ministry of Health website, newspapers, radio, television, public campaigns and the internet.
  • 4. Citizens will be actively involved in monitoring the implementation of the framework through a public forum on a quarterly basis.
  • 5. Findings and deliberations from the forum to be systematically discussed with government counterparts to ensure follow up actions.

Responsible institution: Ministry of Health, Nutrition and Indigenous Medicine

Supporting institutions: Sarvodaya, Patient’s Rights Movement, People’s Health Movement

Start date: July 2016 End date: July 2018

Editorial Note: The text of the commitment was abridged for formatting reasons. For full text of the commitment, see the Sri Lanka National Action Plan 2016–2018 at http://bit.ly/2wv3jXR.

Commitment Aim:

This commitment aimed to establish a National Health Performance Framework (NHPF) and thus, enhance public access to information on health performance in Sri Lanka. The Ministry of Health anticipated that the public will use this information to proactively participate in—and promote—constructive, evidence-based dialogue on health policy. [49] This, in turn, was expected to improve the quality of decision-making and mitigate the broader challenges faced by the public health sector.

Status

Midterm: Limited

This commitment achieved limited completion by the midterm. In April 2016, the Ministry of Health published consolidated National Health Accounts for 2013 on its website (Milestone 3.1). [50] However, the ministry had not made more recent budget records available.

As the National Health Performance Framework (NHPF) was not finalised by the midterm, no progress was made in raising awareness, through public consultations or otherwise. There was also no public forum to monitor implementation of the framework (Milestone 3.2–3.5). [51]

End of term: Limited

Although the commitment saw positive incremental improvements, implementation remained limited by the end of term.

Milestone 3.1: The Ministry of Health published further budgetary data and spending information through the 2017 Annual Performance Report. [52] This report was available in all three languages. [53]

Milestones 3.2–3.5: The ministry developed the NHPF and published it on its website in April 2018. [54] The framework contains over 80 indicators that may be analysed to assess the state of healthcare in the country. [55] According to the ministry, data is available for nearly 50 of these indicators; however, work is needed to extract useful information from the datasets and compile it in an easily accessible format. [56] According to civil society, the ministry has not oriented staff or conducted any public-awareness campaigns. [57] Also, as highlighted by civil society and verified by the IRM researcher, the ministry has not yet translated the framework into Sinhala and Tamil.

The ministry conceded that more is needed to be done to institutionalise the NHPF, including the appointment of dedicated personnel to drive and oversee implementation of the framework. [58] The monitoring forum, with citizen participation, was also not established by the end of term.

Did It Open Government?

Access to Information: Marginal

Civic Participation: Did Not Change

This commitment marginally improved access to information and open government overall. It did not, however, contribute to a noticeable improvement in civic participation.

At the outset of the action plan, government and civil society efforts to address growing challenges in the healthcare system were stymied by a lack of useful or quality health information. [59] In the absence of a health performance framework, stakeholders were unable to set clear targets, benchmark progress, or adopt evidence-based policies to improve healthcare in Sri Lanka.

The ministry published budgetary data and spending information through the trilingual Annual Performance Report, uploaded on the ministry website. [60] According to civil society, this improved access to fundamental information on health expenditure. [61] Prior to this, the Ministry of Health had published consolidated National Health Accounts from 2013, [62] as well as annual health bulletins [63] which contained limited financial information. Similarly, the ministry also developed and published the National Health Performance Framework (NHPF) [64] which provides a framework to measure the performance of the health system through specific indicators. If effectively implemented, stakeholders agree that the framework would facilitate access to a range of hitherto unavailable information on the effectiveness, efficiency, and equity of health services. [65]

However, civil society noted that some of the data intended to be collected through the NHPF was not available or easily accessible. [66] The NHPF itself was also unavailable in Sinhala and Tamil, and has not been introduced to the public through awareness campaigns. [67] Therefore, the commitment only contributed to a marginal improvement in access to information.

As the ministry has not yet set up the multistakeholder forum to monitor implementation of the NHPF, this commitment did not improve civic participation.

Carried Forward?

Sri Lanka’s second action plan was not released by the time of this report. However, the IRM researcher recommends that this commitment is carried forward into the next action plan. The effective use of the NHPF can significantly improve access to important health service information and may, thus, contribute to constructive discourse toward improved healthcare.

In the 2016–2017 IRM midterm progress report, the IRM researcher recommended a few additional measures to address the lack of information on health and enhance the impact of this commitment. These include: prioritising the introduction of efficient data collection mechanisms; introducing budgetary allocations for collecting data; and publishing key, easily-accessible information gleaned from the NHPF.

[48] “Sri Lanka’s healthcare Challenges,” Economist Intelligence Unit, 24 November 2014, http://country.eiu.com/article.aspx?articleid=1502512534&Country=Sri%20Lanka&topic=Economy&subtopic=Forecast.

[49] Dr. Susie Perera (Ministry of Health, Nutrition, and Indigenous Medicine) and Dr. Amila Chandrasiri (Ministry of Health, Nutrition, and Indigenous Medicine), interview by IRM researcher, 6 October 2017.

[50] Sri Lanka National Health Accounts 2013, Health Economics Cell (Ministry of Health, Nutrition, and Indigenous Medicine, April 2016) http://www.health.gov.lk/moh_final/english/public/elfinder/files/publications/NHA/Sri%20Lanka%20National%20Health%20Accounts%202013.pdf.

[51] Perera and Chandrasiri, interview; and Dr. Vinya Ariyaratne (Sarvodaya), interview by IRM researcher, 26 October 2017.

[52] Annual Performance Report 2017 (Ministry of Health, Nutrition, and Indigenous Medicine, 2018) https://bit.ly/2NtepkR.

[53] List of Publications (Ministry of Health, 2018) https://bit.ly/2y5Bkya.

[54] National Health Performance Framework 2018 (Ministry of Health, 2018) https://bit.ly/2y7zhJN.

[55] Dr. Susie Perera (Ministry of Health, Nutrition and Indigenous Medicine), interview by IRM researcher, 28 September 2018.

[56] Id.

[57] Dr. Vinya Ariyaratne (Sarvodaya), interview by IRM researcher, 27 September 2018.

[58] Perera, interview.

[59] “Upgraded Record Keeping Helps Save Lives in Sri Lanka” (The World Bank, 17 April 2014) http://www.worldbank.org/en/news/feature/2014/04/17/upgraded-record-keeping-helps-save-lives.

[60] Annual Performance Report 2017 (Ministry of Health, Nutrition, and Indigenous Medicine, 2018) https://bit.ly/2NtepkR.

[61] Ariyaratne, interview.

[62] Sri Lanka National Health Accounts 2013, Health Economics Cell (Ministry of Health, Nutrition, and Indigenous Medicine, April 2016) http://www.health.gov.lk/moh_final/english/public/elfinder/files/publications/NHA/Sri%20Lanka%20National%20Health%20Accounts%202013.pdf.

[63] Annual Health Bulletin (Ministry of Health, Nutrition, and Indigenous Medicine, 2016) https://bit.ly/2tGOjn9.

[64] National Health Performance Framework 2018 (Ministry of Health, 2018).

[65] Dr. Susie Perera (Ministry of Health, Nutrition, and Indigenous Medicine), Dr. Amila Chandrasiri (Ministry of Health, Nutrition, and Indigenous Medicine) and Dr. Vinya Ariyaratne (Sarvodaya), interviews by IRM researcher, 27 September 2018.

[66] Ariyaratne, interview.

[67] Id.


Sri Lanka's Commitments

  1. Integrity Officers to Decrease Bribery and Corruption

    LK0024, 2019, Capacity Building

  2. Asset Declaration System

    LK0025, 2019, Asset Disclosure

  3. Increase Use of RTI

    LK0026, 2019, E-Government

  4. Citizen Participation in Health

    LK0027, 2019, E-Government

  5. Campaign Against Youth Drug Use

    LK0028, 2019, Education

  6. Open Data

    LK0029, 2019, E-Government

  7. Agriculture Support Policy

    LK0030, 2019, Capacity Building

  8. Participation for Persons with Disabilities

    LK0031, 2019, Land & Spatial Planning

  9. Disability Rights Bill

    LK0032, 2019, Legislation & Regulation

  10. Disaster Management Planning

    LK0033, 2019, Capacity Building

  11. Nationak Environmental Policy

    LK0034, 2019, Environment and Climate

  12. CEDAW Implementation

    LK0035, 2019, Capacity Building

  13. Local Service Delivery

    LK0036, 2019, E-Government

  14. Feedback on Public Bus

    LK0037, 2019, E-Government

  15. Implementing UN Convention on the Rights of the Child in a Participatory Manner

    LK0038, 2019, Legislation & Regulation

  16. Improving Public Access to Preventive and Curative Strategies to Combat Chronic Kidney Disease

    LK0001, 2016, Health

  17. Transparent Policy to Provide Safe and Affordable Medicines for All

    LK0002, 2016, Capacity Building

  18. National Health Performance

    LK0003, 2016, Capacity Building

  19. Ensuring Transparency and Impartiality in Teacher Recruitment Policy and Process in Sri Lanka

    LK0004, 2016, Capacity Building

  20. Enhance the Services of Government Information Center (GIC- 1919) for Inclusive, Transparent, Accountable and Efficient Governance, Using ICT As Enabler

    LK0005, 2016, Capacity Building

  21. Promote the Open Data Concept and Delivering the Benefits to Citizens Through ICT

    LK0006, 2016, Capacity Building

  22. National Environmental Act (NEA) Amendments

    LK0007, 2016, Capacity Building

  23. Coast Conservation

    LK0008, 2016, Capacity Building

  24. Flora and Fauna Protection

    LK0009, 2016, Capacity Building

  25. Transparent and Accountable Procurement System for Local Authorities in Sri Lanka

    LK0010, 2016, Capacity Building

  26. Local Authority Procurement System Implementation

    LK0011, 2016, Legislation & Regulation

  27. Annual Work Plan of the Ministry of Women and Child Affairs to Include a Transparent and Accountable Process to Implement Selected Convention on Elimination of All Forms of Discrimination Against Women (CEDAW) Concluding Observations.

    LK0012, 2016, Gender

  28. CEDAW Implementation – Accountability

    LK0013, 2016, Gender

  29. CEDAW – Inclusion

    LK0014, 2016, Gender

  30. Strengthening Women Participation in the Political Decision Making Process at the Local Level

    LK0015, 2016, Capacity Building

  31. Strengthen the Anti-Corruption Framework to Increase Constructive Public Participation

    LK0016, 2016, Anti-Corruption Institutions

  32. Implement UNCAC

    LK0017, 2016, Anti-Corruption Institutions

  33. Coordination Among Anti-Corruption Agencies

    LK0018, 2016, Anti-Corruption Institutions

  34. Corruption and Money Laundering

    LK0019, 2016, Anti-Corruption Institutions

  35. Campaign Finance

    LK0020, 2016, Anti-Corruption Institutions

  36. Disseminate Asset Declaration

    LK0021, 2016, Anti-Corruption Institutions

  37. Starred commitment The Enactment and Implementation of the RTI Act

    LK0022, 2016, Anti-Corruption Institutions

  38. Proactive Disclosure

    LK0023, 2016, Legislation & Regulation