Abstract
Sri Lanka's healthcare systems attempts to provides access to universal healthcare services for all citizens and is designed to be free of out-of-pocket payments. Despite a 30-year civil conflict, natural disasters, and COVID-19, the healthcare system within the country remains robust and strong. However, due to a lack of formalized pathways and centralized record keeping, the pattern of service utilization is still relatively unknown, which raises concerns regarding effective allocation of scarce resources and efficiency of referral pathways. To address this gap in knowledge, part of the parent study (COMGAP-S), consisted of a survey on healthcare service use conducted among adults attending primary care facilities. The results from this quantitative data analysis indicate the majority of people seeking care originate from rural areas, are older (50+), attend divisional hospitals, and report paying fees at point of contact. Our findings indicate a need for more efficient use of healthcare services, creation of referral routes to ensure limited healthcare resources are used effectively. Additionally, further investment in services is needed to ensure Sri Lanka's healthcare system meets the standard of universal healthcare as proposed by the World Health Organization. These findings address a gap in knowledge for national decision-makers within Sri Lanka along with other similar post-conflict healthcare settings across the globe.
Highlights
The country of Sri Lanka provides a publicly funded, universal healthcare system that is meant to be available to all without restriction (1, 2)
We found that there are significant associations between older age, employment, lower education and living in rural or coastal areas and healthcare utilization among conflict-affected, adult, primary care attendees for chronic disease
This study indicates health seeking preferences, such as utilization of divisional hospitals with specialized services over more locally available primary medical care units
Summary
The country of Sri Lanka provides a publicly funded, universal healthcare system that is meant to be available to all without restriction (1, 2). Within Sri Lanka’s healthcare system, inpatient and outpatient services are available within divisional hospitals, while primary medical care units provide only outpatient care. Primary medical care units and outpatient services at divisional hospitals comprise the “primary care” level of Sri Lanka’s healthcare system. Even facing adversities of conflict, natural disaster, internal displacement, and a pandemic, Sri Lanka’s under-five mortality rate is low, and 99% of women (15–49 years) received postnatal care within 2 days of giving birth (4). This indicates that the health system has a strong foundation in child/maternal health already meeting one of the SDGs Goal 3 indicators. Sri Lanka’s healthcare system appears robust and seems to contribute to good health outcomes, if compared to other middle-income countries (1)
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