Sri Lanka's post-tsunami health system recovery: a qualitative analysis of physician perspectives.

Abstract

The 2004 Indian Ocean tsunami caused significant damage to the health system in Sri Lanka. Rebuilding infrastructure and improving the mental health system were targets of recovery policies. Retrospective analyses of the post-tsunami health system recovery in Sri Lanka lack the perspectives of local stakeholders, including health care providers. In 2014 we interviewed 23 Sri Lankan physicians from the Eastern and Southern regions. Participants were recruited with snowball sampling. We used a content analysis approach in analysing the transcriptions. Sri Lankan physicians critiqued governance, sustainability and equity in the health system recovery. They held leadership roles as facilitators and sustainers of specific projects but were rarely formally consulted in recovery strategic planning. They identified instances of poor coordination among partners, corruption trends, local resource mismatches, regional resource disparities and the influence of the Sri Lankan civil war. Post-tsunami health system recovery planning and implementation in Sri Lanka did not involve local physician stakeholders in ways that have been prioritized more recently in other recovery frameworks. Despite limited formal inclusion, local physicians developed significant leadership roles that have informed their critical perspectives on the health system recovery.