Multisectoral collaboration vital to achieving universal health coverage
The Sri Lanka Institute for Policy Studies (IPS) with the Sri Lanka Medical Association (SLMA) and the Center for Policy Impact in Global Health (CPIGH) at Duke University, USA, held a policy dialogue Virtual on “Planning for Universal Health Coverage Amid the 4Ds of Health Transitions Recently.”
The dialogue was structured around a recent IPS study aimed at understanding how government, donors and key national actors in the health sector perceive these transition challenges and their impact on progress towards UHC, where they see the most. big gaps emerge, and what action can help to address those challenges and gaps.
Health sector experts who spoke at the Dialogue stressed the need for multisectoral collaboration to achieve universal health coverage (UHC) in Sri Lanka.
Director of Research, IPS, Dr Nisha Arunatilake said that there are four major and interconnected transitions in the areas of disease, demography, development assistance for health and national health financing – the “4Ds” of the global health transition – complicating Sri Lanka’s efforts to reach CHU. The challenges associated with these have been compounded by the COVID-19 pandemic. Against this background, IPS and Duke University have conducted research that emphasizes the importance of achieving UHC and the Sustainable Development Goals (SDGs).
SLMA President Padma Gunaratne spoke about some of the achievements of the national health system, including increased life expectancy and the quality of health care. She said that while these achievements are laudable, inequalities and inefficiencies in health care continue to persist and a constructive dialogue on planning for UHC is most welcome.
Deputy Director General, Planning, Ministry of Health, Dr S. Sridharan said donor support for the health sector is declining. Meanwhile, there is a growing demand for health services, an aging population and inadequate national funding for health.
He recommended seven steps to address the challenges: (1) strengthen community response systems; (2) supporting reproductive health – adolescence, motherhood and newborn health; (3) support platforms for the delivery of integrated services; (4) strengthen the country’s population and supply chain; (5) invest in human resources (HR) for health and data systems for health; (6) strengthen and align national and global strategies; and (7) strengthen financial management and oversight.
Policy Associate, Duke University, Ipchita Bharali, provided the public with evidence on health transitions in an international context. She said many middle-income countries (MICs) are expected to abandon concessional multilateral and bilateral development assistance soon. However, they still face several health sector challenges such as high mortality rates, weak health systems and large pockets of poverty in the countries. These challenges have intensified with the onset of the Covid-19 pandemic.
Session 1: Knowledge gaps and opportunities
Research Economist, IPS, Ashani Abayasekara presented a summary of the study findings identifying knowledge gaps. One of the results highlighted was the growing burden of NCDs, as the focus was on curing these diseases by seeing only drugs as the solution and understanding them as disease problems and not as disease problems. health. Emphasis was also placed on gender disparities regarding NCDs.
Lack of detailed and accurate data, poor research and development (R&D) and dissemination of knowledge were some of the many gaps that were later identified as areas requiring immediate action.
Deputy Director General (Public Health Services II), Department of Health, Dr Susie Perera, said one of the ways to narrow the gaps is to target investments and incentivize stakeholders to conduct R&D, appropriate data collection and knowledge dissemination. She noted that Sri Lanka has had many opportunities to strengthen its primary health and education systems with donor support, both of which are relevant to reducing the burden of NCDs. “A whole-of-government and multisectoral approach is needed,” she stressed, adding that digital literacy must be encouraged in the health sector, as well as a culture of innovation.
Colombo University economics professor Prof Amala De Silva shared similar sentiments and said that NCDs have an indirect relationship with economic performance. She stressed the need for multidisciplinary studies and an appropriate lead agency in research activities to achieve UHC in Sri Lanka.
Capacity gaps and opportunities
Research Assistant, IPS, Thisali de Silva presented the findings of the study on the capacity gaps hampering UHC in the country. Weak financial capacity and human resources proved to be the notable shortcomings in Sri Lanka. Some of the gaps in financial capacity included inefficiencies in financial allocation and problems with financial management to name just two. On the other hand, the imbalanced distribution of health professionals and the lack of commitment to the financial side of the health sector have created worrying gaps in terms of workforce capacity.
The first to comment on the study was the head of the human resources department of the Ministry of Health, Dr Dileep de Silva. On the HR front, he said the problem with the imbalanced distribution of healthcare professionals was due to the low number of applicants, especially when it came to nurses, therapists, midwives and nurses. PHI. In addition, one of the main reasons for financial capacity deficits is the result of under-spending of investment budgets for the health sector.
Senior Lecturer in Community Medicine at Sir John Kotelawala Defense University, Dr Anuji Gamage identified healthcare migration as a problem driven by economic factors, an unsatisfactory work environment and professional career opportunities.
She said that a way to resolve the unequal distribution of labor is a mechanism that would provide security, and this is especially important in times of a global pandemic. “It is important to use strategies to ensure the security of the workforce and improve their well-being,” she said.
Policy gaps and opportunities
Frequent changes in the number of ministries, reversal of implemented policies and several other obstacles to implementation, especially at the provincial level, turned out to be some of the major policy gaps identified by the study. Ashani Abayasekara highlighted several opportunities to focus amidst all these gaps, such as creating a knowledge center, collaboration and coordination with non-state sectors.
Former SLMA president Dr Ruvaiz Haniffa called for a grassroots approach through family physicians and home care.
“Currently, too many people do not have health coverage in the preventive primary care sector. We have not put in place policies in the primary curative sector, ”he said, stressing that the need of the hour is to provide holistic primary curative care.
Former Finance Committee chair Uditha Palihakkara said the policy gaps are the result of weak national budgets for the health sector as a whole.
Session 2: Reflections from development partners, the private sector, academia and civil society.
Based on the study, Dr Deepika Attygalle, Senior Health Specialist, World Bank and Ms Shiranthi Rathnayake, Additional Director General, National Planning Department affirmed that multisectoral collaboration is vital to Sri Lanka’s goal. To achieve UHC, collaboration between healthcare professionals and the medical sectors is particularly important. Dr Olivia Nieveras, Public Health Officer, World Health Organization, explained how donors should be more agile in their activities. Additional Director General, Department of External Resources, Sampath Manthreenayake said there should be a collective system for better results on donor funding.
The question-and-answer session was moderated by Dr. Nisha Arunatilake.