Sri Lanka needs a national health policy: A survey of past national health policy documents

Abstract

INTRODUCTION: Sri Lanka does not have an explicit national health policy (NHP). The health system to date is geared to meet the challenges of the past. Though there have been periodic reviews of epidemiological and demographic trends, they have not resulted in policy changes to address current and future health challenges. The concept of free healthcare is widely accepted. These factors have slowed the development of the health sector, resulting iirinequities at the point of service delivery. OBJECTIVES: To identify reasons for non-implementation of developed health policies and to assess the need/reasons for policy reform. DESIGN, SETTING AND METHODS: A retrospective survey of health policy documents and studies conducted on health policy reforms during the period 1992 - 2002 was undertaken. RESULTS: Ail policy documents had responded to the issues of epidemiology, patient satisfaction and efficiency of the system to varying degrees. A study conducted on key stakeholder opinion using a self-administered questionnaire revealed that the principal reasons for non-implementation were lack of bureaucratic (24.3%) and political (18.9%) commitment and lack of insight for policy and planning (17.6%). The main reasons which prompted policy reforms were increasing health demand (70.3%), financial constrains (63.5%), pressure from donors (63.5%), and political pressure (59.5%). Key stakeholders identified the Ministry of Health (95.9%) and Professional Associations (85.3%) as organizations which should play a leading role in policy development and implementation CONCLUSION: There is a conducive atmosphere for health sector reforms. The means to capitalize on it is through a comprehensive, equitable and financially viable NHP, which collates, identifies and prioritizes achievements of past national health policies.