Sri Lanka


Gunanawathie, a public health midwife with Navodhya who has recovered from a cleft palate. Image and case study credit: UNICEF

“I know all the children and mothers in my area” says Gunanawathie, a public health midwife in Bulathsinhala in southern Sri Lanka. During her home visits, she goes beyond the call of duty to help young children in this tea plantation area, including those with disabilities.

“When Payani was one and half years old, her mother noticed the baby had difficulties walking and talking” Gunanawathie explains. “I urged the mother to take her to the Children’s Hospital in Colombo immediately”. And there sadly delays in her development were discovered. Payani’s mother Sunitha was terrified and became very protective. She did not want Payani to play outside and was afraid to let her do anything alone.”

Gunanawathie encouraged Sunitha to let Payani play and learn as she liked. Gunanawathie increased her home visits, played with Payani, and even helped her to ride a bicycle. “It was difficult for the mother to believe what I was doing for Payani, but when she finally rode a bike by herself, she was convinced that her daughter had tremendous potential to develop herself.” Gunanawathie said. “Thanks to Gunanawathie’s care and concern now Payani now attends pre-school’ boasted Sunitha, Payani’s mother.

In the next house lived little Navodhya with her mother Dinusha. The midwife remembers the first home visit to Navodhya’s house. Dinusha was crying since Navodhya had a cleft palate. Observing Navodhya struggling to drink her mother’s milk Gunanawathie told the mother, “You should take Navodhya to the Children’s Hospital in Colombo right away.” The midwife immediately referred them to the Children’s Hospital, where Dinusha received special instructions on how to take care of Navodhya. Three months later, Navodhya was fit enough for the operations. Now her lips look just fine and the scars of the operations are hardly seen. “One more operation to go, and it will be over”, Dinusha said happily.

Neonatal mortality rate  (per 1,000 live births) (2011) 8
Under-five mortality rate (per 1,000 live births) (2011) 12
Maternal mortality ratio (per 100,000 live births) (2010) 35
Number of doctors, nurses and midwives per 10,000 people (2010) 24.2
Births attended by skilled personnel (2007) 98.6%
Total expenditure on health as a percentage of gross domestic product (2011) 3.4%
General government expenditure on health as a percentage of total expenditure on health (2011) 44.6%

In Sri Lanka, most public health services are available free of charge to all citizens. The main health challenge is the rising burden of non-communicable diseases, including heart disease, stroke, and diabetes.

The performance of the workforce across the different dimensions is generally good, with some remaining challenges. The availability of skilled health professionals is currently above the 22.8 threshold and requires only a slight increase to keep pace with population growth 3up to 2035; it might even be feasible to meet the higher 34.5 threshold. There is however, a skewed distribution of staff towards urban areas, which affects accessibility. The ratio of nurses to physicians is above the OECD average. In terms of indicators of quality, there may be scope for improvement in accreditation of educational institutions. Improving in-service training is another area in need of attention. There is a strong policy backing for developing HRH, including a costed strategic plan (2009-2018), but better information systems on HRH are required.

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