In Sri Lanka, organized delivery for provision of health services is implemented mainly
through the allopathic (western) system and both the public and the private sectors
contribute to health services. The term public health services usually include those
services that provide promotive and preventive health services. However in Sri Lanka
public health services are mainly focused on the provision of preventive and promotive
health services and do not include first contact medical care.
The main provider of Public health services in Sri Lanka is the state health services. The
role of the private sector in public health activities could be considered as being
relatively limited. Non governmental organizations too play a limited role in public
health services except in the area of family planning.
The levels at which the health care services have been organized are in keeping with the
levels of the organization for other administrative activities i.e. central, provincial, district
and divisional levels.
The Ministry of Health (Central Government) and Provincial Directors of Health services
are responsible for planning, implementation and monitoring of all health programmes
including public health programmes at central and provincial levels respectively. Deputy
Provincial Director of Health Services is responsible for management and effective
implementation of all health services including public health services in the respective
district. Within each district, there are several divisions, each in charge of a Divisional
Director of Health Services who is responsible for the provision of comprehensive health
care services to a defined population, with special emphasis on preventive and promotive
health care.
Rapid Assessment technique was utilized to conduct this survey on EPHF and it included
following components. Study of existing situation, key personnel interviews, workforce
survey, Community based study, facility assessment and a SWOT analysis
Key informant interviews were conducted to obtain the views relevant to EPHF among
responsible personnel responsible for health care provision at the central level. Public
health field staff at district and divisional level was included in the workforce survey.
Self administered questionnaires were developed to with appropriate modifications to suit
each category of personnel were used in this. Qualitative technique of FGDs was used to
gather information on community perception on EPHF. Two public health agencies were
included in the facility assessment which assessed the extent of delivery of EPHF and the
availability of resources and mechanisms to effectively deliver EPHF. Health
administrators, academics and representatives from NGO and WHO participated in the
SWOT analysis.
All central level public health staff agreed that the specified essential public health
functions as being important in the Sri Lankan context and being aware of the global
influences that affect health status was also considered as an important public health
function.
The workforce survey showed that the district level staff recorded highest average
competence to perform majority of the public health functions compared to different
categories of divisional level staff. Public health functions and tasks that need to be
strengthened among each category of workforce were identified.
Community survey revealed that involvement of community in carrying out public health
functions is minimal due to lack of awareness on such functions being implemented in
the community.
Weaknesses were identified in the key informant interviews, workforce survey as well as
in the SWOT analysis were related to deficiencies in existing organizational system.
Most of the strengths identified were attributed to existing public health infrastructure in
the country and the threats were in many instances concerned with poor community
support.
Strong need to recruit competent personal into the public health agencies with clear
recruitment and transfer policies were indicated in facility assessment of public health
agencies.
Further enquiry with regard to EPHF in Sri Lanka was also suggested.