to improve the scope and functions of this unit, which could also lead to transforming health professional education through coordination with other ministries such as Education/Higher Education and units in the MoH. Slow but steady progress of this Unit has increased its acceptance and its coordination functions, which extend to liaising with administrative bodies that influence HRH outside the Ministry. However, this Unit has to strengthen its own capacity in the main HRH functions and infrastructure facilities to conduct its operations and liaise with existing units in the Ministry mandated to perform these functions.
6.3 Future developments 6.3.1 Health service delivery for UHC, emphasizing primary care reforms Primary health care, which was introduced through the establishment of the health unit system (MOHs) to address health needs in 1926, has been the backbone of the Sri Lankan health system. Subsequent governments have supported and enhanced this model of addressing the preventive health issues of a defined population. The population served by an MOH area and its subunits is defined so that it coincides with local government boundaries. The strengths of the MOH system have been its well-trained field public health staff, supportive supervision and a system of accountability for health outcomes in a defined population, supported by a good management information system. In 1987, a major political and administrative reform was the Thirteenth Amendment of the Constitution of Sri Lanka, which created provincial councils with a degree of decentralization of governance to the provinces. With this process, health became a partially devolved subject. Important service components that became the responsibility of the provinces were the primary-level health services comprising the MOH system for preventive care, the network of DHs and PMCUs for curative care, and the BHs that form the secondary level. Larger secondary-level hospitals are being managed with difficulty by the provincial health authorities due to limitations in resources. Eight BHs out of 83 have been handed over to the MoH. Although difficult, many provincial authorities maintain their management position to secure even the limited financial allocations they receive. The Treasury is tasked with allocating the limited health budget between the Centre and provincial authorities. More large and specialized institutions coming under the direct management of the Centre has seemed to justify the Centre receiving a significantly higher financial allocation than the provinces.
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