2.2 Overview of the health system

The Colombo Medical School was founded in 1870 to train doctors to serve in the government health services. The locals trained in allopathic medicine were able to exert pressure on the government for the extension of health services to the general population. The granting of universal franchise in 1931 and election of people’s representatives to the state council led to a demand for health care, education and increased road access. Furthermore, the devastating malaria epidemic of 1934–1935 (with an estimated 80 000–100 000 deaths) was instrumental in extending the health infrastructure to hitherto neglected rural regions. Two principles that have influenced the health system of the country to date, i.e. the emphasis on well-dispersed services and the need to provide protection from financial impoverishment following illness, emerged from this calamity (Ranan Eliya and Sikurajapathy, 2009).

An important development in the preventive services of the country was the establishment of the first health unit in Kalutara in 1926. A health unit is headed by an MOH and a team of professionals who serve the population of an identified geographical area. This system of provision of care spread gradually to cover the whole island.

The World Health Organization (WHO)’s concept of health as a fundamental human right was accepted by the very first government of independent Sri Lanka in 1949 and all subsequent governments have maintained this commitment.

2.2 Overview of the health system

The Sri Lankan health system comprises western allopathic and other systems, namely Ayurveda, Siddha, Unani, acupuncture and deshiya chikitsa, which derives from ancient Sri Lankan traditional knowledge. Almost all preventive care and most of the curative care needs of the country are provided by the government health system free of charge at the point of delivery.

In both systems, i.e. allopathic and indigenous, health care is provided by the government and the private sector, with very limited services being provided by non-profit organizations. Although both allopathic and traditional systems come under the purview of the MoH, the allopathic system caters to the needs of the majority (Ministry of Health, Nutrition and Indeginous Medical Services, 2019). In 2017, the government allopathic system provided care for 6 910 249 inpatients and 55 339 335 outpatients (Ministry of Health, Nutrition and Indeginous Medical Services, 2019), while the government indigenous system served only 36 088 inpatients (0.5% of the allopathic case