by Shanika Sriyananda
Until our own national flag was hoisted on February 4, 1948, every
sector of the country was under the influence of the ruling Britishers.
Being under foreign domination for over four and half centuries under
the Portuguese first, Dutch and British later, the country took on a new
road to stand up on its own.
Country's health sector before the colonial rule was predominantly
the Ayurvedic system passed down the generations. Despite the foreign
influence, the majority depended on Ayurveda.
Although, a tiny island in the Indian Ocean, Sri Lanka had a highly
developed medical system and according to Mahawansa and ancient
inscriptions on rock surfaces, an organised medical services did exist
The hospitals established during the foreign rule served mainly the
military and their officials but not the local. But undoubtedly, the
Civil Medical Department set up in 1858 was the beginning of the health
The first village level dispensary was opened in 1877 and
concentration was given to improve healthcare facilities to south Indian
immigrant labourers in coffee and tea plantations.
The specialised campaigns to control the major diseases like malaria,
tuberculosis, leprosy, filariasis and venereal diseases were carried out
and the first international organisation, the Rockefeller Foundation,
arrived the country to assist in the prevention programs.
However, between 1870 to 1948, the death rate there was a marked drop
from 22.8% to 13.2% and infant mortality from 158 to 92 per 1,000 due to
good progress in the health sector facilities.
These rates dropped as a result of combined outcome of malaria
control, improved nutrition, better environmental sanitation, expansion
of health facilities and provisions of maternal and child care including
immunisation, improved quality, efficiency and effectiveness of health
care and delivery system.
"There were two types of hospitals, General and Special in 1948 with
a bed capacity of 18,585. Since independence all the successive
governments took steps to expand curative and preventive services.
As a whole, health sector in Sri Lanka has shown a considerable
progress since independence'', said Deputy Director General of Health
Services (Planing) Dr. Sarath Samarage.
At independence the Ministry of Health managed six hospitals in
Colombo with a total bed strength of 2,600.
Today the total number of beds in state hospitals has shot up to
61,835 and the total number of hospitals including central dispensaries
is 604. The National Hospital alone has 2,926 beds.
According to Dr. Samarage, universal child immunization that Sri
Lanka achieved in 1989 was one of the major achievements the country
could boast of. "The other achievements since independence are the
increased life expectancy, reduced birth and death rates, declining
infant and maternal mortality rates, elimination of small pox and
poliomyelitis and marked reduction in the number of cases of leprosy",
Dr. Samarage also added that significant increase in number and
different categories of human resources of health improvements in health
administration, technical innovation, expansion and strengthening of
health infrastructure had also contributed to the progress in health,
Under free education and with a high literacy rate, the health
sector, compared to other countries in the region, has improved as it
had helped to launch awareness campaigns successfully.
The basic health massages reached the people to all four corners of
the country and this helped to contain most of the communicable
Specialised campaigns for the control of diseases which were
considered of major public health importance were established from time
to time ; the Anti-malaria campaign in 1922, the anti-filariasis
campaign in 1947, the Anti-TB campaign in 1952, the Anti-VD campaign in
1952, the Anti-leprosy campaign in 1954 and the Rabies Control campaign
The secrets behind this very successful immunization, where over 89
per cent of children under one year of age were protected against TB,
diphtheria, tetanus, polio and measles was purely because of strong
political commitment to immunization after independence with adequate
number of trained staff, necessary funding and the support of mothers.
The activities that led to the successful immunization campaign were
commenced after the independence and it became a success following the
introduction of the Expanded Program on Immunization in 1978.
The BCG vaccination against TB was introduced in 1949, Triple
vaccination against diphtheria, whooping cough and tetanus in 1961, oral
polio vaccine in 1962, BCG vaccination for new born babies in 1963,
Tetanus toxoid administration to pregnant mothers was introduced in 1969
and measles vaccination in 1984.
After independence maternal and child health took a new turn. With
the increase of number of trained manpower (midwives), the health care
services reached the grass root level.
The establishment of Family Health Bureau helped to strengthen the
health infrastructure to provide an efficient and effective family
health services throughout the country. Several programs to improve the
health of the mother and child had launched and while promoting breast
feeding to reduce the malnutrition a greater emphasis was given to
improve the nutritional status of the girl child.
Among the achievements in maternal mortality and morbidity of 16 in
1945 to the present level of 0.6 per 1,000 live births, reduction of
stillbirths - 20 per 1,000 births, reduction of stillbirths - 20 per
1,000 births, reduction of infant and neonatal morbidity and mortality.
The main focus of the health sector is ensuring equity through easy
access to quality and modern health care services, mainly to the lower
income groups and the most vulnerable groups.
Human resources in the health sector is another vital section that
had improved since independence. The free education system helped to
produce our own medical staff. The gradual increase in the health cadre
with planned training programs to enhance their quality of work has
contributed immensely to the progress of the sector since 1948.
Today there are over 10,500 doctors, 19,700 nurses in the health
sector. The country has been able to produce consultant doctors in
different sectors in medicine and 85 new consultants have been added to
the cadre in 2006.
Establishment of nurses training schools were also an achievements in
the health sector. A total of 9,500 student nurses follow training at 14
institutes at present.
Since independence every successive government have given attention
to develop the primary health care services.
The gradual development in the sector had resulted in carrying out
the health message through the health staffers, who are specially
trained to look after the health of the rural people.
Last year only 567 Public Health Midwives and 169 Public health
Inspectors were recruited to strengthen the primary health care services
in the country.
Upgrading the 140 year-old Colombo General Hospital to a National
Hospital is one major milestone in the health history.
Establishment of the Medical Supplies division, National Drugs
Quality Assurance Laboratory, the State Pharmaceutical Corporation, and
Medical Research Institute were also other major milestones.
With increased budgetary allocations each year, the modern facilities
have been added to the state health sector and major disease
identifications in various sectors including cardiology and neurology
have done due to the availability of modern medical equipment like CT
Over Rs. 381.2 million had spent last year to purchase medical
equipment to hospitals and Rs. 1348.8 million for construction and
rehabilitation of health institutions, last year.
Development of the best and modern blood bank in South Asia at a cost
of Rs. 311 million, the first ever 'Linear Accelerator' for cancer
treatment at Maharagama Cancer Hospital, Cardiology Unit at the Lady
Ridgeway Children's Hospital, which is considered to be the largest
children's hospital in South East Asia, are a few major achievements in
the health sector since independence.
Tsunami disaster was one major challenge that was faced by the health
sector. The first ever and the worst disaster destroyed over 104 health
care institutions. And many of them have been rehabilitated and
reconstructed spending over Rs. 5,257 million.
With the considerable improvement in the health sector after
independence the country faces new challenges with an increase in
non-communicable diseases. There was marked increase in diabetes,
hypertension, heart diseases, cancer, thalassaemia, kidney diseases,
The National Authority on Tobacco and Alcohol was established.
Introducing new policies and legislations to strengthen and improve
the health services were another also step taken to develop the
country's health sector.
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