Dr. Champika Wickramasinghe Director, Health Information Unit Ministry of Health & Indigenous Medicine

Transcription

1 Dr. Champika Wickramasinghe Director, Health Information Unit Ministry of Health & Indigenous Medicine

2 Country profile Population million Density per sq/km Literacy % Male 92.3 Female 89.1 Life expectancy at birth 79.4 female, 72.2 male CDR-5.92/1000pop CBR /1000pop IMR- 8.2/1000 LB (2013) MMR- 32 / live births(2014) LBW -16.5% (2015)

3 Structure of the health sector and flow of funds Health care in Sri Lanka is provided by the government, private sector and to a very limited extent by the non-profit sector. The government sector comprises of Central Government and Provincial Councils. Predominantly financed from general revenue taxation Public sector healthcare is universally accessible to the entire population of Sri Lanka and is almost wholly free of charge Private sector financing is through out-of-pocket spending employer payments(direct payments and insurance payments) private insurance contributions from non-profit organizations Donor financing Largely channeled through the government sector, and in certain instances through non-profit organizations, is an extremely small percentage of health financing

4 Rupees Mn. (in constant 2002) Percent of GDP 73% of total public health spending is for the line ministry and the remaining on the provinces (26%) and local government(1-3%). Public Health Expenditure as a % of GDP 45,000 40, % 1.7% 2.0% 1.8% 35,000 30,000 25,000 20,000 15,000 10,000 5, % 1.4% 1.4% 1.3% Provincial expenditures Central expenditures Public Health Expenditure as % of GDP * 1.6% 1.4% 1.2% 1.0% 0.8% 0.6% 0.4% 0.2% 0.0%

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6 Priority setting for finances Budget call in June every year All organizations look at their progress and decide 1. the activities that will continue for next year. 2. the activities that will be initiated next year. Activity plan will be developed for the next year based on the estimated allocations. Discussion at ministry level, to identify activities that will be taken up. All existing line items given in the budget will be given some funding Budget meeting with the treasury. All the items in the budget discussed in details.

7 budget Funding sources will be decided by the treasury. Budget will be read Final allocations will be sent to the ministry Final activity plan will be made based on the allocations.

8 Line item budgeting. Used till Inquire the need from the organizations. Based on the plans to be implemented and new activities allocation is made. Some times adding of a % to last years estimates made. This ensures there is funding in those budget lines. Problems Sometimes that budget line may not be needed now. But funds allocated. Accountability is low. The policies change or new policies adopted but difficult to introduce new items.

9 In order to utilize public resources efficiently and effectively, it has been decided to introduce zero based budgeting approach through a comprehensive review of public expenditure since 2016

10 1. Review missions, objectives and functions of each organization to assess their relevance in the current context and to identify irrelevant activities, duplications, wastes and gaps. 2. Review all programs/projects/sub projects in relation to objectives. 3. Prioritize all programs/projects /sub projects in accordance with the national priorities/goals and identify low priority and irrelevant activities that can be eliminated. 4. Link all activities to the sectoral targets in line with desired results. 5. Estimate costs of projects/sub projects based on cost unit. 6. Identify Key Performance Indicators (KPIs) relating to the cost units to evaluate the achievements of targets.

11 What is free Almost all. Drugs, investigations, surgeries. When items not available(not in the EML/formulary) local purchase and give. Cancer drugs When it is not possible to get services from the government sector, presidential fund provides funds to get it done from the private sector/necessary items could be purchased.

12 Challenges for UHC and financing in Sri Lanka Free healthcare system to be maintained covering all areas of the health sector. Out of pocket expenditure for purchase of drugs(ncd), investigations, interventions due to non availability or delays to be reduced improving the supply chain, minimizing waste and corruption, accreditation of laboratories and implementing quality assurance. Ensure advanced technologies are introduced to the healthcare system in a regular manner to improve service delivery. Need to carry out technology assessment to ensure appropriate technology to each level of care.

13 Challenges to provision of UHC ct.. Preventive sector State bear the total cost Curative sector 50% of the ambulatory care by the private sector

14 Action taken Planning for cluster system of healthcare Planning for accreditation of laboratories and healthcare institutions Planning for technology assessment Implementing MSMIS system to improve drugs management

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