Intersectoral Action for Health. The Sri Lanka Case Study

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Elijah Pearson
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1 Intersectoral Action for Health The Sri Lanka Case Study

2 The Structure of the Study The rapid health transition in Sri Lanka during the period The simultaneous progress made in other states of wellbeing: which included education, housing, living conditions, livelihoods of the rural poor, and democratic political participation The intersectoral synergies that were mutually supportive and advanced all indicators together Simultaneity of progress as the critical factor

3 Selected Social Indicators Lif e expect ancy at Birt h Inf ant mort alit y rat e Selected So cial Indicato rs Crude birth rate Crude death rate Select ed Social Indicat ors M aternal mortality rate T ot al Fert ilit y R at e 197 Life Expectancy at Birth Male Female L i t e r a c y L e v e l M ale Female T ot al School E nr ol l ment Rat e Primary Secondary Changes in the National Housing Stock Permanent Semi Permanent Temporary C hanges in t he R ural Housing Stock Permanent 3/4 Semi Permanent Temporary C onst r uc t i on Mat irials Ho using T enure, Rooms, Occupat ion 3/4 Water Supply & Sanitation P e r Ca pi t a Ca l or i e i nt a k e 2 2 Ca l or i e s P e r Ca pi t a Consumpt i on , 197, Rupe e s Lo west, H ighst P er C apita Inco me - % Year 1 Ind icat o rs of Change 1 Mean per cap: consumption p.m at 198 prices 19, Rate of Unemployment, 19,. Growth of Percapita Income Growth of GDP in 19 Prices Income Decile in which Poverty Line is Crossed 2 Per cap: consumption p.m at pov: line at 198 prices

4 The Policy Pre-Conditions in the Sri Lankan Case An overall social development strategy which enabled the society to make simultaneous progress on all the key social indicators. A political process that evolved a high degree of national consensus for such a strategy As far as possible equal weight and commitment given to each of the key indicators Shared responsibility for the programme at the highest level of government Purposive intersectoral action that can shape sectoral policies and goals to promote uninterrupted progress on the health indicators can take place best within such a framework

5 Missed Opportunities The intersectoral processes did not lead to clearly articulated programes of intersectoral action for health. Why? Each sector simultaneously pursued its own goals to improve the conditions for which it was responsible. The senior professionals and administrators did not develop the capacities to study and identify the intersectoral linkages in their activities. The decision making structures and the administrative culture were not conducive for intersectoral team work., issues of hierarchy and leadership constantly arose in any interministerial arrangement. A pre-requisite of intersectoral action is a resource base which continuously identifies and analyses the intersectoral process in health applying the criteria of simultaneously identifying lags and shortfalls and promoting intersectoral action on the different combinations of these lags.. What was needed was a model of intersectoral action of a more co-operative type where each sector was given an equal stake and status and worked collectively to identify the intersectoral links on which they needed to act together. Intersectoral apex bodies have to be structured in a manner that gives a sense of collective ownership. Sufficient attention was not paid to community- based, participatory approaches.

6 Scope For Future Intersectoral Action The regional disparities in health status that exist despite the equity oriented strategy for the provision of health care. Surveys reveal the different combinations of vulnerability in different settings. They provide the basis for developing a typology of intersectoral action for health in Sri Lankan conditions. The persistently high level of undernutrition despite other relatively high social indicators. While malnutrition declines with income, the poverty- malnutrition nexus is not clear. Sri Lanka is entering a phase of the demographic transition which is unusual for a low income country. The mix of aging, the new disease burden, persistently high levels of consumption poverty and malnutrition requires a strategy much more proactive in identifying the intersectoral links and acting on them than in the past.

SECTION - 13: DEVELOPMENT INDICATORS FOR CIRDAP AND SAARC COUNTRIES

Development Indicators for CIRDAP And SAARC Countries 485 SECTION - 13: DEVELOPMENT INDICATORS FOR CIRDAP AND SAARC COUNTRIES The Centre for Integrated Rural Development for Asia and the Pacific (CIRDAP)