October 3, 2018
Sri Lanka: achieving so much with so little
Sri Lanka is considered a "fast track” country in the prevention and control of NCDs.
By Dr Mahen Wijesuriya, Dr Chamari Warnapura
We have achieved “so much with so little’’ in spite of the 30-year civil war which ended in 2009. We have a 92% literacy rate and life expectancy of 75 years. This is not by accident but due to welfare oriented political commitment to provide free health and education as part of the Universal Health Coverage [UHC] adopted by successive governments. We have achieved more than 70% of UHC which started way back in 1931. In 2017, this was augmented further by a reduction of cost of essential medicines in private sector by more than 50% which increased affordability and further accelerated our march towards achieving UHC by 2030. Sri Lanka is classified as a ‘’fast track” country and enjoys One WHO integrated technical support due to the progressive outlook of the Government with respect to prevent and control noncommunicable diseases (NCDs).
Sri Lanka is experiencing a paradigm shift of disease burden from maternal and child health and communicable diseases to noncommunicable diseases [NCDs] due to its demographic and epidemiological transition and a move from a low-income country to a middle-income country.
NCDs are 85% of total burden of disease and overweight and obesity accounts for 35.2% in the above 18 years category according to STEPS survey in 2015. 75% of mortality is due to NCD’s, out of which 18% are premature (30-69 years).
Diabetes is seeing an exponential rise with an alarming decline in age of onset. The first survey in Sri Lanka was done in 1988 which showed a 2% prevalence rate in rural areas which in two decades increased to 21.8% having diabetes or pre-diabetes in the country.
Diabetes Association of Sri Lanka [DASL] was established as an NGO registered in Parliament in 1992 and the first National Diabetes Centre [NDC] opened in 1995. At the time, specialized facilities for persons living with diabetes were not available in the country. It is a center of excellence committed to primary and secondary prevention and care. DASL provides clinical and laboratory service through the NDC, health promotion through education, awareness and screening programmes, conducts research in collaboration with national and international Universities and promotes policy planning and advocacy with government and other related organisations.
A holistic care package is offered free of charge to 700 less fortunate young persons living with type 1 diabetes (T1D) through the Insulin Bank. The National registry for T1D is also compiled at the DASL.
Sri Lanka and its fight against NCDs
In our quest to reduce premature deaths from NCDs by one-third by 2030 we have a National multi-sectoral action plan and a National NCD Council which includes NCD Alliance Lanka established in 2016. In addition, we are in the process of prioritizing health in all government policies.
Sri Lanka has received a World Bank grant and aid from Japan International Corporation Agency [JAIC] to finance development, reorganize primary health care and to scale up strategies for NCD prevention. At present, we have established 488 healthy lifestyle centers in the National hospital network where any person over 35 is able to access the facilities. Further, health was included in the school’s curriculum as a mandatory subject up to grade 10.
In 2017, smart fiscal policies of tax on sugar and an easy identification with the traffic light system (TLS) was brought into force for ready to drink sugar sweetened beverages (SSBs). We are one of 30 countries to implement such a taxation. Tobacco tax is currently at 90% and is the highest in the region. We also carry 80% coverage of graphic imagery on cigarette packs. Tax on alcohol is also in effect and advertising, promotion and sponsorships are banned for both alcohol and tobacco.
Mental health and wellbeing is absorbed as an integral part of NCD’s. Suicide rate in Sri Lanka was one of the highest in the world. This has been reduced by more than half by curtailing accessibility to pesticides. Sri Lanka has set in motion the four Time Bound commitments requested from countries at the last UN High-level Meeting in 2014. Further recommendations made by the Joint mission of the UN Interagency Task Force on NCD’s in 2015 have also been implemented.
In our quest to reduce premature deaths from NCDs by one-third by 2030 we have a National multi-sectoral action plan and a National NCD Council.
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