9 Provinces, 25 Districts and 331 Divisional Secretary Areas. Percentage HDI

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1 SRI LANKA BASIC INFORMATION Value Year Source Total population (million) 2, {1} Land area (sq.km.) 62,7 {1} Density of population (per sq.km.) {1} Administrative divisions 9 Provinces, 2 Districts and 331 Divisional Secretary Areas DEVELOPMENT Gross national income(gni) per capita (US$) {3} Highest in the world - Norway {3} Highest in the Region - Maldives {3} Population below poverty line - Intl.$1.2 per day (%) {3} Lowest in the Region -Thailand <1 21 {3} Population below national poverty line (%) /13 {24} Lowest in the Region -Sri Lanka {3} of Population Below National Poverty Line Adult literacy rate >1 years (%) {} Highest in the Region - DPR Korea 1 21 {} Net enrolment ratio primary (%) {6} Highest in the Region -Indonesia {6} 199/91 199/ /7 29/1 212/13 Data source: 4 Trends in Human Development Index Human Development Index {} 1 Highest in the Region - Sri Lanka {} Population in multidimensional Poverty (%) {} Lowest in the Region - Thailand {} HDI Gender Inequality Index {} Lowest in the Region - Maldives {} Data source: Salient basics The country has achieved relatively high standards of social and health development compared with countries with similar economic development around the world. Level of human development as measured by HDI figures in world's high human development group of countries. Although success on the HDI is not a necessary and sufficient condition for success in terms of rapid economic growth, however Sri Lanka's proportion of population below national poverty line is the least among the countries of the SEA Region. Sri Lanka has a long history of being a welfare state. The case of Sri Lanka is often cited as the "support-led" strategy where around 4% of GDP has been redistributed to households over the years in the form of free education and health services.

2 Q.1 What are the basic demographic features? POPULATION Value Year Source Total population (million) 2, {1} Population growth rate per year (%) {1} of Population by major < Urban population (%) {2} AGE-SEX STRUCTURE Population Sex ratio (Females per 1 males) {1, C} Children <1 years (%) {2} Elderly 6 years (%) {2} % % 1% Data source: 2, 9 Highest in the world - Japan {7} Highest in the Region - DPR Korea {7} Total Dependency Ratio ((Age Age 6+) / Age 1-64) (%) {2, C} FERTILITY Lowest in the world - UAE {7} Lowest in the Region - Thailand {7} Crude birth rate (per 1 population) {1} Lowest in the world - Germany {7} Trends in Crude Birth Rate and Crude Death Rate PER 1 POPULATION CBR CDR Data sources: 2,9 Lowest in the Region - Thailand {7} Total fertility rate (TFR) (per woman) {8} Trend in Total Fertality Rate Lowest in the world - Macao SAR (China) {7} Lowest in the Region - Thailand {7} 4 Contraceptive prevalence rate (any modern method) (%) {8} GROSS MORTALITY TFR (per woman) Crude death rate (per 1 population) {1} 1 Lowest in the world - UAE {7} Lowest in the Region - Maldives {7} DHS DHS DHS DHS Data source: 8 Salient demographic features Sri Lanka is one of the few countries in the Region with a favourable sex ratio. The proprtion of adult population (1-9 years) which has been increasing like in most other countries in the Region is somehow showing downward trend from 24 to 212 and calls for investigation of the cause. The death rate has been low in Sri Lanka for at a least quarter of a century, indicating that the country achieved success in this area long time ago. Sudden increase in TFR from 1.9 in 2 to 2.3 in 26-7 also calls for investigation of the reasons for it. Also unlike other countries in the Region, it has been noted that illiterate women in Sri Lanka seem to have lower TFR than the woman with some level of education. This also needs to be investigated.

3 Q.2 What is the progress regarding some health-related MDGs? POVERTY AND HUNGER Population below minimum level of dietary energy consumption (Prevalence of undernourishment in general population) (%) (211) Under-weight (<-2SD) children (%) (26/7) CHILD MORTALITY 21 (National target) Infant mortality rate (per 1 live births) Under-five mortality rate (per 1 live births) 22. (1991) One year olds immunized against measles (%) (211) MATERNAL HEALTH Maternal mortality ratio (per 1, live births) 42. (1991) 23. (1996) Deliveries attended by health staff (%) HIV/MALARIA/TUBERCULOSIS HIV prevalence in 1-49 years (%) <.1 <.1 (21) <.1 <.1 - Malaria incidence (per 1, population) MMR UMR Under-five mortality rate (per 1 live births) 19 Trend Projection 39 Year Maternal mortality ratio (per 1 live births) Trend Projection Target 31 Target Tuberculosis prevalence (per 1, population) Tuberculosis Treatment Success rate (%) 79 (199) (211) Year WATER AND SANITATION Trends in HIV/AIDS, TB, Malaria Population with access to improved water source (%) Population with access to improved sanitation (%) (211) (211) Malaria, TB (per 1 population) Malaria TB HIV HIV/AIDS prevalence (%) Year MDG Progress With regard to MDG 4, Sri Lanka already had low 199 baseline mortality rate in children under-five and the progress in further decline has been somewhat slow.the challenge therefore now is to scale up interventions to reduce neonatal mortality as the further reduction in under-five mortality from this low baseline level will be driven mainly by reduction in deaths that occur in the first month of life of newborns. Related to MDG, progress in decline of Maternal mortality also has been slow from already low 199 baseline and as shown in the graph above the progress has been unstable during the period 1991 to 212. Progress towards MDG 6 has been mixed: - Although HIV prevalence in the adult population remains low and below.1% since 21, Sri Lanka perceives it as a low-level truncated epidemic despite the high vulnerability and risks target of reduction in malaria incidence rate and death rate has already been achieved in Although the TB prevalence in Sri Lanka has been relatively of low magnitude, further decline from 199 level has been slower than what was expected in order to meet the 21 target. Progress in redction in TB death rate has also been slow. TB incidence is much higher than the national average in some districts. As the risk of getting infected with TB appears to rise with age, and with the proportion of the eldely population increasing steadily in Sri Lanka, it poses a challenge to the country.

4 Q.3 What are the major health problems? IN CHILDREN UNDER FIVE YEARS Value Year Source Low birth weight (%) {8} Lowest in the Region - DPR Korea 6 29 {1} Stunted children (%) {8} Lowest in the world - Germany {11} Lowest in the Region - Thailand {11} Under-weight children (%) {24} Lowest in the world - Australia {11} Lowest in the Region - Thailand {11} CHILDHOOD DISEASES Spatial differential in stunting in children under-five National average = Urban Rural Estate Data source: 8 Diarrhoeas - 2-week incidence (%) {8} Acute respiratory infections - prevalence (%) {8} OTHER DISEASES (causes for seeking hospitalization) Trends in Body Mass Index among ever-married women age 1-49 Tuberculosis (cases per 1, population) {2} Malaria (cases per 1, population) {2} Diabetes mellitus (cases per 1, population) {2} Hypertensive disease (cases per 1, population) {2} Ischaemic heart disease (cases per 1, population) {2} Asthma (cases per 1, population) {2} Intestinal infectious diseases (cases per 1, population) {2} 7 BMI <18. BMI >3. Data source: 8 COMPREHENSIVE INDICES Trends in diseases for which hospitalization sought (per 1 population) Healthy life lost (in years) {14} Healthy life lost as % of expected life at birth (ELB) {14} Asthma Intestinal infectious diseases Hypertensive disease Ischaemic heart disease Diabetes mellitus Tuberculosis 3 81 Malaria 679 Data source : 13 Major health problems Although stunting (height -for-age), the indicator of chronic malnutrition in children under-five is one of the lowest in the Region, the spatial disparity is rather high in Estate sector, Undernutrition in women as determined by BMI <18. has declined from 22% in 2 to 16% in 26-7, but the overnutrition (obesity) as measured by BMI>3 has gone up from % in 2 to 7% in The rapid demographic and epidemiological transition is influencing the disease pattern in the country. This is reflected by the increasing trend in hospitalization for diseases such as diabetes mellitus, hypertensive disease and ischemic heart diseases

5 Q.4 What is the mortality profile? MORTALITY RATES Value Year Source Fetal death rate (still births) (per 1 total births) {22} Lowest in the world - Finland, Germany, Iceland, Singapore 2 29 {1} Lowest in the Region - Thailand 4 29 {1} Neonatal mortality rate (NMR) (per 1 live births) {8} Lowest in the world - Japan, Singapore, Sweden {1} Lowest in the Region - Maldives {1} Infant mortality rate (IMR) (per 1 live births), p, {8} Iceland,Sweden {1} Lowest in the Region - Maldives {1} Under- mortality rate (UMR) (per 1 live births) {8} Lowest in the world - San Marino {1} Lowest in the Region - Maldives {1} Maternal mortality ratio (per 1, live births) {12} AGE AT DEATH Lowest in the world - Estonia 2 21 {11} Lowest in the Region - Sri Lanka 3 21 {11} Expectation of life at birth (ELB) (years) - Male / Female 72 / {13} Highest in the world (combined)- Japan {7} Highest in the Region - Maldives {7} Deaths under- years (% of of total deaths) {16, C} Number of under- deaths (thousands) {16, C} CAUSES OF DEATH Per 1 live births Years Trends in children's mortality rates Data source: 8,9 67 Trends in Life expectancy at birth UMR IMR NMR Data source: 13 Female Male Hospital deaths (per 1 population) Ischaemic heart disease {2} Neoplasms {2} Pulmonany heart diseases and diseases of pulmonary circulation {2} Cerebrovascular disease {2} Diseases of the gastrointestinal tract {2} Diseases of the respiratory system, excluding diseases of the upper respiratory tract {2} Zoonotic and other bacterial diseases {2} Trends in causes of hospital deaths (per 1 population) Ischaemic heart disease Diaseases of liver Septicaemia Asthma Diseases of the urinary system {2} Traumatic injuries {2} Pneumonia {2} Hypertensive disease Diabetes mellitus Tuberculosis Intestinal infectious diseases.4 3. Data source : 13 Mortality profile Mortality rates in children are low. Maternal mortality ratio is also low but has been unstable lately. Life expectancy is among the highest in the Region. Female to male difference which had been increasing has now seems to have stabilized over the period 1996 to 26 when females lived about years longer than males. Although death rate attributable to hypertension has declined over 17 years period from 199 to 27, Heart diseases remain the the leading cause of death followed by diseases of liver, septicaemia, Asthma, and diabetes mellitus.

6 Q. What resources are available for the health sector? EXPENDITURE ON HEALTH Value Year Source Percent of GDP {17} Highest in the world - Sierra Leone {11} Per capita total health expenditure Highest in the Region - Maldives {11} 1 Per capita (US$) {17} Per capita (Intl.$) {17} Highest in the world - USA (Intl.$) {11} US $ Highest in the Region - Maldives (Intl.$) 1 21 {11} 4 49 FOOD 2 32 Dietary Energy Supply (DES) as a percentage of the Average Dietary Energy Requirement (ADER) {18} Data source : 17 SERVICES Trends in place of deliveries Antenatal care coverage (at least one visit) (%) {19} 1 Pregnant women immunized with TT(%) {8} Deliveries by qualified attendant (%) {19} 6 Children fully immunized by age one year (%) {8} BCG {8} DPT {8} Polio {8} Measles {8} Hospital beds (per 1, population) {2} Highest in the world - Monaco {11} Highest in the Region - DPR Korea {11} HUMAN RESOURCES Government Doctors (per 1, population) {2} Highest in the world - Monaco {11} Highest in the Region - DPR Korea {CC} Nurses (per 1, population) {2} Government facility Private facility Data source : 8 Trends in number of key health personnel 2 Per 1 population Highest in the world - Norway {11} Highest in the Region - Maldives {CC} Medical officers Data source : 2, 21, 2 Nurses C: Computed, CC = country comments (country reported) Health resources The total expenditure on health which has been between 3%.to 4% of GDP over last two decades is lower than % of general norm, although in terms of per capita it has been increasing and isince 2 has been above the US$ 44 minimum needed as per WHO estimate for providing everyone access to a set of essential health services. Service coverage is more than 9%. The objective of institutional delivery is to protect the life and health of the mother and her child. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infections leading to morbidity and mortality of either the mother or the baby. 98 percent of births in Sri Lanka take place at a health facility, one of the highest in the Region. Number and mix of key health personnel are better than in many other countries in the Region.

7 Q.6 What is the system of health governance? ORGANIZATION The National Health Council is presided over by the Prime Minister. It is supported by a National Advisory Committee and task forces of experts to deal with specific health problems. The Ministry of Health is assisted by the Director-General of Health Services. The central Ministry is primarily responsible for the policies, medical and paramedical education, management of teaching and specialized medical institutions, and bulk purchase of medical requisites. The health services are devolved to the provinces. The nine Provincial Directors of Health Services are totally responsible for management and effective implementation of health services in the respective provinces. HOSPITALS, DISPENSARIES AND CLINICS DEPUTY PROVINCIAL DIRECTORS OF HEALTH SERVICES MEDICAL OFFICER OF HEALTH ASSISTANT MEDICAL OFFICERS OF HEALTH PUBLIC HEALTH INSPECTORS AND NURSES/MIDWIVES The Deputy Provincial Director of Health Services (DPDHS) generally works at the district level. Each DPDHS area is sub divided into several Medical Officer of Health (MOH) areas where preventive and promotive health care services are provided through the field staff, and curative services through hospitals, dispensaries and clinics. Most MOH areas cover less than 1, population. The Assistant Medical Officer of Health provides services at the Health Centre level and nurses/midwives work at the village level. In 212, Sri Lanka had 621 Government hospitals and 487 central dispensaries. PRIVATE SECTOR In Sri Lanka both the public and the private sector provide health care services. There are around 1638 health institutions in public sector and around 186 in private sector. The Public sector provides health care for nearly 6 percent of the population. The public health sector encompasses the entire range of preventive, curative and rehabilitative health care provision. The private sector provides mainly curative care services. TRADITIONAL SYSTEM The public sector provides care under allopathy and ayurvedic systems. But there are private practioners of Unani, Siddha and Homeopathy systems as well. Nearly 6% of the rural population relies on traditional and natural medicine for their primary health care. The Ministry of Indigenous Medicine was established in 1994 that has set-up traditional medicine dispensaries and hospitals. These provide some medical care to the user.

8 Q.7 Who pays for health care? GENERAL GOVERNMENT EXPENDITURE ON HEALTH Value Year Source Out of total health expenditure (%) {11} Per capita (US$) {11} Trends in public / Private share in total health expenditure Per capita (Intl.$) 8 21 {11} Highest in the world - Luxembourg (Intl.$) {11} Highest in the Region - Maldives (Intl.$) {11} PRIVATE EXPENDITURE ON HEALTH Out of total health expenditure (%) {11} Public Data source : 11 Private Lowest in the Region - DPR Korea.4 21 CC Out-of-pocket expenditure (% of total expenditure on health) {11, C} Lowest in the Region - DPR Korea.4 21 CC Social Security expenditure on health (as % of total expenditure on health (%) <.1 21 {11} Private prepaid plan ( as % of total expenditure on health) {11} Constituents of private expenditure on health, 21 Ins ( 3.7 %) SSEH (.2 %) Other (11. %) Other (as % of total expenditure on health) {11} OOPs (84.6 %) Data Source : 11 Trend in private prepaid plan as % of private expenditure on health Data source : 11 Health expenditure The share of private expenditure on health is more than the government expenditure and this trend with increasing difference has been continuing over the last decade. As social security and private prepaid plans are limited in the country, 8% of private expenditure is out of pocket at the time of buying health services and must be minimized to extent possible in view of general norm of <1-2%. Although still low, share of private prepaid plans that is private health insurance is on rise from 2.8% iof private expenditure on health in 2 to 4.% in 21.

9 Q.8 What are the recent reforms and achievements of the health system? HEALTH SECTOR REFORMS Inter-sectoral action and the contribution of health-related sectors has paved the way for adopting new strategies and timely decision-making for improving the health sector, and strengthing health development. Health for All 2 necessitated orientation of primary health workers to community health, restructuring of training programmes and curriculae to produce personnel of required skills and competencies, and training and recruitment of health volunteers. Recognizing community participation as an important ingredient, health volunteers have been used to assist government staff, especially in rural areas. Community action has helped to improve activities relating to early childhood development. Health Committees have been established at village, district and divisional levels. Significant improvements have been made in the health manpower situation due to the country s strategic policy using the primary health care approach. The midwives and public health inspectors has increased although they are still short of the requirement. The private sector is being encouraged and new regulations are underway with a view to provide good quality health services to at least those who can afford to pay. In 2, a new national mental health policy and the national medicinal and drugs policy were finalized. A locational management programme is being conducted by the Family Health Bureau to promote breastfeeding at the periphery. Some hospitals have been declared Baby Friendly Hospital. The Sri Lanka breastfeeding code has been effective in regulating the sale of breastmilk substitutes and related products. Implementation of the Health Master Plan is in full swing for guiding a 1-year strategy for health sector management. ACHIEVEMENTS Sri Lanka has shown tremendous improvement in demographic and epidemiological indicators in the recent past. Infant mortality declined to 9.2 per 1 live births in 212 and institution deliveries was high at 98.% in Immunization coverage is more than 9% in all districts. Efforts to prevent and control communicable diseases have resulted in a marked reduction in vaccine-preventable and vector-borne illnesses. LEGISLATION The Provisional Food (Genetically Modified Foods) Regulations, 21, prohibit the importation, manufacture for commercial purposes, transportation, storage, distribution, etc., of any food that has been genetically modified. Act no. of 1998 provides for the establishment of the National Child Protection Authority for the purpose of formulating a national policy on the prevention of child abuse. The Act providing the legal framework for monitoring the private health sector in terms of quality assurance, setting up a regulatory framework, sharing information systems and resources, outsourcing clinical services and manpower training was passed by the Parliament in 26. National Mental Health Policy of the country was developed with the support of WHO and was adopted by Parliament in 2

10 Q.9 What are the constraints and challenges of the health system? Sri Lanka s main development challenges, as emphasized in the government s 1-year Development Framework, are to : Accelerate growth through increased investment in infrastructure, achieve more equitable development through assistance to the lagging regions, and strengthen public services delivery to ensure quality and performance of services to meet modern development needs. There is also a significant need for developing the North and the East of the country which suffered in great measure from the recent civil conflicts and inadequate investment over a considerable period of time At the same time, the government faces the challenge of stabilizing the economy by reducing inflation and the fiscal deficit while aiming at a higher growth over a sustained period of time. Sustainability of the free health services at the point of delivery FINANCIAL CONSTRAINTS The current expenditure by the government is not able to meet the needs. Tax-based financing is insufficient. Social health insurance needs more attention. Health services personnel account for a large share (78%) of the total health spending. Preventive and public health expenditure declined to.3% of the national budget at the national level in 29 from 11% in 199. EXPERTISE AND OTHER PHYSICAL CONSTRAINTS There is a serious shortage of nurses and other paramedical staff. In addition, there is geographic imbalance, exacerbated by the unwillingness of some health professionala to work in peripheral areas. This has resulted in concentration of health workers in the large cities. A mismatch exists between the skill available and the skill needs in different health facilities, resulting in inefficient utilization of resources, and increasing the cost. There is a gap between expected job performance and training. SOCIAL CONSTRAINTS Gender empowerment in Sri Lanka in much higher than in the rest of the countries in the Region. Spatial disparities are glaring in some indicators. The population below the poverty line in 29/1 was.3% in urban areas, 9.4% in rural areas and 11.4% in the estate sector. (Estate sector comprises the plantations in the central highlands and surrounding areas.) Inequalities Gender Value Year Source Spatial inequality in maternal mortality ratio (22) Expectation of life at birth F:M {13} Female share in employment (nonagricultural sector) (%) {23} Seats held in parliament F (%).8 24/7 {23} Ratio of girls to boys in primary schools (%) {23} Inequalities Spatial Per 1 live births Kalutara 2 Nuwara Eliya National average (14) Infant mortality rate (per 1 live births) Kilinochchi {13} National average {13} Batticaloa {13} Data source : Spatial differntial in poverty level (29/1) HEALTH SECTOR CONSTRAINTS Inter-sectoral coordination is poor due to weak horizontal linkages between health-related ministries and the Ministry of Health, as well as lack of appreciation of each other s importance. For sustainable and efficient district health systems, the capacity of health managers and planners as well as instruments such as health information and material procurement need substantial improvement. The tertiary and secondary level hospitals have bed occupancy in excess of 1% (2 persons on one bed in some cases) whereas the primary care hospitals often have 3% occupancy. This highly cost-ineffective situation arises because many people bypass the lower level facilities even for relatively simple illnesses. The health information system needs further strengthening with IT support, and inclusion of community and private sector information. Data on private sector patient workload and disease profiles are not collected, which makes a comprehensive overview of the entire health sector impossible. Stewardship is required to engage and regulate the private sector, collaborate with the education and other sectors as well as other stakeholders. Quality control in pharmaceutical production, pricing and prescriptions has been a major issue which is yet to receive adequate attention. CHALLENGES NUTRITION Despite rapid progress, childhood malnutrition rates are still high with 21% under-weight, 17% stunting and 1% wasting in 26/7. HEALTH SERVICES Not only are demographic and epidemiological changes are rapidly occurring in Sri Lanka but health needs and demands have been moulded due to the technological and social advances. This has increased the people's expectation from the health system. Meeting this expectation is difficult with the present resources. Development of capacity for full utilization of resources for maximum benefit is a critical issue for the system that must maintain its focus on the poor and the marginalized. Geographical disparities in communicable diseases need to be addressed. Emerging diseases such as dengue and HIV/AIDS also require more attention. Maternal mortality has declined steadily for nearly half a century but has been unstable lately. LIFESTYLE Sri Lanka has among the world s highest suicide rates in adolescents and young adults, and it is also very high in those over 7 years of age. Though there is a declining trend in suicides now, on an average 11 people commit suicide every day Noncommunicable diseases are gradually becoming major contributors to morbidity and mortality as the population is ageing. Lifestyle changes and other services to prevent and manage noncommunicable diseases are now emerging as major challenges including cost-escalation for the health system Vavuniya Data source : Colombo Moneragala Batticaloa National average (9 %)

11 Q.1 What does the country hope to achieve in the near future in health? To maximize the financial allocation for health development so that the government can provide more efficient health services throughout the country and maintain the continuum of free health care for all. The Health Master Plan aims to facilitate equity by making health services accessible, especially to the poor and marginalized. For this, the strategies are: - delivery of comprehensive health services, which can reduce the disease burden and promote health; - empowering communities to participate actively in health maintenance; - improving human resources for health delivery and management; - improving health financing, mobilization, allocation and utilization of resources; and - strengthening of stewardship and management within the health system. The Ministry of Health is planning and sponsoring a major national behaviour change communication programme which is expected to initiate healthy lifestyle in targeted population.the objective is to reduce preventable risk factors that may be increasing due to technological advances, affluence and ageing. Past activities to address environmental degradation have fallen short of what is required to maintain and improve environment in the wake of growing demands on the island s limited natural resources. The national environment policy commits more effective management of the environment within the framework of sustainable development in the country. There is comprehensive document on drug policy. Efforts are on to bring together scattered elements in one document through discussion with all stakeholders.the existing legal framework needs to be brought up to date on the basis of the National Medicinal Drug Policy approved by the Cabinet in 2. The essential drugs list is being revised with more emphasis on educating health professionals and the public.

12 Q.11 How is WHO collaborating with the country? WHO's engagement with the Government of Sri Lanka began in 192, the year when the first WHO office was opened at the Galle Face Hotel. The Country cooperation strategy (CCS) is a key instrument of the World Health Organization for technical cooperation in support of Sri Lanka s National health plan, policies and strategies. The previous CCS in Sri Lanka covered the period , a time when the country was recovering from the effects of the devastating tsunami of 24. The current CCS ( ) is aimed to address the long term health and health system effects of that disaster and that of evolving economic, social, epidemiological and demographic transitions. POLICY DEVELOPMENT AND PLANNING WHO assisted the Ministry of Health in conducting a detailed assessment of the health sector and in the development of the Health Master Plan The three priority areas which received the most support during previous CCS were: emergency preparedness and response, child, adolescent and reproductive health, NCD and mental health, which is consistent with the country situation reflected in the post-tsunami period WHO has sharpened its programmatic focus in the current CCS Strategy as a result of reviewing the previous cycle. Six strategic priorities of new CCS are : 1. Contribute to the strengthening of the health system to further develop capacity for policy development,planning and improved service delivery 2 Enhance country capacity in prevention, control and elimination of communicable diseases, and prevention and control of pandemics and disease outbreaks 3 Noncommunicable diseases, injuries and mental health : (a) To prevent and reduce disease, disability and premature death from chronic noncommunicable diseases including injuries; (b) to support the Government of Sri Lanka in the development of effective and holistic decentralized mental health services, in line with the National Mental Health Policy. 4 Maternal, child and adolescent health, including nutrition and food safety: (a) To sustain and expand the existing maternal, child and adolescent health services, including nutrition and reproductive health programmes by supporting the addition of new evidence based interventions and approaches through effective policies, plans, strategies, and periodic monitoring and programme evaluation; (b) To address issues of food safety and nutritional problems among pregnant women, children under five and other vulnerable groups; (c) To strengthen the health sector response to gender and gender-related issues.. Emergency preparedness and response: (a) To support and strengthen the capacity of the health sector for disaster risk management (DRM) and build an evidence-base to guide the strengthening of DRM in the health sector; (b) To continue addressing the health and rehabilitation needs of those in the areas that were affected by conflict and to integrate recovery efforts with the longer-term health system development 6 Enhanced partnerships and resource mobilization for health: (a) To help the MoH to coordinate and collaborate with all health stakeholders; (b) To mobilize resources for addressing health priorities HEALTH SYSTEMS MANAGEMENT Technical assistance was provided in the areas of health planning and management, development of health information system, decentralization, and health services delivery. WHO has been instrumental in successfully mobilizing external resources for the health sector. Support was provided for training on result-based management and planning, and on monitoring and evaluation with emphasis on provincial and district level capacity building. Technical and other support was provided to the North-East Provincial Council for the health sector after the LTTE ceasefire in 22. PROMOTION OF HEALTHY LIFESTYLES AND SETTINGS WHO has been able to respond quickly to a number of potential disasters and provide immediate humanitarian support to the affected population. Immediately following the tsunami disaster in December 24, support was provided to the national and local health authorities for needs assessment, in essential medical supplies, strengthening the cold chain, and in ensuring mobility of health teams. Although WHO has not played a major role with NGOs the tsunami relief operations provided the opportunity to coordinate international and national NGO activities. Support was extended for the introduction of health promotion competencies in Sri Lanka related to the five strategies of health promotion enunciated in the Ottawa charter, and for mapping national capacity in health promotion. With technical assistance from WHO, the Ministry of Health has developed new mental health legislation and a new national mental health policy that may help to provide a comprehensive range of hospital and community services in all districts. With WHO's technical assistanceand financial support from Japan, Sri Lanka has greatly improved its blood transfusion system. Human resource development in blood transfusion services was supported with the establishment of in-country training programmes and by providing opportunities for international training in specialized areas. PREVENTION AND CONTROL OF PRIORITY DISEASES WHO has provided technical and financial support to a number of communicable disease prevention and control programmes during the period , with special emphasis on pandemic influenza, emerging and re-emerging diseases such as dengue, leptospirosis, rabies, and surveillance of adverse events following immunization (AEFI) for vaccine-preventable diseases and diseases targeted for elimination, including leprosy, lymphatic filariasis and malaria. Disease surveillance and laboratory diagnosis capabilities, particularly in the North-East were strengthened. For malaria and dengue, considerable material and training support was provided to ensure more effective vector control throughout the country. The piloting of new strategies for rabies control, the monitoring of leprosy elimination activities, and social mobilization for filaria control including development of a one-day treatment strategy were supported.

13 Sources 1 Sri Lanka Statistical Data Sheet The World Bank, World Development Indicators 213 (26 October 213 update) 4 Poverty Indicators 29/1 UNDP, Human Development Report UNESCO, Institute for statistics data centre 7 UN, World Population Prospects, The 212 Revision 8 Sri Lanka Demographic and Health Survey 26/7 9 1 UNICEF, Childinfo, 11 WHO, World Health Statistics Country update provided to MDG dataset, March Annual Health Statistics Sri Lanka Census of Population and Housing Time Trend of Poverty Indicators on Population, Employment and Socio-Economic Situation Department of Census & Statistics, Ministry of Finance & Planning, Colombo, Sri Lanka. The Institute of Health Metrics and Evaluation (Accessed 9 May 213) 1 WHO, Global Health Observatory ( 16 Statistical abstract Vital statistics 17 WHO Global Health Expenditure database 18 FAOSTAT Data reported by the country from "Family Health Bureau" for MDG dataset 2 Sri Lanka, Statistical Pocket Book 213 (chapter 12) 21 Sri Lanka, Health at a glance Sri Lanka Annual Bulletin of Medical Statistics Sri Lanka, country MDG report Country reported data (source document not cited) 2 Sri Lanka Annual Health Bulletin 212