Intersectoral Action for Health in Sri Lanka A case study commissioned by the Health Systems Knowledge Network Dr. M.A.L.R. Perera, MB; BS, M.Med.Sc. & MD (community Medicine) Director, Institute for Health Policy Sri Lanka 2006 Recommended citation: Perera, M.A.L.R. Intersectoral action for health in Sri Lanka, 2006 Background to the Health Systems Knowledge Network The Health Systems Knowledge Network was appointed by the WHO Commission on the Social Determinants of Health from September 2005 to March 2007. It was made up of 14 policy-makers, academics and members of civil society from all around the world, each with his or her own area of expertise. The network engaged with other components of the Commission (see http://www.who.int/social_determinants/map/en) and also commissioned a number of systematic reviews and case studies (see www.wits.ac.za/chp/). The Centre for Health Policy led the consortium appointed as the organisational hub of the network. The other consortium partners were EQUINET, a Southern and Eastern African network devoted to promoting health equity (www.equinetafrica.org), and the Health Policy Unit of the London School of Hygiene in the United Kingdom (www.lshtm.ac.uk/hpu). The Commission itself is a global strategic mechanism to improve equity in health and health care through action on the social of determinants of health at global, regional and country level. Intersectoral action for health in Sri Lanka ______________________________________________________________________________________ Contents Abbreviations...................................................................................................................... 4 1. Acknowledgements......................................................................................................... 5 2. Executive summary......................................................................................................... 5 2.1. Pre independence phase ........................................................................................... 5 2.2. Post independence phase.......................................................................................... 6 2.3. Post Alma Ata.......................................................................................................... 6 2.4. The contemporary phase.......................................................................................... 6 2.5. Decentralization ....................................................................................................... 7 2.6. Lessons learned from the Sri Lankan experiences in IAH & their applicability..... 7 3. Introduction..................................................................................................................... 9 3.1. What is Intersectoral Action?................................................................................... 9 3.2. Relevance to Commission on Social Determinants of Health (CSDH) & the Health Systems Knowledge Network (HSKN) ........................................................................ 10 4. Methodology................................................................................................................. 11 5. IAH in Sri Lanka........................................................................................................... 12 5.1. Country profile....................................................................................................... 12 5.2. Political and Social Context................................................................................... 13 5.3. Historical perspectives of IAH............................................................................... 15 5.4. IAH in the pre independence era ........................................................................... 16 5.5. IAH in the post independence era.......................................................................... 17 5.6. IA for other specialized campaigns........................................................................ 18 5.6.1. Anti-tuberculosis campaign ................................................................................ 18 5.6.1.1. The Ceylon National Association for the Prevention of Tuberculosis ............ 18 5.6.1.2. Rural Development Societies........................................................................... 18 5.6.1.3. The Sarvodaya Movement ............................................................................... 18 5.6.1.4. Schools............................................................................................................. 19 5.6.1.5. Local Government Authorities ........................................................................ 19 5.6.2. IA for anti filariasis Campaign ........................................................................... 19 5.6.2.1. Local authorities............................................................................................... 19 5.6.2.2. Schools............................................................................................................. 19 5.6.3. Sexually transmitted Diseases Control programme............................................ 19 5.6.3.1. District Administration .................................................................................... 20 5.6.3.2. Social Services Department ............................................................................. 20 5.6.4. Anti-Leprosy Campaign...................................................................................... 20 5.6.3.1. Social Services Department ............................................................................. 20 5.6.3.2. Schools............................................................................................................. 21 5.6.3.3. Sri Lanka Broadcasting Corporation (SLBC).................................................. 21 5.6.3.4. Rural Development Societies, the Sarvodaya Movement and the Saukyadana Movement ..................................................................................................................... 21 5.6.3.5. The Leprosy Association of Sri Lanka ............................................................ 21 5.6.4. Legislation for IAH............................................................................................. 21 5.6.5. Social Security Measures for Workers’ Health .................................................. 21 5.6.6. Transport facilities for access to medical institutions......................................... 22 5.6.7. IAH in the education sector ................................................................................ 22 __________________________________________________________________________________ 1 Dr. M.A.L.R. Perera, Institute for Health policy, Sri Lanka Intersectoral action for health in Sri Lanka ______________________________________________________________________________________ 5.6.8. The role of local level institutions, both governmental and non governmental, in IAH ............................................................................................................................... 23 5.6.9. IAH by the community ....................................................................................... 23 5.6.10. Role of NGOs in IAH ....................................................................................... 24 5.6.11. Community development with community participation ................................. 25 5.6.12. Integrated Rural Development Program (IRDP) .............................................. 26 5.7. IAH – post HFA..................................................................................................... 27 5.8. Decentralization & IAH......................................................................................... 29 5.9. IA for leprosy elimination – social marketing ....................................................... 30 5.10. Janasaviya / Suwasaviya / Samurdhi ................................................................... 31 5.11. Some innovative IAH in the contemporary era ................................................... 32 5.11.1. IA for implementing policy on the aged........................................................... 32 5.11.2. World Bank funded health sector development project (HSDP)...................... 33 5.11.3. Food and Nutrition Policy of Sri Lanka, 2004-2010 ........................................ 34 5.11.3. IAH for specific diseases - Global Fund to fight Aids TB & Malaria (GFATM) ....................................................................................................................................... 34 5.11.5. World Bank grant for HIV / AIDS project ....................................................... 35 5.11.6. Population and reproductive health policy ....................................................... 36 5.11.7. National Commission on Macroeconomics & Health ...................................... 36 5.11.7.1. Institutional support mechanisms for NCMH - Planning Committee ........... 37 5.12 The impact of IAH on equity................................................................................ 37 5.13 Armed conflict, equity & IA................................................................................. 38 6. Current & future challenges for equity & IAH............................................................. 39 6.1. Ten year master plan for health development........................................................ 39 6.1.1. The Strategic