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Multi-sectoral collaboration vital for Sri Lanka to achieve Universal Health Coverage

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The Institute of Policy Studies of Sri Lanka (IPS) together with the Sri Lanka Medical Association (SLMA) and the Center for Policy Impact in Global Health (CPIGH) of the Duke University, USA organised a virtual policy dialogue on ‘Planning for Universal Health Coverage amidst the 4Ds of Health Transitions’ on 25 August 2021. The dialogue was structured around a recent IPS study aimed at understanding how government, donors and key country stakeholders in the health sector perceive these transition challenges and their impact on the progress towards UHC, where they see the biggest gaps emerging, and what actions can help to address these challenges and gaps.

Health sector experts who spoke at the Dialogue flagged the need for multi-sectoral collaboration to achieve universal health coverage (UHC) in Sri Lanka.

Commencing the discussion, Dr Nisha Arunatilake, Director of Research, IPS explained that there are four major, inter-linked transitions in diseases, demography, development assistance for health and domestic health financing – the “4Ds” of global health transition – that complicate Sri Lanka’s efforts to achieve UHC. The associated challenges of these have been worsened by the COVID-19 pandemic. In this context, IPS and Duke University have conducted research that brings into focus the importance of achieving UHC and the sustainable development goals (SDGs).

Speaking next, Dr Padma Gunaratne, President, SLMA reflected on some of the achievements of the national health system including increased life expectancy and quality of healthcare. She noted that while these achievements are commendable, inequities and inefficiencies in healthcare continue to persist and a meaningful dialogue on planning for UHC is most timely.

Delivering the keynote address thereafter, Dr S Sridharan, Deputy Director-General (Planning), Ministry of Health pointed out that donor support for the health sector is declining. Meanwhile, there is rising demand for health services, an ageing population, and inadequate domestic financing for health. He recommended seven steps to address the challenges: (1) strengthening community response systems; (2) supporting reproductive health – adolescence, maternity and new-born health; (3) supporting platforms for integrated service delivery; (4) strengthening country population and supply chain; (5) investing in human resources (HR) for health and data systems for health; (6) strengthening and aligning national and global strategies; and (7) strengthening financial management and oversight.

The next speaker, Ipchita Bharali, Policy Associate, Duke University provided the audience with evidence on health transitions in an international context. She stated that many Middle-Income Countries (MICs) are expected to transition away from concessional multilateral and bilateral development assistance soon. However, they still face several health sector challenges such as high mortality rates, weak health systems, and large pockets of poverty in the countries. These challenges are intensified with the onset of the COVID-19 pandemic.

Session 1: Knowledge, capacity, and policy gaps that hinder UHC progress in Sri Lanka in the context of the 4Ds of health transitions and potential opportunities to tackle these gaps.

Knowledge gaps and opportunities

Ashani Abayasekara, Research Economist, IPS presented a summary of the study findings identifying the knowledge gaps. One of the findings highlighted was the rising burden of NCDs, as there was an acute focus on curing such illnesses by only considering drugs as the solution and understanding them as disease issues and not health issues. Prominence was also given to the gender disparities regarding NCDs. Lack of detailed and accurate data, poor research and development (R&D), and knowledge dissemination were some of the many gaps that were further identified as areas that needed immediate action.

Dr Susie Perera, Deputy Director-General (Public Health Services II), Ministry of Health in her reflections explained that one of the ways of alleviating the gaps is by targetted investments and incentivising stakeholders to conduct proper R&D, data collection, and knowledge dissemination. She noted that Sri Lanka has had many opportunities to strengthen its primary health and education systems with donor support, both of which are relevant to reducing the NCD burden. “A whole of government, multi-sector approach is needed,” she emphasised adding that digital literacy needs to be fostered in the health sector, along with a culture of innovation.

Prof. Amala De Silva, Professor in Economics, University of Colombo shared similar sentiments and noted that NCDs have an indirect relationship with economic performance. She flagged the need for multidisciplinary studies and proper accountable agency in research activities to achieve UHC in Sri Lanka.

Capacity gaps and opportunities

Thisali de Silva, Research Assistant, IPS presented the findings of the study on the capacity gaps that hinder UHC in the country. Poor financial and HR capacity was found to be the notable gaps in Sri Lanka. Some of the financial capacity gaps included inefficiencies in financial allocation, and financial management issues to name but two. On the other hand, the lopsided distribution of medical professionals and the lack of engagement in the financial side of the health sector have made for concerning capacity gaps in labour.

First to give thoughts on the study was Dr Dileep de Silva, Head of Human Resource Department, Ministry of Health. On the HR front, he explained that the issue in the lopsided distribution of medical professionals was due to the low applicants especially when looking at nurses, therapists, midwives and PHIs. Furthermore, one of the major reasons for the financial capacity gaps is a result of the underutilisation of capital budgets for the health sector.

Dr Anuji Gamage, Senior Lecturer in Community Medicine, Sir John Kotelawala Defence University identified healthcare migration as a problem driven by economic factors, unsatisfactory work environment, and professional career opportunities. She stated that a way of solving the uneven distribution of labour is a mechanism that would assure safety, and this is particularly important in a time of a global pandemic. “It is important to use strategies to keep the workforce safe and improve their wellbeing,” she affirmed.

Policy gaps and opportunities

The frequent changes made to the number of ministries, reversal of implemented policies and several other implementation hurdles, especially at the provincial level were shown to be some of the major policy gaps identified through the study. Ashani Abayasekara highlighted several opportunities to focus amid all these gaps such as creating a knowledge hub, and collaboration and coordination with non-state sectors.

Dr Ruvaiz Haniffa, Past President, SLMA in his reflections, called for a grassroots level approach through family doctors and homecare. “Too many people are currently missing out on health coverage in the primary preventive care sector. We have not put in policies in the primary curative sector,” he said stressing that the need of the hour is to provide holistic primary curative care. Uditha Palihakkara (Past Chairman of the Finance Commission), speaking in his personal capacity, expressed the view that the policy gaps are a result of low national budgets to the health sector as a whole.

Session 2: Multi-sectoral collaboration for Sri Lanka’s health systems – reflections from development partners, private sector, academia and civil society.

Based on the study, Dr Deepika Attygalle, Senior Health Specialist, World Bank and Ms Shiranthi Rathnayake, Additional Director General, Department of National Planning asserted that multi-sectoral collaboration is vital for Sri Lanka’s goal of achieving UHC of which, collaboration between the finance and medical sectors is particularly important. Dr Olivia Nieveras, Public Health Administrator, World Health Organization spoke about how donors should more agile in their activities. Sampath Manthreenayake, Additional Director-General, Department of External Resources added that there should be a collective system for better results on donor financing.

Way Forward

Moderated by Dr Nisha Arunatilake, a fruitful question and answer session took place with several important questions raised from participants around the world. The proceedings were wrapped up with an iteration on the need for a strong primary curative healthcare system and multi-sectoral collaborations as the way forward.

Link to original blog: https://www.ips.lk/talkingeconomics/2021/08/27/multi-sectoral-collaboration-vital-for-sri-lanka-to-achieve-universal-health-coverage/



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Eravur Fabric Park could transform sustainable textile manufacture in Sri Lanka

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Since the first announcement in June 2020, expectations have been high on the potential of the Eravur Fabric Processing Park to catalyze a new era for Sri Lankan textile and apparel manufacture.

Supported through the Ministry of Industry and Commerce and the Board of Investment (BOI) of Sri Lanka, working in close collaboration with the Joint Apparel Association Forum (JAAF), the apex body of the apparel industry in Sri Lanka, the vision for Eravur is beginning to take shape.

Of the allocated approx 300 acres of land, fifty have been allocated for the Park’s maiden investment of US$ 35 million to establish a state-of-the-art fabric mill. Negotiations are also underway with two international companies to infuse mega investments for the remainder. The Park is estimated to attract a cumulative investment of US$ 300 million. The zone is also seeking further investments towards Dyeing, Washing, Knitting, Weaving, and other associated and ancillary activities.

Cabinet approval for the Zone’s classification under the Strategic Development Projects Act was also secured, enabling the extension of tax and other relief and incentives to investors.

Rapid progress towards vertical integration

“We would like to see the first company commence commercial operations in the next 6 months to 1 year,” stated BOI Chairman Sanjaya Mohottala. “We have been very aggressive on timelines because of the clear consensus on the nationally significant value that the Park can generate. At present, all land has been demarcated, and water and electricity supply are being finalized. In excess of half the commercial land has been allocated or reserved, and we are seeing great demand. There is clear recognition locally and internationally as to the immediate potential. If necessary, we are able to expand the zone even further.”

Leveraged in support of Sri Lanka’s highly developed apparel manufacturing sector, which has steadily benchmarked itself on global standards for ethical, sustainable production and high levels of technical and technological expertise, Eravur’s promoters also see the project as an opportunity for Sri Lankan-made apparel to take global leadership on sustainability in its most holistic sense.

Mohottala explained further that the most immediate benefit from the Park’s establishment will be in the cost advantages and enhanced economies of scale gained through capacity expansion and vertical integration of domestic supply chains.

Currently, Sri Lanka has approximately 300 apparel manufacturing facilities across the country. By contrast, it has only 7 textile and raw material factories capable of producing fabric for export, and for conversion into garments for export. At its peak, Sri Lanka imported over 250,000 MT of fabric both for export-oriented apparel manufacturing and for local consumption in 2019, at a cost of US $ 2.2 billion.

In the context of unprecedented disruptions across global supply chains in particular and persistent commodity and currency volatility, increased availability of high quality raw materials will enable an immediate and drastic reduction in raw material costs, while also conserving foreign currency.

Increased domestic production of textiles also translates to a higher percentage of domestic value. If that threshold increases from its current 52% to 65%, it qualifies for a larger proportion of Sri Lankan exports for zero-duty benefits under GSP Plus1.

The culmination of a pioneering national journey in sustainability

The economic argument in favour of investing in Eravur is bolstered by its potential to also be the most sustainable venture of its kind in the entire Asian region, with local stakeholders having already committed to establishing extensive renewable energy facilities, water recycling facilities, science-based targets, and circular business models.

At a macro-level, increased local production capacity will contribute significantly to all these targets by reducing the end-to-end length of Sri Lanka’s apparel supply chains. This in turn enables tighter backward integration and lower carbon emissions.

Taking a cue from the Sri Lankan textile and apparel’s industry’s outstanding achievements on environmental sustainability to date, the Zone is being designed from the ground-up to facilitate and incentivize sustainability in every facet of its operations. In terms of fabric processing, the main focus is on wastewater treatment.

Mohottala continues: “Sri Lanka’s environmental standards for industries are quite stringent, especially compared with regional competitors. A key feature of the Zone will be its central wastewater treatment facility with a sea outfall, which will require a high standard of treatment. Fortunately, we already have strong expertise available locally, with many of Sri Lanka’s textile producers having established facilities on par with global best practices on wastewater treatment. We have used this to our advantage by calling in the local industry’s technical experts and drawing on their pioneering experiences to optimize wastewater treatment protocols at Eravur.”

Adding that this will be one of many positive attributes all stakeholders downstream of the textiles produced at the Zone can lay claim to, Mohottala says, “With the greater localization of production, we also gain improved oversight and control over environmental standards within the Zone. This also enables greater transparency, traceability, and accountability across the supply chain, which in turn will confer preferable competitive advantages to Sri Lankan apparel exporters. In addition, this will empower brands and retailers to make clear and credible claims to genuine sustainable sourcing.”

An end-to-end opportunity

Another significant advantage for Eravur is that it is purpose-built with the most advanced environmentally friendly technology available. This will also promote efficiency in energy and water consumption, as well as additional infrastructure for recycling and recovery of water used in production, for which the BOI aims to provide investors with additional incentives.

Notably, Eravur also enjoys a high level of solar irradiance and consistent high-wind conditions, making any manufacturing facility established in the area, ideally suited for solar and potentially, wind turbine power generation.

“Augmentation of the Zone’s energy requirements with plentiful renewable energy will enable cost savings on the energy-intensive aspects of wastewater recycling. Given the consistent annual reduction in the cost of solar and wind energy, the conditions at Eravur are another unique attraction for investment into the Zone, and potentially enables the entire supply chain to utilize global incentivizes around responsible and sustainable production,” Mohottala said.

In addition to the wastewater treatment protocols, the Zone will also include a sludge treatment facility, with further trials already underway for responsible disposal. These include tests using micro-algae to breakdown sludge, as well as utilizing sludge to fuel furnaces and as bricks with a bio-mat mask.

The final and potentially most vital contribution which the Eravur Fabric Processing Zone is the empowering impact it will have on the lives of Sri Lankans in Batticaloa. At present, the district has an estimated population of 621,887, of which, an estimated 60,912 individuals are below the poverty line. As at 2019 – prior to the pandemic – unemployment in the region stood at 6.4%

“With the development of the Zone, we will be able to create thousands of stable, well-paying direct and in-direct jobs. This could prove to be one of the most transformative developments to take place in the Eastern Province in recent history,” Mohottala concluded.

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‘The insurance industry continues to drive the message of safety and optimism’

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The Insurance Association of Sri Lanka has been working overtime to ensure the smooth operation of the insurance industry with the objective of spreading awareness and inculcating knowledge on the importance of insurance. Similar to multiple other industries, in global and local contexts, the insurance industry has experienced its share of fluctuations with the onset of the pandemic and displayed its resilience to the resultant challenges.

Dinesh Yogaratnam, the Chairman of the Marketing and Sales Forum (MSF) of the Insurance Association of Sri Lanka (IASL), shared his perspectives on the marketing of insurance during these tumultuous times. He expounded on the ways in which the MSF of the IASL adapted to overcome the hurdles of the circumstances that arose during 2021, while promoting insurance penetration.

“The Insurance Association of Sri Lanka (IASL) is the industry body comprised of all the Life and General Insurance companies that operate in the market. The Marketing and Sales Forum (MSF) is a subcommittee thereof and as the name implies, addresses matters pertaining to the sales and marketing of insurance products and services. Further, the MSF also carries out various initiatives to increase insurance penetration in the country via education and knowledge-sharing. One of the major efforts of the MSF this year is to help the public better appreciate what insurance is. In addition, helping them understand how, when, and why they should purchase a policy, so that they may provide themselves, their loved ones, their assets, as well as their enterprises with the financial protection required, are key objectives.

“The MSF has resorted to using mainly digital and print media for its insurance promotion activities. Employing a two-pronged approach, whereby, the MSF under the IASL banner is carrying various pieces of communications on social media channels and is working with the country’s print houses and their digital arms to disseminate information and educate the public, the individual companies too have been encouraged to promote their products and services, as well as to carry knowledge building pieces of communication on their own platforms. Through this, we are witnessing a heightened level of activity and dialogue across social media channels.”

Giving further insight into the current insurance marketing landscape prevalent in the country, Dinesh Yogaratnam stated, “The insurance industry has grown in 2021 by approximately 14% in terms of Gross Written Premium as of the end of the 1st quarter; while long term insurance has seen significant growth, general insurance has contacted very marginally. As an industry, we are confident that the growth trajectory we have witnessed in the first half will continue to the end of the year.

“With the pandemic impeding movement, insurers had to very quickly realign themselves to front the customer both for new business acquisition as well as for premium collection, equipping themselves with various digital assets and recalibrating their sales teams to embrace a new hybrid model of interacting with and engaging the customer. From a servicing perspective; industry players have infused many digital interventions as part of their customer touchpoint strategy so that customers are able to seamlessly interact with them and obtain whatever services they require, regarding their policies. On the customer’s side, the pandemic has made people appreciate the need for a meaningful health insurance plan and they have also begun to appreciate the need for long-term insurance. The Sri Lankan insurance industry has always stood by society not only during times of normalcy but more so during times of widespread calamity and dire need. In this respect, the industry has come forward to pay COVID-related claims, irrespective of the fact that pandemics are excluded as part of insurance contracts.”

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SL’s Kithul-based treacle and jaggery for Gulf markets

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By Hiran H.Senewiratne

A local company is now in the process of venturing into the lucrative export Gulf market through its flagship product, Kithul based treacle and jaggery. Initially, the company will target the UAE market and afterwards other Arab countries.

“Both our products were introduced to the local market as niche products one year ago and are already exporting to Australia and several other countries, chairman, C-lon Kitchen & Healthy Foods, Rohan Wijeweera told The Island Financial Review.

‘The Gulf region is a lucrative market and there is a big demand for pure Kithul treacle among Arabs, which could be harnessed if we supply quality products, he said.

Wijeweera adds: “Now we have secured an order from a Gulf online sales company to market these products under the tag, ‘Made in Sri Lanka’ under the “Deegayush” brand and initially two containers will be exported to Dubai most probably next month. After that we will be targeting Canada and the UK markets.

“Kithul treacle and jaggery are made from the sap harvested directly by tappers living in border areas of the Sinharaja forest in the Rathnapura district. We have come to a forward buying agreement with around 250 tappers in this region, whom we also support by paying a premium price and also by some other CSR initiatives.

“The sap is then brought to our processing plant in Piliyandala where we process it. Kithul treacle is known to contain polyphenols, which are antioxidants, organic acids which are bioactive, amino acids that have many functions, beta carotenes that produce vitamin A and ascorbic acid or vitamin C that improves immunity.

“Thus, it is known to yield as many health benefits as Kithul jaggery. It prevents arthritis, improves complexion, alleviates constipation, aids weight loss and combats blood sugar. For nearly the same reasons as Kithul jaggery, Kithul treacle or syrup is witnessing massive demand locally as well as internationally.

“Today the demand for pure and natural Kithul products far outstrips the supply and due to lack of sap many local manufactures add sugar and other artificial sweeteners to the products thereby diluting the health benefits of it. However, we ensure not to add artificial ingredients and due to this our products are sold at a premium price from leading super markets under the brand name, “Deegayush”.

“Behind the scarcity of Kithul products there are several reasons, such as the shortage of tappable jaggery palms, fewer people being engaged in this industry due to the inherent risks and the profession not being accepted among the youth.

“Also less numbers are involved in jaggery palm planting since the tree takes around 7 years to mature before being fit for tapping.

“I am also looking at making Kithul treacle and jaggery from sugarcane, once again, targeting the export market as well.

“We are also manufacturing several immune boosters from locally sourced material. We next plan to introduce a curd to the market. More details could be obtained from, ceykitchen@gmail.com”

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