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.
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/
Sri Lanka still ‘under test’ before it can receive crucial second tranche from IMF
by Sanath Nanayakkare
International Monetary Fund (IMF) staff concluding their visit to Sri Lanka yesterday reaffirmed their support to Sri Lanka to move out of the ongoing economic crisis, but did not specify an exact timeline for releasing the second tranche of its Extended Fund Faculty (EFF) arrangement to Sri Lanka.
The IMF mission team led by Peter Breuer and Katsiaryna Svirydzenka that visited Colombo from September 14 to 27, is yet to be convinced that it has received a robust programme from the Sri Lankan authorities where they indicate how they would be addressing the persistent revenue shortfall besides outlining progress in foreign debt restructuring which would give Sri Lanka a breather to balance its financing requirements as it starts to repay its foreign debt.
“We had constructive and productive discussions with the Sri Lankan authorities on economic performance and policies underpinning the first review under the IMF Extended Fund Facility (EFF) arrangement. The people of Sri Lanka have shown remarkable resilience and the authorities have made significant progress on important reforms. The discussions will continue towards reaching a staff-level agreement in the near term that will maintain the reform momentum needed to allow Sri Lanka to emerge from its deep economic crisis, Peter Breuer said.
“The objectives of the IMF-supported program will continue to focus on restoring macroeconomic stability and debt sustainability, while protecting the poor and vulnerable, safeguarding financial stability and stepping up structural reforms to address corruption vulnerabilities and unlock Sri Lanka’s growth potential, he said.
However, the press briefing given by the IMF team yesterday signaled that they needed to see more economic and financial policies to support the approval of the First Review of the program under the EFF arrangement.
“Sri Lanka has made commendable progress in implementing difficult but much-needed reforms. These efforts are bearing fruit as the economy is showing tentative signs of stabilization. Inflation is down from a peak of 70 percent in September 2022 to below 2 percent in September 2023, gross international reserves increased by $1.5 billion during March-June this year, and shortages of essentials have eased. Despite early signs of stabilization, full economic recovery is not yet assured. Growth momentum remains subdued, with real GDP contracting by 3.1 percent in the second quarter on a year-on-year basis and high-frequency economic indicators continuing to provide mixed signals. Reserve accumulation has slowed in recent months, he said.
Speaking further Peter Breuer said: “Sustaining the reform momentum is critical to put the economy on a path towards lasting recovery and stable and inclusive economic growth. The authorities have met the program’s primary balance targets and remain committed to this important pillar of the program so as to support their efforts to restore debt sustainability. However, revenue mobilization gains – while improved relative to last year – are expected to fall short of initial projections by nearly 15 percent by year end, in part due to economic factors.
“The onus of fiscal adjustment would fall on public expenditure if there were no efforts to recoup this shortfall. This could weaken the government’s ability to provide essential public services and undermine the path to debt sustainability. To increase revenues and signal better governance, it is important to strengthen tax administration, remove tax exemptions, and actively eliminate tax evasion.
“Against continued uncertainty, it also remains important to rebuild external buffers through strong reserves accumulation. Building on the Central Bank of Sri Lanka’s success in controlling inflation, refraining from monetary financing will help keep inflation in check. Other challenges include maintaining cost recovery in electricity pricing.
“The government has made steady progress on structural reforms. Key legislations passed in Parliament, including the new Central Bank Act and the Anti-Corruption Act, could improve governance if implemented effectively. The IMF Governance Diagnostic report would inform future reform measures to strengthen governance when published.
“A new welfare benefit payment scheme was enacted with new eligibility criteria that aims to improve targeting, adequacy, and coverage of social safety nets. To ensure financial stability, steps were taken on conducting bank diagnostics, developing a roadmap for addressing banking system capital and liquidity shortfalls and improving the bank resolution framework.
“The authorities have also made headway on regaining debt sustainability through the execution of the domestic debt restructuring and advancing discussions with external creditors. As Sri Lanka is restructuring its public debt which is in arrears.
“Executive Board approval of the first program review requires the completion of financing assurances reviews. These financing assurances reviews will focus on whether adequate progress has been made with debt restructuring to give confidence that it will be concluded in a timely manner and in line with the program’s debt targets.
“Discussions are on-going, and the authorities are continuing to make progress on their plans for revenue mobilization targets, anti-corruption efforts, and other important structural reforms.”
The IMF team held meetings with President and Finance Minister Ranil Wickremesinghe, Central Bank of Sri Lanka Governor Dr. P. Nandalal Weerasinghe, State Minister Shehan Semasinghe, Chief of Staff to the President Sagala Ratnayaka, Secretary to the Treasury K M Mahinda Siriwardana, and other senior government and CBSL officials, during the visit. The IMF team also met with parliamentarians, representatives from the private sector, civil society organizations, and development partners.
‘Imposing minimum room rates on five star hotels could ruin tourism sector’
By Hiran H.Senewiratne
The imposing of a minimum room rate on five star hotels on the basis of a recent gazette notification is actually killing the industry. Room rates, accordingly, could henceforth rise to between 80 percent and 100 percent, top travel and tourism industry expert Chandana Amaradasa said.
“The minimum room rate of a five star hotel currently comes to about US $ 65 but with the new gazette notification it would go up to US $ 170 per day. But our competitors, such as, Thailand, Malaysia and Vietnam are maintaining a minimum room rate of US$ 80 to US$ 85, Amaradasa told The Island Financial Review.
Amaradasa said that the tourism industry is just picking- up and ‘this type of move is detrimental to the entire sector because these room rates are normally determined by demand and supply and not by gazette notifications.
Amaradasa added: ‘At present, Colombo five star hotels are mainly patronized by Indian tourists, corporate clients and MICE tourists. This will not only impact hotel revenue but the outside supply chain as well. Nowhere in the world is the tourism industry regulated in this manner and this would enable our competitors, such as, Vietnam and Thailand to attract tourists.
“As a long term consequence, some of the airlines could also pull out of Sri Lanka and hotels will halt recruiting new staff and training them with the limiting of their revenue sources.’
ADL’s journey continues: Unveiling new offices in Indonesia and Malaysia for tech excellence
Axiata Digital Labs (ADL), the renowned technology hub of Axiata Group Berhad, is proud to announce the grand opening of two new offices in Indonesia and Malaysia. These strategic expansions, respectively, mark significant milestones in the company’s journey since it’s inception in 2019. This signifies ADL’s unwavering commitment to revolutionizing the telecommunications industry and propelling the global rate of digital transformation.
The inauguration of these state-of-the-art offices exemplifies the dedication ADL has towards expanding its footprint and harnessing the power of innovation across Southeast Asia. As the first CMMI 2.0 Level 3 IT organization in Sri Lanka and an ISO-certified company, ADL is well-positioned to lead the charge in transforming traditional telcos into techcos through its groundbreaking Axonect Product Suite.
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