News

Sri Lanka must sustain its health gains: malaria a case in point

Published

5 years ago

2021/04/25

by Prof. Kamini Mendis

Today, April 25, is World Malaria Day, and as many countries in the tropical world are laboring to control malaria and others racing towards the finish line to eliminate the disease, we in Sri Lanka are enjoying the prestige of being malaria-free. More importantly our people, possibly unknown to many of them, are benefiting from being free of a scourge, which destroyed lives and livelihoods, which took away most of our health budgets for insecticides, which stifled the cognitive development of our children and which greatly hindered Sri Lanka’s economic development for centuries past.

Today, we may be beleaguered by many health problems, not least, by the SARS-CoV-2 epidemic, but malaria is no more. The year 2012 saw the last case of malaria transmitted by a mosquitoe in Sri Lanka – a colossal achievement by any standards. And despite anxieties and worries whether the disease will return, the country has been kept free of malaria transmission for nearly nine years now, thanks to an exceptionally robust programme within the Ministry of Health, the Anti Malaria Campaign.

What we should be talking about today, though, is not the globally acclaimed achievement of malaria elimination from Sri Lanka, but whether and how the country can sustain its malaria-free status. A famed example etched in global public health chronicles is the historic achievement of Sri Lanka in 1963 of nearly eliminating malaria, and of the disease returning with a vengeance, to devastate the country for the next 50 years. This is a poignant reminder that malaria could still return.

Why so? The mosquito that transmits malaria is prevalent in parts of the country that were previously malarious. Even a new and highly efficient vector mosquito, which transmits malaria in India has been recently and inadvertently introduced into the country. Its implication is that if malaria returns to Sri Lanka it will affect cities as well as rural areas to which it was confined in the past. The threat of malaria becoming endemic again comes from imported malaria patients – those who acquire the infection abroad and return to Sri Lanka with the disease.

Most imported malaria infections are acquired in neighbouring India and African countries, and brought to Sri Lanka by such persons as business travelers, pilgrims, imported labour, and members of the armed forces and the Police Department who return from United Nations Peace Keeping Missions in malarious countries. Unless such infected persons are detected and treated without delay they could infect mosquitoes, and malaria could become endemic again – a possibility, that many health experts agree, must be averted at any cost.

What then must Sri Lanka do to remain free of malaria? It is to sustain a state-of- the art surveillance system to detect malaria patients returning from overseas and treat them without delay so that they will not infect mosquitoes and thereby transmit the disease to other people. Malaria can be easily diagnosed by testing a sample of blood using a rapid antigen test or by examining a blood smear under a microscope. Such diagnostic facilities are widely available throughout the country, and highly effective medicines are available to treat the disease.

Yet, simple as it might sound, the task of maintaining a rigorous programme of malaria case surveillance and treatment is fraught with challenges. This is because malaria is a rare and forgotten disease in the country today. Medical doctors fail, only too often, to test for malaria when a patient presents with fever. No blame to the physicians here, because there are so many other far more common causes of fever in the country – dengue, and a spate of other viral and bacterial infections to be explored as a cause of fever rather than malaria. But the clue to suspecting malaria is taking a history from the patient of recent travel overseas, which if present should place malaria high on the list of diseases to be tested for.

So, a combination of fever and having recently returned from overseas should be the signal to test for malaria. This is a message that the Anti Malaria Campaign is vigorously transmitting to its medical colleagues throughout the country – “when a patient presents with fever, ask for a travel history and test for malaria”. The Anti Malaria Campaign does far more than reminding doctors. It screens high-risk traveler groups for malaria throughout the country year round, and when a patient is detected it sets in motion a series of activities to ensure that the patient is cured, and that the infection has not spread to others in the country. it keeps track of the mosquito vector in all parts of the country and even controls it where necessary. It provides prophylactic medicines for travelers free-of-charge, and is the sole custodian of antimalarial medicines in the country, its staff being on call 24 hours a day seven days a week to keep the country malaria-free.

In truth, and the inspiration for me to write this article is that Sri Lanka has not had the most impressive record of sustaining its health gains, which have been made with enormous effort and major financial investments. We eliminated leprosy in 1995 but the disease has now returned to concerning levels in most parts of the country. We eliminated lymphatic filariasis a few years ago, but there is evidence that the disease may be lurking in parts of the country, with a risk of its transmission being resumed. Intestinal worm infestations, which sapped the nutrition of children for generations, have greatly declined in incidence, as have many other sanitation-related infectious diseases such as hepatitis. But, can we follow these achievements through to the point of extinction, and even more importantly, can we sustain the gains made?

“Out of sight, out of mind” is, unfortunately, a slogan, which most poor developing countries seem to live by when it comes to controlling diseases. They function on flimsy and short-sighted grounds that when a disease is not a health burden any more, the limited budgets for health are better assigned to other more prevalent health problems and diseases. Such thinking is clearly flawed on many counts: As careful studies and estimates have shown the price of preventing the return of malaria is only a mere fraction of the cost that Sri Lanka will have to bear if malaria returns to the country. It is estimated that the return on an investment of one rupee to prevent malaria will be 13 rupees in terms of the savings gained by preventing the return of malaria.

Developing countries must also desist a poorly informed but fashionable idea promoted in health circles even globally, of promoting the integration of dedicated disease control programmes into the general health services no sooner than the disease has been eliminated. Disbanding of these excellent programmes, the very ones which once eliminated the disease has been to the peril of countries as in the case of leprosy in Sri Lanka. Assigning the work of the leprosy campaign to the general health services too soon may not have been the most judicious of actions, and it may have contributed to the rapid return of the disease.

It is obvious that the workforce that was needed when a disease is highly prevalent would not be required to the same magnitude or degree of functionality when the disease is no longer a major burden. A carefully planned transition over time to shift work programmes from intervention delivery to surveillance, and share work time of staff with other related diseases has to be made, if it must, whilst maintaining a core of dedicated expertise on the disease at a central programme level.

The challenges of sustaining a malaria-free Sri Lanka and of keeping at bay other infectious diseases that we have successfully eliminated are many, but none that cannot be overcome by continued investment in, and maintaining the focus on, these diseases. It is an issue that falls broadly under the umbrella of “health security’, a term that has risen in importance with the SARS-CoV-2 pandemic, in the highly connected world that we live in. Today public health has come to the fore of our consciousness with the SARS-CoV-2 pandemic. Let our policy makers not forget that eliminating diseases is not the end-game, and that keeping those diseases at bay is as important as fighting other prevailing health problems.

About the author

Kamini Mendis is an Emeritus Professor and an international expert on malaria. She was instrumental in launching a Global Initiative to eliminate malaria in 1998 while working for the World Health Organisation Geneva. She has provided expert guidance to Sri Lanka and many countries on combatting malaria, and is gratified by the success achieved in the past few decades in many parts of the world. She continues to be engaged in advising the global and regional health communities and the Ministry of Health of Sri Lanka on the subject.

All News Advertisement

Latest News

ITS Giuseppe Garibaldi’ departs Colombo

Published

17 hours ago

2026/09/12

Priyan

The Italian Naval Vessel ‘ITS Giuseppe Garibaldi’ departed the Port of Colombo today, 12 September 2026, after completing a replenishment stop for logistics and services.

During the ship’s stay, the Commanding Officer of ITS Giuseppe Garibaldi, Captain Marco GUERRIERO, called on the Commander Western Naval Area, Rear Admiral Harsha De Silva, at the Western Naval Command Headquarters.

Members of the visiting crew also toured several tourist attractions across the Colombo area during their port call.

News

Green Climate Fund (GCF) Regional Dialogue for East and South Asia will be held from 14 to 17 September 2026 at Cinnamon Life at City of Dreams Hotel, Colombo

Published

21 hours ago

2026/09/12

Priyan

The Green Climate Fund (GCF) Regional Dialogue for Eastern and Southern Asia is scheduled to be held from September 14 to 17, 2026, at Cinnamon Life at City of Dreams, Colombo.

The Dialogue is hosted by the Government of Sri Lanka. The Green Climate Fund is the world’s largest dedicated climate fund established under the United Nations Framework Convention on Climate Change to assist developing countries in responding to the challenges of climate change.

The Green Climate Fund aims to promote a paradigm shift towards low-emission and climate-resilient development
pathways by supporting developing countries in reducing their greenhouse gas emissions and adapting to the impacts of climate change.

The Ministry of Environment of Sri Lanka serves as the country’s National Designated Authority for the Green Climate Fund, playing a critical role in coordinating access to climate finance, nominating institutions for accreditation to the Green Climate Fund and approving funding proposals, and ensuring that activities supported by the Green Climate Fund are aligned with national development objectives.

More than 120 delegates from 10 countries are expected to participate. The participating countries are Bangladesh, Bhutan, China, India, the Maldives, Mongolia, Nepal, Pakistan, the Republic of Korea, and Sri Lanka.

Participants will include representatives of National Designated Authorities of the above countries, Direct Access Entities, Accredited Entities, civil society organizations, the private sector, development partners, and technical institutions across the region.

Sri Lanka’s delegation comprises Dr. Dammika Patabendi, Minister of Environment, Anton Jayakody, Deputy Minister of Environment, K.R. Uduwawala, Secretary, Ministry of Environment, and high-level government officials.

The Dialogue will provide a platform to:

Share challenges, experiences, and lessons learned from the implementation of climate change projects and programmes.

Strengthen regional cooperation and partnerships on climate finance.

Discuss the Green Climate Fund’s evolving strategies, policies, and approaches.

Identify opportunities to accelerate climate investments across East and South Asia.

Hosting the Regional Dialogue in Colombo will provide Sri Lanka with an important opportunity to engage with senior government officials, private-sector representatives, development partners, technical experts, and international climate finance institutions.

The event is expected to support Sri Lanka’s efforts to improve access to climate finance and international grants, showcase national climate action initiatives and achievements, and strengthen the country’s engagement with the global climate community.

The Dialogue will also offer a strategic platform for Sri Lankan institutions that have applied for direct accreditation to present their project concepts and engage directly with representatives of the Green Climate Fund. These engagements are expected to support the accreditation process and contribute to the expansion of Sri Lanka’s network of Direct Access Entities through stronger regional partnerships and increased cooperation on climate finance, the Regional Dialogue will
contribute to positioning Sri Lanka as a credible and reliable partner for climate investment.

Projects that Sri Lanka has received funding from this fund are:
• The main projects that Sri Lanka has received support from the Green Climate Fund at present include the Wevu Gam Pubuduwa Project (52.1 USD Million) and the GCF Knuckles Project (49 USD Million).

7.5 USD Million has been allocated from GCF for 5 National Designated Authority Readiness Projects (NDA Readiness Projects) and for the National Adaptation Plan Readiness Project (NAP Readiness Project).

Approval has also been obtained for 3 regional projects. (Cooling Facility Programme, Global Fund for Coral Reef Investment Window, PEEB COOL Programme)

Sri Lanka has also identified 5 project concepts as priority projects for the Green Climate Fund period 2024-2027 and has taken steps to submit those project concepts (Concept Notes) for
approval by the Green Climate Fund.

The “Climate-resilient Fisheries in Sri Lanka” project concept (USD 107.5 million) submitted by DFCC Bank has already received approval.

News

Prof. Pieris says Buddha Dhamma recognised as source of law under Constitution

Published

23 hours ago

2026/09/12

Thilina Walpola

G.L. Peiris

Former Minister and People’s Joint Opposition Convener Prof. G.L. Peiris has challenged the assertion that the Supreme Court’s determination on the 22nd Amendment to the Constitution would be based solely on law and not Buddhist teachings, arguing that such a position is inconsistent with Article 9 of the Constitution and established judicial precedent.

In a special statement, titled “Buddhist Doctrine as a Source of Law in Sri Lanka”, Prof. Peiris has said the issue had arisen during the 22nd Amendment determination proceedings when Ven. Balangoda Kassapa referred to the Buddha Dhamma in his submissions.

According to Prof. Peiris, the Chief Justice responded that the determination would be made on the basis of the law and not Buddhist teachings.

Describing this as a “cavalier dismissal” of the Buddha Dhamma. Prof. Peiris has said it is contrary to Article 9, which gives Buddhism the foremost place and requires the State to protect and foster the Buddha Sasana.

Full text of the statement: In the 22nd Amendment determination proceedings, Venerable Balangoda Kassapa, in his submissions, made reference to the Buddha Dhamma. His Lordship the Chief Justice, in reply, made the strong assertion that the determination would be made on the basis of the law and not Buddhist teachings. This cavalier dismissal of the Buddha Dhamma is totally inconsistent with Article 9 of the Constitution and its authoritative interpretation in judicial decisions.

I. Authoritative Sri Lankan Judicial Authority A few examples may be cited.

In the Antiquities Amendment Bill, the Supreme Court, in its determination, observed: “The expression Buddha Sasana is wider than Buddhism and includes the entire establishment, together with objects and places of religious practices and worship of Buddhists”.

In Re the Thirteenth Amendment to the Constitution and the Provincial Councils Bill, 1987 2 Sri Lanka LR 312, Wanasundera J, referring to the term Buddha Sasana, said that it was “a compendious term encompassing all ancient, historic and sacred objects and places which have from ancient times been associated with the religious practices and worship of Sinhala Buddhists”.

It is clear that the Buddha Sasana is not confined to matters of ritual or practice, but includes the substance of Buddhist teachings. This is borne out clearly in other judgments of the Supreme Court.

An explicit example is the determination of the Supreme Court in the Ayurveda Amendment Bill, SCSD, numbers 22-35/2023, where the Court declared: “We hold that Buddha Sasana in Article 9 of the Constitution includes the dhamma, principles and teachings of Buddhism, including in particular recognized and undisputed codifications of the teachings of Lord Buddha”.

There are several other passages in the judgment which offer strong authority on the point.

The Court declared: “We determine that the word Buddha Sasana in Article 9 is a compendious term and includes the entire establishment of Buddhism as defined above. We conclude that the Tripitaka, consisting of the Vinaya Pitaka, the Sutta Pitaka and the Abhidhamma Pitaka, falls within the word Buddha Sasana. Hence the State has a duty inter alia to protect and foster the Tripitaka”.

The Court was uncompromising in its declaration that “While retaining the word Buddhism to denote the religion to which foremost place has been accorded in the Republic, the word Buddha Sasana was used to impose a duty on the State to protect and foster the entire establishment of Buddhism”.

The Court’s approach is very clear from the following passage: “We must proceed to interpret Article 9 of the Constitution on the basis that this change was intentional on the part of the legislature. It was meant to cover an area wider than Buddhism”.

II. International Judicial Authority

There is valuable material in the jurisprudence of the International Court of Justice at The Hague.

Judge C. G. Weeramantry, in his dissenting opinion in the ICJ’s 1996 advisory opinion on the legality of the threat or use of nuclear weapons, said that Buddhism could provide an important humanitarian perspective when considering the legality of nuclear weapons. The judge cited as his source the work by Walpola Rahula, entitled What the Buddha Taught, 1959.

Similarly, Judge Weeramantry, in his separate opinion in the maritime delimitation in the area between Greenland and Jan Mayen case, 1993, commented on the international legal concept of equity. In this connection, he referred to “the elaborately researched concept of fairness and justice in Buddhism”.