ANNUAL

HEALTH BULLETIN
2016

Ministry of Health, Nutrition and

Indigenous Medicine
Sri Lanka
 Editorial Board

Dr. Champika Wickramasinghe

Mrs. Sajeewa Kodikara
Dr. Kusal Wijayaweera
Dr. Praveen De Silva
Dr. Buddika Dayaratne
Dr. Prabath Werawatte
Dr. Neranga Liyanarachchi
Dr. Lahiru Rajakaruna
Dr. Nalinda Wellapulli
Dr. Nimali Widanapathirana
Dr. Aruna Sandanayake
Dr. Aravinda Wickramasinghe
Mrs. M.M. Darshanie
Mr. L.S. N. Perera
Mrs. M.M.G.D. Manamperi

ISBN 978-955-702-109-6

Medical Statistics Unit

Ministry of Health, Nutrition and Indigenous Medicine
385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo 10

Telephone +94 11 2695734

E-mail [email protected]
www.health.gov.lk

Printed by M.D.GUNASENA AND COMPANY PRINTERS (PRIVATE) LIMITED

II
Preface

This Annual Health Bulletin of 2016, published by the Ministry of Health, Nutrition and
Indigenous Medicine of Sri Lanka is the 31st in the series, which is being published since 1980. The
Annual Health Bulletin, which is the main publication for health data provides information and indices
which illustrate health situation of the country and needed for various purposes such as planning and
management of healthcare services, monitoring and evaluation of health and health related projects and
programmes, disease surveillance activities etc.

The demand for accurate health statistics and therefore the need of the Annual Health Bulletin
(AHB) was a seriously felt need over the past with the introduction of the evidence based decision
making. As the AHB played a significant role in the health planning process, it was necessary to improve
the quality and coverage of the health statistics as well as the methodology of presentation of the
information in AHB; thus the timely requirement of restructuring the AHB. Therefore it was decided to
change the structure of AHB so as to meet the needs of health service planners and other sectors using
health data. The new structure presents health information on four major areas; Health Status of the
country, Health Risk Factors among the population, Health Service Coverage and Health System inputs
and outputs.

I appreciate the generous contribution made by the officers of the Ministry and its institutions, by
providing data and write-ups which is the core of this publication.

Wasantha Perera
Secretary
Ministry of Health, Nutrition and Indigenous Medicine

III
IV
Message from the Director General of Health
Services

Annual Health Bulletin is the main annual publication of the Ministry of Health, Nutrition and Indigenous
Medicine. Since 1980, the Bulletin has provided comprehensive information on the state health sector in
Sri Lanka to meet the information needs of policy makers, health planners, researchers and other
interested stakeholders.

This year, based on stakeholder input the Ministry of Health, Nutrition and Indigenous Medicine identified
the need to revise the Annual Health Bulletin to provide more strategic information to support policy
formulation and program decision-making. Hence, a Technical Working Committee was appointed to
collaborate with the Medical Statistics Unit and the experts from Bloomberg Philanthropies’ Data for
Health Initiative, to lead the effort to revise the Annual Health Bulletin.

The main body of the 2016 Annual Health Bulletin (AHB) has a new structure that organizes the
information into four major health domains, content that focuses more on the results of the year, and
improved data visualizations that help communicate key information. Some of the data has been moved
to tables in the appendix, for convenient reference. As we are in transition to the new strategic focus the
future edition should be further improved with the feedback of the key stakeholders.

The 2016 AHB presents an overview of the country’s health status, the risk factors which have contributed
to current health status and may help determine the future health status of the country, details of service
coverage, and information on the health system which facilitated the provision of health services. It is
expected that the revised AHB will be used by the policy makers, health planners, health administrators
and the development partners as the main reference document for strategic decision making in Health
Sector.

At this occasion, let me thank Dr. Champika Wickramasinghe (DDG-NCD) and Dr. Udaya Ranasinghe
(Senior Assistant Secretary - Medical Services) for facilitating and leading the process, and all the DDGs
for supporting and providing valuable insights. I would like to take this opportunity to extend my sincere
gratitude to Mrs. Sajeewa Kodikara Director, Medical Statistics Unit and her staff for their hard work,
members of the Technical Working Committee for providing their expertise, and the medical officers who
involved in the editorial work. I also thank the two experts from Bloomberg Philanthropies Data for Health
Initiative, Dr. Cecilia Fabrizio and Mr. Richard Delaney, for sharing their expertise on advanced data
analysis and visualization. Finally, I thank all the Directors and other health staff who gave their support
by sharing the data and information and by providing the writes-ups, without which this publication would
not have become a reality.

Dr. Anil Jasinghe

Director General of Health Services

Viv
VI
Table of Contents

Table of Contents v
VII

List of Figures x
XII

List of Tables xiii

XV
List of Abbreviations xvi
XVIII

Health Status
1. Country Profile 1
1.1.Background 1
1.2.Population size and growth 2
1.3.Introduction to Sri Lankan Health Sector 9
1.4.Trends in Life Expectancy 9
1.5.Trends in Fertility Rates 10

2. Morbidity and Mortality 12

2.1. Hospital Morbidity and Mortality 13
2.2. Hospital Morbidity 13
2.3. Hospital Mortality 17
2.3.1. Leading Causes of Hospital Deaths 18
2.3.2. Case Fatality Rate 20
2.4. Registration of Deaths 20

3. Health Related Sustainable Development Goals (SDG) 21

4. Reproductive, Maternal, New-born, Child Adolescent and Youth Health 23
4.1. Maternal and Child Health 23
4.1.1. Maternal Mortality Ratio 23
4.1.2. Still Birth Rate 28
4.1.3. Neonatal Mortality Rate 29
4.1.4. Infant Mortality Rate 32
4.1.5. Under Five Mortality Rate 33

5. Infectious Diseases/ Communicable Diseases 35

5.1. Dengue Fever (DF) / Dengue Haemorrhagic Fever (DHF) 35
5.2. Tuberculosis 43
5.3. HIV/ AIDS and Sexually Transmitted Infections (STIs) 47
5.4. Vaccine preventable disease 53
5.4.1. Encephalitis 53
5.4.2. Mumps 53

VII
 5.4.3. Measles 53
5.4.4. Rubella 53
5.4.5. Congenital Rubella Syndrome (CRS) 53
5.4.6. Poliomyelitis 54
5.5. Leptospirosis 55
5.6. Influenza 57
5.7. Food Borne Diseases 58
5.8. Malaria 60
5.9. Filariasis 65
5.10. Leprosy 66
5.11. Leishmaniasis 71
5.12. Rabies 71

6. Non-communicable Diseases (NCD) 72

6.1. Major Non-Communicable Diseases 72
6.2. Chronic Kidney Disease 74
6.3. Injuries 75
6.4. Cancer 77
6.5. Mental Health 85
6.5.1. Suicides 85
6.5.2. Mental health issues 87

7. Oral Health 90
7.1. Oral Disease Trends 90

Risk Factors
8. Risk Factors 93
8.1. Food and Nutrition Related Risk Factors 93
8.1.1. Maternal and Child Nutrition Related Risk Factors 97
8.1.2. Risk Factors Related to Nutrition status of children under the age of five years 100
8.1.3. Malnutrition among School Children 102
8.2. Adolescence Health Risk Factors 105
8.3. Gender based violence 106
8.4. Risk factors for Non Communicable Diseases 108
8.4.1. Prevalence of behavioural and intermediate risk factors for NCD 108
8.4.2. Prevalence of risk factors among the screened population at HLCs 109
8.4.3. Alcohol Consumption 111
8.5. Physical Environment 113
8.5.1. Water 113
8.5.2. Sanitation 113

vi

VIII
Service Coverage
9. Health Service Coverage 116
9.1. Reproductive, Maternal, New-born, Child, Adolescent and Youth Health (RMNCAYHP)
services coverage 116
9.1.1. Pre-pregnancy care 116
9.1.2. Antenatal Care coverage 116
9.1.3. Peri-Natal and Post Natal Care Coverage 118
9.1.4. Infant and Child care service coverage 119
9.1.5. Coverage of School Medical Inspections 120
9.1.6. Immunization coverage 121
9.1.7. Well women service coverage 122
9.1.8. Reproductive Health 123
9.2. Non-Communicable diseases Service Coverage 125
9.2.1. NCD Screening at Healthy Lifestyle Centres 125
9.2.2.Diabetes 126
125
9.2.3. Hypertension 126

Health System
10. Organization of the Healthcare Delivery System 128
10.1. Achievements for 2016 129

11. Curative Care Services 132

11.1. Distribution of Beds and Bed Strength 132
11.2. Service Utilization 134
11.2.1. Attendance to Out Patient Departments (OPD) of Hospitals 134
11.2.2. Attendance to Curative Care Health Clinics 135
11.2.3. Maternal Services 135
11.2.4. Utilization of Medical Institutions 138

12. Public Health Services (Preventive Health Services) 141

12.1. Deputy Director General 141
12.1.1. Epidemiology Unit 141
12.1.2. Directorate of Environment Health, Occupational Health and Food safety 142
12.1.3. National STD/AIDS Control Programme 147
12.1.4. National Programme for Tuberculosis Control and Chest Diseases 150
12.1.5. Anti-Malaria Campaign 150
12.1.6. Anti-Filariasis Campaign 151
12.1.7. Quarantine Unit 151
12.1.8. Anti-Leprosy Campaign 154
12.1.9. National Dengue Control Unit 155

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IX
 12.2. Deputy Director General – Public Health Services II (DDG PHS II) 156
12.2.1. Maternal and Child Health (Family Health Bureau) 156
12.2.2.Health Education and Publicity (Health Education Bureau) 158
12.2.3. Directorate of Nutrition (Nutrition Division) 162
12.2.4. Nutrition Coordination Division (Nutrition Coordination Unit) 163
12.2.5. Directorate of Youth, Elderly and Disability (YED) 164

13. Medical Services 166

13.1. Deputy Director General (Medical Services) I 166
13.1.1. Directorate of Healthcare Quality and Safety 167
13.2. Deputy Director General (Medical Services) II 170
13 .2.1.Directorate of medical Services/ Medical Services Branch 170
13.2.2. Directorate of Primary Care Services 174
13.2.3. Medical Administration Branch 175
13.2.4. Prison Medical Services 176
12.2.5. National Intensive Care Surveillance (NICS) 177

14. Education Training and ResearchDeputy Director General - Education Training &
Research (DDG-ET&R) 181
14.1. Medical Research Institute 181
14.2. National Institute of Health Sciences (NIHS) 185

15. Management, Development and Planning 186

15.1. Deputy Director General – Planning 186
15.2. Directorate of Organizational Development 186
15.3. Directorate of Health Information 188
15.4. Finance planning Unit 189

16. Services for Prevention and Control of Non-Communicable Diseases 190

16.1. Non- Communicable Disease Unit 190
16.2. Directorate of Mental health 192
16.3. National Cancer Control Programme (NCCP) 192

17. Laboratory Services 193

17.1. Deputy Director General Laboratory Services 193
17.2. National laboratory system 194
17.3. National Blood Transfusion Service (NBTS) 201

18. Dental Services 206

18.1. Deputy Director General – Dental Services 206
18.2 Dental care services 206

19. Medical Supplies 212

19.1 Medical Supplies Division 212

viii

X
20. Biomedical Engineering, Logistics and Administrative Services 216
20.1 Deputy Director General Biomedical Engineering 216
20.2 Biomedical Engineering Services 216

21. Indigenous Medicine Sector 217

22. Financial Services 221
22.1 Health Sector Finances 221

23. Human Resources for Health 228

23.1. Human Resource Unit establishment 228
23.1.1. Clinical specialist cadre projection 228
23.2 Training for health workforce 235
23.2.1 Postgraduate Institute of Medicine 235

Annexure l – Detailed Tables of Statistics by Medical Statistics Unit

Annexure ll – Detailed Tables of Statistics by Medical Statistics Unit

ix

XI
 List of Figures

Figure 1.1: Population Size and Annual Growth Rate, 1901 – 2016 ............................................................. 2
Figure 1.2: Crude Birth and Death Rates, 1945 – 2016 ................................................................................ 3
Figure 1.3: Population by Broad Age Group, 1981 and 2016 ....................................................................... 4
Figure 1.4: Population Trends for Sri Lanka by Age and Sex, 1981, 2012 and 2041 ................................... 5
Figure 1.5: Population Density by District, 2016 .......................................................................................... 8
Figure 1.6: Life Expectancy at Birth by Sex, 1920 – 2013 ........................................................................... 10
Figure 2.1: Percentage of Hospital Live Discharges and Deaths by Gender, 2016 ..................................... 15
Figure 2.2: Distribution of Live Discharges and Deaths due to Traumatic Injuries by Gender, 2016 ......... 15
Figure 2.3 : Leading Causes of Hospitalization, 2016 ................................................................................. 17
Figure 2.4 : Leading Causes of Hospital Deaths, 2016 ................................................................................ 18
Figure 2.5 :Leading Causes of Hospital Deaths for Children Aged between 0-4 Years, 2016..................... 19
Figure 2.6: Trends in Case Fatality Rates of Selected Diseases, 2012 – 2016............................................. 20
Figure 4.1: Trends in Maternal and Infant Mortality Rates, 1940 – 2014 .................................................. 23
Figure 4.2: National MMR 2000 – 2016 ...................................................................................................... 24
Figure 4.3: Number of Maternal Deaths (2001 – 2016) ............................................................................. 24
Figure 4.4 : Maternal deaths by categories ................................................................................................ 25
Figure 4.5: Leading causes of maternal deaths in 2016 ............................................................................. 26
Figure 4.6: MMRs and maternal deaths by district .................................................................................... 27
Figure 4.7: Still Birth Rate ........................................................................................................................... 28
Figure 4.8: Early Neonatal Mortality Rate .................................................................................................. 29
Figure 4.9: Neonatal Mortality Rate ........................................................................................................... 30
Figure 4.10: Comparison of trends in National IMRs determined from RH – MIS .................................... 32
Figure 4.11 : Percentage distribution of cause of infant deaths 2016 ....................................................... 33
Figure 4.12: Percentage distribution of cause of 1-5-year child deaths 2016 ............................................ 34
Figure 4.13: Under five mortality rate per 1000 live births ........................................................................ 34
Figure 5.1: Annual Trend in Dengue Cases 2000 to 2016 ........................................................................... 35
Figure 5.2: Dengue incidence according to the districts of the country in 2016 ........................................ 36
Figure 5.3: Cases and Case Fatality Ratio (CFR) .......................................................................................... 37
Figure 5.4: Weekly reporting of cases in 2016 indicating seasonality ........................................................ 38
Figure 5.5: Weekly reporting of cases over the past five years indicating the seasonality ........................ 39
Figure 5.6: Age Distribution as a percentage of the total cases in 2016 .................................................... 40
Figure 5.7 : Summary of Vector breeding sites (2016) ............................................................................... 41
Figure 5.8 : Gap between the estimated TB cases (new & relapse) and notified case .............................. 43
Figure 5.9 : Percentage of presumptive TB cases referred for sputum microscopy .................................. 44
Figure 5.10 : Contacts screening of TB patients, Q4 -2016......................................................................... 44
Figure 5.11 : Treatment outcome of all forms of TB-2010-2015 ............................................................... 45
Figure 5.12 : Treatment phase of death occurrence- 2015 patient cohort ................................................ 45
Figure 5.13 : Trends of reported HIV cases by Sex 2007-2016 ................................................................... 47
Figure 5.14 : Cumulatively reported HIV cases by Age Groups (2016) ....................................................... 48
Figure 5.15 : Rate of HIV cases reported in 2016 per 100,000 population ................................................ 48

XII
Figure 5.16 : Probable modes of transmission of HIV cases reported in 2016 (N=249) ............................. 49
Figure 5.16
5.17 : Probable
Number of modes
condoms of transmission
distributed of by HIV
STDcasesclinicsreported
during 2016 in 2016 (N=249) ............................. 49
................................................ 52
Figure 5.17 : Number of condoms distributed by STD clinics during 2016 ................................................
5.18 Leptospirosis incidence rate per 100,000 population ........................................................... 55 52
Figure 5.18
5.19 : Leptospirosis incidence
deaths andrate CFRper from 100,000
2008 –population ........................................................... 55
2016................................................................... 56
Figure 5.19
5.20:: Leptospirosis
Leptospirosis seasonality
deaths and........................................................................................................
CFR from 2008 – 2016................................................................... 56
Figure 5.20:
5.21 :Leptospirosis
Distribution of seasonality
ILI patients ........................................................................................................
as reported by the sentinel sites by month in 2015 & 2016 ...... 56 57
Figure 5.21
5.22 : Distribution
Reported Food of ILI patients
Borne as reported
diseases by the sentinel
to the Epidemiology Unit sites
fromby 2009-2016
month in 2015 & 2016 ...... 57
.......................... 58
Figure 5.22
5.23 : Reported Food Borne
Trend of imported diseases
malaria cases toduring
the Epidemiology
2013 - 2016Unit from 2009-2016 .......................... 58
............................................................ 60
Figure 5.23
5.24 : Trend
Importedof imported
malaria casesmalariaby cases
regionduring
of origin 2013 - 2016..............................................................
in 2016 ............................................................ 60
61
Figure 5.24
5.25 : Imported
Microscopic malaria
screeningcasesforbymalaria
region of byorigin
Regional in 2016 ..............................................................
Malaria Clinics in the years 2015 and 2016 61 62
Figure 5.25 : Microscopic screening for malaria by Regional Malaria Clinics in the
5.26 Distribution of Malaria vectors by Regional Malaria Clinics in 2016 ..................................... 63 years 2015 and 2016 62
Figure 5.26
5.27 : Distribution of Malaria
Filariasis endemic vectors
districts in SribyLanka
Regional Malaria Clinics in 2016 ..................................... 63
.................................................................................. 65
Figure 5.27
5.28:: New
Filariasis
Caseendemic
Detection districts
Rates of in Leprosy
Sri Lankaper ..................................................................................
100,000 Population 1990 -2016 .......................... 65 67
Figure 5.28:
5.29: NewNumberCaseofDetection
New Leprosy Rates of Leprosy
Cases Detected peron 100,000
DistrictPopulation
Basis 20161990 -2016 .......................... 67
............................................
Figure 5.29:
5.30 :Number
New Leprosyof NewCase Leprosy CasesRate
Detection Detected on District
per 100,000 Basis 2016
population ............................................
by Districts in 2016 .................. 67 68
Figure 5.30
5.31 : New
GradeLeprosy Case Detection
2 deformity percentage Rate pertime
at the 100,000 population
of diagnosis among by Districts
leprosy in 2016
cases .................. 68
..................... 69
Figure 5.31
5.32:: Child
Gradecase
2 deformity
percentage percentage
among new at the time cases
leprosy of diagnosis among leprosy
from 2002-2016 cases ..................... 69
........................................
Figure 5.32:
5.33: Child case percentage
Multi-Bacillary percentage among newtime
at the leprosy cases from
of diagnosis among 2002-2016
leprosy........................................
cases from 2002 -2016 69 70
Figure 5.33: Multi-Bacillary percentage at the time of diagnosis among leprosy
5.34 : Human rabies cases reported to the Epidemiology Unit from 2000-2016............................ 71 cases from 2002 -2016 70
Figure 5.34 : Human
6.1: No. of CKDurabies casesas
patients reported
reported toto thethe Epidemiology
National Renal UnitRegistry
from 2000-2016 ............................ 71
............................................ 74
Figure 6.1:
6.2 :No.
Trendof CKDu patients as reported
of hospitalization and mortality to thedue National Renal Registry
to traumatic injuries............................................
(2006 – 2016) .................... 74 76
Figure 6.2
6.3 : Trend of hospitalization
Age standardized death and
ratesmortality
due cancer due2001to traumatic injuries (2006 – 2016) .................... 76
- 2010 ........................................................... 81
Figure 6.3
6.4 : Age
Crude standardized
Cancer incidencedeath rate
ratesfor due Topcancer 2001 - sites
five cancer 2010in ...........................................................
females 1985 – 2010 ...................... 81 83
Figure 6.4
6.5:: Crude
CrudeCancer
Cancer incidence
incidence rate rate forfor Top
Top five
five cancer
cancer sites sites inin males
females 1985 – 2010
1985-2010 ...................... 83
.............................
Figure 6.5:
6.6 :Crude
SuicidesCancer
haveincidence rate fordecrease
shown a gradual Top five cancerover the sites
past infewmales 1985-2010
years ............................. 83
.......................................... 85
Figure 6.6
6.7:: Suicides
Suicides among
have shown
malesahas gradual
shown decrease
a gradual over the pastover
decrease fewthe yearspast..........................................
few years ...................... 85
6.8:
Figure 6.7: Admissions
Suicides due
among to
males moodhas (affective)
shown a disorders
gradual have
decrease
8.1 : Transition of stunting among under five-year-old children: district rank almost
over doubled
the past fromyears
few 2004......................
from - 2015..........
2006-2012 ....88
85
94
Figure 8.1
8.2 : Transition
Body MassofIndex stunting among under
and unhealthy foodfive-year-old children: district rank from 2006-2012 .... 94
habits ........................................................................... 96
Figure 8.2
8.3 : Body Mass
In 2016, 25%Index and unhealthy
of pregnant womenfood are habits
found ...........................................................................
to be anaemics (Hb< 11g/dl) ............................ 96 98
Figure 8.3
8.4 : In 2016,antenatal
visiting 25% of pregnant women
clinics over are five
the last found to be
years anaemics (Hb< 11g/dl) ............................ 98
..................................................................... 99
Figure 8.4
8.5 : visiting
Low birth antenatal clinics over
weight shows a slight thereduction
last five years over the .....................................................................
years .................................................... 100 99
Figure 8.5
8.6:: Malnutrition
Low birth weight among shows
undera slight reduction
five children fromover 2011theto years
2016 ....................................................
................................................. 100
101
Figure 8.6:
8.7 :Malnutrition
Percentages amongof school under five children
children in different from 2011 to
Grades with 2016 .................................................
stunting, wasting % overweight ... 101 102
Figure 8.7
8.8 : Percentages of schoolGrade 10 children
children in different
with overweight Grades with stunting, wasting
BMI 2012-2016 % overweight ... 102
....................................
Figure 8.8
8.9 : Percentages of Grade 10 children with overweight
low BMI 2012-2016 ................................................. 102
BMI 2012-2016 ....................................
Figure 8.9
8.10: Percentages of Grade
: Teenage pregnant 10 children
mothers out of with low BMI 2012-2016
all registered pregnancies .................................................
............................................ 102
105
Figure 8.10
8.11 : Teenage
Percentage pregnant
of teenage mothers out of allamong
pregnancies registered pregnantpregnancies
mothers............................................
by age group in 2016 ....... 105
Figure 8.11
8.12 : Percentage
Reported cases of teenage pregnancies
of gender-based amongbypregnant
violence RDHS areas, mothersCMCby & age
NIHSgroup in 2016 ....... 105
............................. 107
Figure 8.12
8.13 : Reported cases ofconsumption
Trend in alcohol gender-based violence
among males by.......................................................................
RDHS areas, CMC & NIHS ............................. 107 111
Figure 8.13 : Trend in alcohol consumption among males .......................................................................
8.14 Percentage of Households with improved source of drinking water by residence............. 113 111
Figure 8.14
8.15 : Percentage
Precentage of Households with improved inproved,not sourceshared,of drinking
Sanitation water by residence
facilities by sector .............
......... 113
114
Figure 8.15
9.1 : :Total
Precentage
numberofofHouseholds
schools where withSMI inproved,not
were conducted shared,increased
Sanitation facilities
over the last byfive
sector
years.........
..... 114
120
Figure 9.1
9.2 : Total number
Progress of theofSMIschools
followwhere
up 2013 SMI –were2016conducted increased over the last five years ..... 120
........................................................................... 121
Figure 9.2
9.3 : Progress
Well Women of the SMI follow
service accordingup 2013 – 2016regions
to Health ...........................................................................
in Sri Lanka ............................................. 121 122
Figure 9.3 : Well Women service according to Health regions in Sri Lanka ............................................. 122

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XIII
 Figure 9.4: Consistent decline in the unmet need for family planning is observed in the last five years 123
Figure 9.5: Modern family planning methods used by eligible families 2012-2016................................. 124
Figure 9.6 : Percentage of Medical Officer of Health areas with at least two healthy lifestyle centers .. 125
Figure 11.1 : Inpatient and Outpatient Attendance in Government Medical Institutions, 1984 – 2016 . 134
Figure 11.2: Distribution of Hospital Live Births by place of occurrence in Sri Lanka, 2016 .................... 137
Figure 11.3 : Registered Births Vs Hospital Births, 1992-2016 ................................................................. 138
Figure 11.4 : Utilization of Medical Institutions, 2016.............................................................................. 140
Figure 12.1: Core capacities of IHR (2005) assessment in 2015 and 2016 ............................................... 152
Figure 12.2 : Organization of RMNCAYH Programme at Different Levels of Health System .................... 157
Figure 13.1 : Post Intern Appointments 2014 to 2016 ............................................................................. 171
Figure 13.2: Age distribution of patients admitted to adult ICUs in 2016 ............................................... 178
Figure 13.3: Patients per nurse ratio in adult ICUs in for 2016 ................................................................ 178
Figure 13.4: Mean beds to patients ratio of adult ICUs for year 2016 .................................................... 179
Figure 13.5: Mean number of organ failures among admissions to adult ICUs ...................................... 179
Figure 13.6: Age distribution of patients admitted to Paediatric ICUs in 2016 ………………………………….…180
Figure 14.1: The total Number of Laboratory tests done at MRI over the last 5 years ............................ 182
Figure 14.2: Total number of Medical Research done at MRI over the last 5 years ................................ 183
Figure 17.1 :Distribution of Laboratories in Primary, Secondary and Tertiary Care Institutions ............. 195
Figure 17.2 : Distribution of laboratories in health care institutions ....................................................... 196
Figure 17.3 : Type of Line Ministry Institution according to availability of Laboratory Facilities ............. 196
Figure 17.4 : Type of Provincial Ministry Institution according to availability of Laboratory Facilities .... 197
Figure 17.5 : Lab financing for purchasing of laboratory equipment for line ministry laboratories ........ 198
Figure 17.6 : Lab financing for maintenance of equipment ..................................................................... 199
Figure 17.7 : Distribution of total blood collection by mode of collection ............................................... 202
Figure 17.8 : Yearly improvement of Voluntary blood collection............................................................. 202
Figure 17.9 : Total blood collection cluster wise ...................................................................................... 203
Figure 17.10 : Comparison of cluster blood collection with previous year .............................................. 203
Figure 17.11 : Prevalence of Transfusion Transmitted Infection and comparison with previous years .. 204
Figure 19.1 : Medical Supplies Estimated ................................................................................................. 214
Figure 19.2 : Medical Supplies Issued ....................................................................................................... 214
Figure 22.1 : Line Ministry expenditure from 2012 to 2016 (in LKR billions) ........................................... 222
Figure 22.2 : Line Ministry Capital expenditure from 2012 to 2016 (in LKR billions) ............................... 223
Figure 22.3 : Line Ministry Recurrent Expenditure from 2012 to 2016 (in LKR billions) .......................... 224
Figure 22.4 : Provincial Expenditure on Health (in LKR billion) ................................................................ 225
Figure 22.5 : Capital Expenditure by the provinces from 2014 to 2016 [in LKR million] .......................... 226
Figure 22.6 : Recurrent Expenditure by the provinces from 2012 to 2016 [in LKR billion] ...................... 227
Figure 23.1 : Clinical specialists cadre projection for 2016-25 ................................................................. 229
Figure 23.2 : Current training and proposed training rates for medical specialists ................................. 230
Figure 23.3 : Current training and proposed training rates for surgical specialists.................................. 231
Figure 23.4 : Current training and proposed training rates for paediatrics specialists ............................ 232
Figure 23.5 : Current training and proposed training rates for other specialists ..................................... 233
Figure 23.6 : Current training and proposed training rates for dental specialists.................................... 234

XIV xii
List of Tables
Table 1-1 : Percentage Distribution of Population by Broad Age Groups& Dependency Ratio ................... 4
Table 1-2 : Age Specific Sex Ratio 1981, 2001 and 2016 .............................................................................. 7
Table 1-3 : Age-Specific Fertility Rates (per 1,000 women) and Total Fertility Rates, 1987 – 2016........... 11
Table 4-1: Epidemiology of Perinatal Deaths in 2015 as reported from the Foeto -infant Morbidity ....... 31
Table 4-2: Under Five Mortality Rate per 1,000 ......................................................................................... 34
Table 5-1 : Relative Productivity of HIV testing methods and testing details in 2016 ............................... 50
Table 5-2 : Number of PLHIV* in pre-ART stage as of 2016........................................................................ 51
Table 5-3 : Number of STIs reported during 2016 ...................................................................................... 51
Table 5-4 : Districts with high prevalence of food borne diseases ............................................................. 59
Table 5-5 : Number of malaria cases investigated and treated during 2016 ............................................. 60
Table 5-6 : Provincial detection indicators of the country for the year 2016 ............................................ 70
Table 6-1 : Number of deaths among all ages due to major NCDs in government hospitals..................... 72
Table 6-2 : Number of deaths among all ages due to major NCDs in Sri Lanka - 2013 ............................. 73
Table 6-3 : Clinic attendance and morbidities detected at Well Woman Clinics 2012 – 2016................... 73
Table 6-4 : Screening for common cancers conducted by National Cancer Control Programme - 2016 ... 78
Table 6-5 : Clinic attendance and morbidities detected at Well Woman Clinics 2012 – 2016................... 79
Table 6-6 : No. of newly registered cancer patients at Government Cancer Treatment Centres .............. 80
Table 6-7 : Top ten cancers reported in females 2001 to 2010 .................................................................. 82
Table 6-8 : Top ten cancers reported in males 2001 to 2010 ..................................................................... 82
Table 6-9 : Distribution of cancer incidence by geographical area - 2010 ................................................. 84
Table 7-1 : Prevalence and Severity of Dental Caries ................................................................................. 90
Table 7-2 : Prevalence of Healthy gums in 12 years and 35-44 year olds .................................................. 90
Table 8-1 : Overweight (BMI ≥25) and obesity (BMI≥30) among adult population (Age 18 – 69) ........... 96
Table 8-2 : Prevalence of behavioural and intermediate risk factors for NCD in 2007 & 2015 ............... 108
Table 8-3 : Numbers and proportions of targeted population screened in Sri Lanka ............................. 109
Table 8-4 : Prevalence of Risk Factors among the screened population (by District – 2016) .................. 110
Table 8-5 : Prevalence of alcohol consumption ........................................................................................ 111
Table 9-1 : Pregnant mother registration and care received through National Programme ................... 117
Table 9-2 : Antenatal Service coverage by Public Health Staff has been consistently over 90% ............ 117
Table 9-3 : Pregnancy outcome and postpartum care for mothers registered during 2012 - 2016 ........ 118
Table 9-4 : Most of the indicators on infant and childcare provided by the field staff is improved ........ 119
Table 11-1 : Number of Health Institutions and Hospital Beds, 2011 - 2016 ........................................... 133
Table 11-2: Availability of Hospital Beds by Type of Institution, 2016 ..................................................... 133
Table 11-3 : Maternal Services by Type of Institution, 2016 .................................................................... 136
Table 12-1 : Export Inspection Activities 2015 & 2016 ............................................................................. 143
Table 12-2 : Registration of Packaged Water Manufacturing Premises ................................................... 144
Table 12-3 : Issue of Permits for Common Salt ........................................................................................ 144
Table 12-4 : Activities of Food Inspection at RCT, Gary Line 1 and 2 ....................................................... 145
Table 12-5 : Activities of Food Inspection at Airport ................................................................................ 145
Table 12-6 : Activities of Food Inspection Unit at Seaport ....................................................................... 145
Table 12-7 : Performance by planned interventions/major activities under GF grant in 2016................ 149

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 Table 12-8 : Financial Allocation and Expenditure for Anti Malaria Campaign - 2016 ............................. 150
Table 13-1 : Implementation of Annual transfers .................................................................................... 172
Table 13-2 : Attachment of Medical Officers after Post Graduate training ............................................. 172
Table 13-3 : Establishment of A&E units. ................................................................................................. 172
Table 16-1 : The number and services of Healthy Lifestyle Centres in Sri Lanka, 2011–2016 ................. 191
Table 17-1 : Comparison of HLA Statistics ................................................................................................ 204
Table17-2 : Nucleic Acid Tests done up to 31st December 2016 ............................................................. 205
Table 18-1: Distribution of dental specialists by specialty....................................................................... 207
Table 18-2 : Number of dental surgeons and dental specialists in place ................................................. 211
Table 18-3 : No. of auxiliary services personnel in place .......................................................................... 211
Table 21-1 : Government Ayurvedic and Homeopathic Medical Institutions in Sri Lanka- 2016 ............. 217
Table 21-2 : Resources in the Ayurvedic Hospitals and Dispensaries - 2016 ........................................... 218
Table 21-3 : Daily Attendance of Patients at Out-patient and In-patient Departments in Hospitals....... 219
Table 21-4 : The Value of the Medicines Imported under Tax Concession .............................................. 220

Annexure l

Table 1: Administrative Divisions and Local Government Bodies, 2016

Table 2: Population, Land Area and Density by Province and District
Table 3: Population by Five Year Age Groups and Sex, 1981, 2001, 2012 and 2016
Table 4: Vital Statistics by District
Table 5: Number of Households in Occupied Housing Units by Main Source of Drinking Water
Table 6: Households in Occupied Housing Units by Type of Toilet Facility and District, 2012
Table 7: Distribution of Government Medical Institutions and Beds by RDHS Division, December 2016
Table 7a: Distribution of Inpatient Beds by RDHS Division, December 2016
Table 8: Beds by speciality and RDHS Division, December 2016
Table 9: Key Health Personnel, 1991 - 2016
Table 10: Distribution of Health Personnel by RDHS Division, December 2016
Table 11: Distribution of Specialists in Curative Care Services by RDHS Division, December 2016
Table 12: National Expenditure, Health Expenditure and GNP, 2011 - 2016
Table 13: Summary of Health Expenditure and Source of Fund, 2011 - 2016
Table 14: Summary of Health Expenditure by Programme, 2016
Table 15: Indoor Morbidity and Mortality Statistics by Broad Disease Groups, 2016
Table 16: Trends in Hospital Morbidity and Mortality by Broad Disease Groups, 2008 - 2016
Table 17: Trends in Hospitalization and Hospital Deaths of Selected Diseases, 2009 -2016
Table 18: Leading Causes of Hospitalization, 2016
Table 19: Leading Causes of Hospital Deaths, 2016
Table 20: Leading Causes of Hospitalization, 2007 - 2016
Table 21: Leading Causes of Hospital Deaths, 2009 - 2016
Table 22: Leading Causes of Hospitalization by District, 2016
Table 23: Leading Causes of Hospital Deaths by District, 2016
Table 24: Cases and Deaths of Poisoning and Case Fatality Rate by RDHS Division, 2016
Table 25: Distribution of Patients with Mental Disorders by RDHS Division, 2016

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Table 26: Case Fatality Rate for Selected Diseases, 2012 - 2016
Table 27: Inpatients Treated and Hospital Deaths by Type of Institution and RDHS Division, 2016
Table 28: Hospitalizations, Hospital Detahs and Case Fatality Rates - 2015 - 2016
Table 29: Hospitalizations, Hospital Deaths and Case Fatality Rates - RDHS Division, 2016
Table 30: Outpatient Attendance by District and Type of Institution, 2016
Table 31: Outpatient Attendance by RDHS Division, 2016
Table 32: Outpatient Department (OPD) Visits byType of Hospital, 2016
Table 33: Clinic Visits by Quarter, by RDHS Division, 2016
Table 34: Clinic Visits by Quarter, by Type of Hospital, 2016
Table 35: Rank Order of Clinic Visits in RDHS Divisions, 2016
Table 36: Clinic Visits by Type of Clinic and RDHS Division, 2016
Table 37: Utilization of Medical Institutions by RDHS Division, 2016
Table 38: Average Duration of Stay (Days) in Selected Types of Hospitals per Quarter, 2004- 2016
Table 39: Registered Births and Hospital Births, 1980- 2016
Table 40: Live Births, Maternal Deaths, Still Births and Low Birth Weight Babies in Government Hospitals
Table 41: Performance of Dental Surgeons by RDHS Division, 2016

Annexure ll

Table 1: Distribution of Notified Cases of Selected Notifiable Diseases by RDHS Division-2016

Table 2: Age distribution of clinically confirmed selected notifiable diseases -2016
Table 3: Distribution of notified cases of selected notifiable diseases by Month, 2016
Table 4: Cases Incidence, Deaths and Case Fatality Rate (CFR) of Dengue Fever(DF)/Dengue
Haemorrhagic Fever(DHF), Leptospirosis and Encephalitis 1996-2016
Table 5: Cases and Deaths of Dengue Fever/Dengue Haemorrhagic Fever and Leptospirosis by Age
Table 6: Incidence of Extended Programme of Immunization (EPI) Target Diseases, 1955-2016
Table 7: Immunization Coverage by (RDHS) area, 2016
Table 8: Number of Selected Adverse Events by Vaccination in 2016
Table 9: Sentinel Site Surveillance of Influenza like Illness (ILI) and Severe Acute Respiratory Illness
Table 10: Reported Cases and Case Fatality Ratios (CFR)
Table 11: High Dependency Units of Health Institutions provided with equipment in 2016
Table 12: Distribution of High dependency unit equipment: Hospital type wise
Table 13: Distribution of High dependency unit equipment: Province wise
Table 14: Summary of emergency Dengue control programs in 2014
Table 15: Distribution of TB cases by district
Table 16: Distribution of treatment outcome of all forms of TB by districts in 2015
Table 17: Functioning miturupiyasa centres
Table 18: Details of number of people attended in 2016
Table 19: Details of local trainings facilitated by DDG (MS)II division
Table 20: Details of foreign trainings facilitated by DDG (MS)II division
Table 21: Major Procurements of Biomedical Engineering Division in 2016

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 List of Abbreviations
A&E Accident and Emergency
ACHS Australian Council for Accreditation Standards
ADC Adolescent Dental Clinics
AFC Anti Filaria Campaign (AFC)
AFP Acute Flaccid Paralysis
AHB Annual Health Bulletin
AIDS Acquired immune deficiency syndrome / acquired immunodeficiency
syndrome
ALC Anti-Leprosy Campaign (ALC)
AMC Anti-Malaria Campaign
ARC Alcohol Rehabilitation Centre
ARV Antiretroviral (drugs)
ASRH Adolescent Sexual and Reproductive Health
BCC Behaviour Change Communication
BES Biomedical Engineering Services
BH-A Base Hospital – Type A
BH-B Base Hospital – Type B
BHT Bed Head Tickets
BIA Bandaranaike International Airport
BMICH Bandaranaike Memorial International Conference Hall
CBR Crude Birth Rate
CCSCH Codex Committee on Spices and Culinary Herbs
CDC Community Dental Clinics
CDR Crude Death Rate
CDS Central Drug Store
CFR Case Fatality Ratio
CIM Cancer Institute Maharagama
CIMIC Civil-Military Cooperation
CIN Cervical intraepithelial neoplasia
CKD Chronic Kidney Disease
CMC Colombo Municipal Council
CMR Child Mortality Rate
CVD Cardiovascular Diseases
DAPH Department of Animal Production and Health
DDG Deputy Director General
DF Dengue Fever
DGH District General Hospital
DGHS Director General of Health Services

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DHF Dengue Haemorrhagic Fever
DHS Demographic and health Survey
DMFT Mean number of Decayed, Missing or Filled Teeth
DNAP District Nutrition Action Plan
DSS Dengue Shock Syndrome
EOH & FS Environment, Occupational Health and Food Safety
eIMMR Electronic Indoor Morbidity & Mortality Return
ELISA Enzyme-linked immunosorbent assay
EMTCT elimination of Mother to Child Transmission
ENAP Every new born Action Plan
ENND Early neonatal deaths
ENNMR Early Neonatal Mortality Rate
EPI Expanded programme on Immunization
EPTB Extra Pulmonary Tuberculosis
ET & R Education Training and Research
ETU Emergency Treatment Unit
EUH Estate and Urban Health
FAC Food Advisory Committee
FBS Fasting Blood Sugar
FC Finance Commission
FCAU Food Control Administration Unit
FHB Family Health Bureau
fIPV fractional Inactive Polio Vaccine
FRC Frozen Red Cell
GAP Good Agriculture Practices
GBV Gender Based Violence
GC/MS Gas chromatography–mass spectrometry
GFATM The Global Fund to Fight AIDS, Tuberculosis and Malaria
GIS Geographic Information System
GMP Good manufacturing practices
GNI Gross National Income
GoSL Government of Sri Lanka
HbA1c Hemoglobin A1C
HDU High Dependency Unit
HEB Health Education Bureau
HIV Human Immunodeficiency Virus
HLA Human Leukocyte Antigen
HLC Healthy Life Style Centres
HMIS Health Management Information System (HMIS)
HPLC High-performance liquid chromatography

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XIX
 HPV Human papilloma virus
HQ&S Health Quality and Safety
HRM Human Resource Management
HRMIS Human Resource Management Information System
HRO High Reliable Organizations
HTC Hospital Transfusion Committees
IARC International Agency for Research on Cancer (IARC)
ICD International Classification of Diseases
ICEAP Institute of Continuing Education for Animal Production
ICTA Information & Communication Technology Agency of Sri Lanka
ICU Intensive Care Unit
IDH Infectious Disease Hospital
IEC Information Education and Communication
IEC Information Education and Communication
IgM Immunoglobulin M
IHR International Health Regulations
ILI Influenza like illness
IMMR Indoor Morbidity and Mortality Return
IMR Infant Mortality Rate
IPV Inactive Polio Vaccine
ISH International Society of Hypertension
IVM Integrated Vector Management
ITI Industrial Technology Institute
JEE Joint External Evaluation
JEE Joint External Evaluation
LAB Laboratory
LIMS Laboratory Information Management System
LKR Sri Lankan Rupees
LPEP Leprosy post exposure prophylaxis
LS Laboratory Services
LSCS A lower (uterine) segment Caesarean section
MAM Moderate Acute Malnutrition
MB Multi-bacillary
MCH Maternal and Child Health
MDR Multi Drug Resistant
MDSR Maternal Death Surveillance and Response
MFA Ministry of Foreign Affairs
MIC Minimal Inhibitory Concentration
MLT Medical Laboratory Technologist
MMR Maternal Mortality Ratio

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MMR Measles, Mumps, and Rubella
MNH Maternal and Neonatal Health
MO/MCH Medical Officer/ Maternal and Child Health
MO/NCD Medical Officer/ Non-Communicable Diseases
MOH Medical Officer of Health
MRI Medical Research Institute
MRSA Methicillin-resistant Staphylococcus aureus
MS Medical Services
MSD Medical Supplies Division
MSG Mother Support Groups
MSMIS Medical Supplies Management Information System
MSU Medical Statistics Unit
NAT Nucleic Acid Testing
NATA National Alcohol and Tobacco Authority
NBC National Blood Centre
NBTS National blood transfusion services
NCCP National Cancer Control Programme
NCI National Cancer Institute
NDCU National Dengue Control Unit
NGO Non-Governmental Organization
NHSL National Hospital of Sri Lanka
NIC National Influenza Centre
NIHS National Institute of Health Sciences
NIP National Immunization Programme
NNMR Neonatal Mortality Rate
NNSS National Nutrition Surveillance System
NOHPP National Oral Health Promotion Program
NPTCCD National Programme for Tuberculosis Control & Chest Diseases
NRR National Renal Registry
NSACP National STD and AIDS Control Programme
NTD Neglected Tropical Diseases
OD Organizational Development
OGP Open Government Partnership
OIC Officer In-charge
OPD Out Patient Department
OPMD Oral Potentially Malignant disorder
PAP Papanicolaou (Papanicolaou smear)
PCI Percutaneous Coronary Intervention
PCR Polymerase Chain Reaction
PCR Polymerase chain reaction

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XXI
 PCU Preliminary Care Unit
PET Protocol for anti-rabies post exposure therapy
PGH Provincial General Hospital
PHEIC Public Health Emergency of International Concern
PHI Public Health Inspector
PHM Public Health Midwife
PHR Personal Health record
PHS Public Health Services
PHVS Public Health Veterinary Services
PI Pathogen Inactivation of Platelets
PLHIV People Living with HIV/AIDS
PMCU Primary Medical Care Unit
PND Perinatal Deaths
PNMR Perinatal Mortality Rate
PNMR Perinatal Mortality Rate
PNMR Perinatal Mortality Rate
PPE Personal Protective Equipment
PPHI Principal Public Health Inspector (PPHI)
PRA Panel reactive antibodies
PTFD Task Force on Dengue Prevention
PWID Persons Who Inject Drugs
PWUD Persons Who Use Drugs
QA/QC Quality Assurance and Quality Control
RAFU Regional Anti Filariasis Unit
RCT Rank container Terminal
RDQA Routine Data Quality Assessment
RE Regional Epidemiologist
RHMIS Reproductive Health Management Information System
RMNCAYHP Reproductive, Maternal, New-born, Child, Adolescent and Youth Health
RMO Registered Medical Officers
RMSD Regional Medical Supplies Division
SARA Service Availability and Readiness Assessment
SARI Severe Acute Respiratory Tract Infections
SBR Still Birth Rate
SDC School Dental Clinics
SDG Sustainable Development Goals
SLAAS Sri Lanka Association for the Advancement of Science
SLENAP Sri Lanka Every New-born Action Plan
SLIDA Sri Lanka Institute of Development Administration

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SMI School Medical Inspection
SPC State Pharmaceutical Corporation
SPHI Supervising Public Health Inspector
SPHM Supervisory Public Health Midwife
SPS Sanitary and Phytosanitary
STD Sexually Transmitted Disease
STEMI ST Elevation Myocardial Infarction
STI Sexually Transmitted Infection
TB Tuberculosis
TCS Tertiary Care Services
TFR Total Fertility Rate
TH Teaching Hospital
TORCH Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19),
Rubella, Cytomegalovirus (CMV), and Herpes
TOT Training of Trainers
U.N. United Nations
U5MR Under five Mortality Rate (U5MR)
UNDP United Nations Development Programme
UNICEF United Nations Children's Fund (United Nations International Children's
Emergency Fund)
VDRL Venereal disease research laboratory
VPD Vaccine Preventable Diseases (VPD)
WEBIIS Web Based Immunization Information System
WFP World Food Programme
WHO/ ISH World Health Organisation and International Society of Hypertension
WP Western Province
WTO World Trade Organization
WWC Well Women Clinic
YED Youth, Elderly and Disability

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 Key Health Indicators 2016

Indicator Year Data Source

Demographic Indicators

Total population (in thousands) 2016* 21,203 Registrar General’s

Department
Land area (sq. km) 1988 62,705 Survey General’s
Department
Population density (persons per sq. km) 2016* 338 Registrar General's
Department
Crude birth rate (per 1,000 population) 2016* 15.6 Registrar General’s
Department
Crude death rate (per 1,000 population) 2016* 6.2

Urban population 2012 18.2 Census of Population &

(%) Housing, 2012
Sex ratio (No. of males per 100 females) 2012 93.8
Child population (under 5 years) % 2012 8.6

Women in the reproductive age group (15-49 years) % 2012 51.0

Average household size (Number of persons per family) 2012 3.8

Socio-economic Indicators

GNI per capita at current prices (Rs.) 2016 546,408 Department of Census
& Statistics
Human 2016 0.768 UNDP, Human
development Development Indices
index and Indicators: 2018
Statistical Update
Unemployment Total 2016 4.4 Department of Census
rate & Statistics
Female 7.0
Male 2.9
Dependency ratio Total 2012 60.2 Census of population &
Housing, 2012
Old-age (60 years and more) 19.8
Young (under 15 years) 40.4
Literacy rate (%) Total 2012 95.7 Census of population &
Housing, 2012
(10 years or Female 94.6
more)
Male 96.9

Pupil teacher ratio Government Schools 2016 18 Ministry of Education

in
Private Schools 20

Pirivenas 10
Singulate mean Female 2012 23.4 Census of population &
age at marriage Housing, 2012
(years)

2
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XXIV
 Indicator Year Data Source

Health and Nutrition Indicators

Life expectancy at
birth (years)
Female 2011- 78.6 Department of Census
2013 and Statistics (Life
Male 72.0 Tables for Sri Lanka
2011-2013 by District
and Sex)
Neonatal mortality rate (per 1,000 live births) 2015* 6.0 Registrar General’s
Department
Infant mortality rate (per 1,000 live births) 2015* 8.5

Under-five mortality rate (per 1,000 live births) 2015* 10.1

Average No. of children born to ever married women in Sri 2012 2.4 Census Population &
Lanka Housing, 2012
Maternal mortality rate (per 100,000 live births) 2014* 25.7 Registrar General’s
Department
Low-birth-weight per 100 live births in government hospitals % 2016 15.5 Medical Statistics Unit

Percentage of 2016 Demographic and

under five Health Survey, 2016
children
Underweight (weight-for-age) 20.5
Wasting (Acute undernutrition or weight-for- 15.1
height)
Stunting (Chronic malnutrition or height-for- 17.3
age)
Primary Health Care Coverage
Indicators
Percentage of pregnant women attended by skilled personnel 2016 99.5 Demographic and
Health Survey, 2016

Percentage of live births occurred in government hospitals 2016 91.7 Medical Statistics Unit

Current contraceptive usage of currently Modern method 2016 53.6 Demographic and
married women age 15-49 years (%) Health Survey, 2016
Traditional method 11.0

Population with access to safe water (%) 2012 81.1 Census Population &
Housing, 2012

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XXV
 Indicator Year Data Source

Health Resources
Government health expenditure as a 2016 1.67 Central Bank of Sri
percent of GNP Lanka - Annual Report
2016, Department of
Government health expenditure as a percent of total 2016 6.2 National Budget -
government expenditure Budget Estimate 2018,
Ministry of Finance and
Planning, Sri Lanka -
Per capita health expenditure (Rs.) 2016 9,081 Annual Report 2016,
Department of state
Accounts, General
Treasury - Financial
Statements for the year
ended 31st December
2016
Medical Officers per 100,000 population 2016 89.5 Medical Statistics Unit

Population per Medical Officer 2016 1,118

Dental Surgeons per 100,000 population 2016 6.8

Nurses per 100,000 population 2016 200.7

Public Health Midwives per 100,000 2016 29.5

population
Number of hospitals 2016 629

Number of hospital beds 2016 81,580

Hospital beds per 1,000 population 2016 3.8

Number of Medical Officer of Health 2016 342

(MOH) Divisions
* Provisional

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XXVII
Health Status
 1. Country Profile
1.1. Background
Sri Lanka, officially known as the Democratic Sri Lanka has a parliamentary democratic
Socialist Republic of Sri Lanka is an island system in which the sovereignty of the people
situated off southern coast of India in the and legislative powers are vested in Parliament.
northern Indian Ocean of South Asia, separated The executive authority is exercised by a
from the Indian sub-continent by a narrow strip Cabinet of Ministers, presided over by the
of shallow water, known as Palk Strait. Sri Lanka Executive President.
lies between northern latitudes 50 55' - 90 50'
and eastern longitudes 790 42' - 810 52'. It has For the purpose of administration, Sri Lanka is
total area of 65,610 square kilometres including divided into 9 provinces, 25 districts and 331
2,905 square kilometres of inland water. divisional secretary areas (Annexure 1: Detailed
Table 1). The provincial administration is vested
The island has a central mountainous region, in the Provincial Councils. Local government
‘Hill country’ with peaks as high as 2,524 meters which is the lowest level of government in Sri
above the sea level and is surrounded by a plain Lanka is responsible for providing supportive
is known as ‘Low country’ which is narrow in services for the public.
East, West and South, broadens in the North. A
number of rivers spring up from the mountain In the year 1931 Universal Franchise was
peaks and flow towards the sea through low granted to all Sri Lankan citizens above the age
lying plains following a radial pattern. These of 18 years and the free education system was
topographical features affect the wind pattern, established in the year 1938. Following
rainfall, temperature, humidity and other independence, the country adapted a free
climatic features. health policy and provides free health care for
all Sri Lankans and it helps to reach higher
The climatic condition of the country is also Human Development Index than all other
affected by its proximity to the equator as well countries in South Asian region.
as the elevation above sea level and the
monsoons. The mean temperature ranges from
26.50C to 28.50C (79.70F to 83.30F) in the low
country and from 140C to 240C (580F to 750F) in
the hill country. Sri Lanka receives an average
2,000 mm of rain annually, amounting to about
130 billion cubic meters of water. The hill
country as well as the South West region
receives sufficient rain. The rest of the island,
mainly the North, North Central and Eastern
parts remain dry for a considerable period of
the year.

Annual Health Bulletin - 2016 1

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 1

1.2. Population size and growth

The fourteenth national Census of Population during the year 2016 to the total population,
and Housing which covered the entire island due to natural increase.
after a lapse of 31 years since 1981 was
conducted by the Department of Census and The first significant decline in Crude Birth Rate
Statistics on 20th March 2012. Data were (CBR) began in 1950s, fertility decline gathered
collected from persons according to their place momentum in 1960s through to the year 2000
of usual residence. According to the final results and has been relatively flat since then (Figure
of the census, enumerated population was 1.2). CBR was 15.6 per 1000 persons in 2016
20,359,439. The first Census of Population in Sri (provisional).
Lanka was held in the year 1871 and population
The rapid mortality decline observed during the
was 2.4 million. So, Sri Lankan population has
post-World War II period in Sri Lanka and
grown more than eight times since the year
gradual decrease can be seen up to 1980s.
1871.
During last few decades, Crude Death Rate
Estimated mid-year population of Sri Lanka for (CDR) was somewhat steady with small
the year 2016 is 21.203 million (Annexure 1: fluctuations and CDR in 2016 was 6.2 deaths per
Detailed Table 2). 1000 population (Provisional).

As shown in Figure 1.1, according to Registrar

General’s Department, annual population
growth rate was 1.13 percent during the year
2016, which added around 200,000 persons

25 3.5

3
20
Population in millions

2.5
Annual growth rate
15 2

10 1.5

1
5
0.5

0 0

Year

Enumerated population Estimated Population Annual growth rate

Figure 1.1: Population Size and Annual Growth Rate, 1901 – 2016
Source: Department of Census and Statistics

Annual Health Bulletin - 2016 2

2 Annual Health Bulletin 2016

 45

Crude Birth Rate Crude Death Rate

40

35

30

25
Rate

20

15

10

Figure 1.2: Crude Birth and Death Rates, 1945 – 2016

Source: Registrar General’s Department

As a result of declining overall mortality and fertility rates and high life expectancy involves
infant mortality rates, life expectancy has in declining share of children and increasing
continuously risen. At the same time low share of elderly.

Annual Health Bulletin - 2016 3

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 3

 60
12.4
and
over
6.6
Percentage of elderly
15-59 62.4 population has doubled during
yrs 58.2
the period 1981 to 2016
0-14 25.2
yrs 35.2

0 20 40 60 80

2016 1981

Figure 1.3: Population by Broad Age Group,

1981 and 2016
Source: Department of Census and Statistics

Accordingly, percentage of child population the last Census of Population & Housing which
(<15 years) in the year 2016 shows a significant was held in the year 2012).
decline compared to the year 1981 and at the
same time working age population as well as According to the report of Census of Population
elderly population show an increase. So, & Housing, 2012, median age of population was
population of Sri Lanka was gradually shifting 31 years which means that half of the
older. (When estimating population for the year population was below the age of 31 years. The
2016, it was assumed that age structure of the median age was around 21.3 years until 1981.
year 2016 remained as same as age structure of

Table 1-1 : Percentage Distribution of Population by Broad Age Groups, Aging Index and
Dependency Ratio
Year 0 - 14 years 15 - 59 years 60 years and Aging Index Dependency
over Ratio
(A) (B) (C) (C/A)*100 (A+C)/B*100
1911 40.9 54.8 4.3 10.5 82.5
1946 37.2 57.4 5.4 14.5 74.2
1971 39.0 54.7 6.3 16.2 82.8
1981 35.2 58.2 6.6 18.8 71.8
2001 1 26.3 64.5 9.2 35.0 55.0
2012 2 25.2 62.4 12.4 49.1 60.2
2015 3 25.2 62.4 12.4 49.1 60.3
2016 3 25.2 62.4 12.4 49.0 60.2
1
Excludes Northern Province, Batticaloa and Trincomalee districts in Eastern province
2
Census of Population and Housing – 2012
3
Estimated midyear population – Registrar General’s Department

Annual Health Bulletin - 2016 4

4 Annual Health Bulletin 2016

 Aging Index defined as the ratio between the 60 It is important to note that working age
years and over population to 0-14-year population was 62.4 percent in 2012 and shows
population in a given year has increased from an increase from 58.2 in 1981, i.e. the working
18.8 percent in 1981 to 49.0 percent in 2016. age population was significantly larger than the
Shifting of median age and increasing trend of dependant population.
aging index are also referring to aging of Sri
Lankan population. Age-Sex Composition Trends

It is noticeable that dependency ratio, which is During the past decades, Sri Lankan population
an approximation of the average number of has changed significantly in size, as well as in
dependents that each person of working age age and sex structure. Changing pattern of age
must support, has decreased from 71.8 in 1981 and sex structure of past, current and future is
to 60.2 in 2016, due to relative decline in the shown in Figure 1.4. A detailed age-sex
proportion of children. breakdown is given in Annexure I: Detailed
Table 3.

In 1981, the base is broad

representing a large number of
children in the population

Working age population has

increased compared to the child
population in 2012

Expected structure in 2041 shows

that growing of elderly
population with less number of
children population

Figure 1.4: Population Trends for Sri Lanka

by Age and Sex, 1981, 2012 and 2041
Source: Census of Population and Housing 2012
– Key Findings, Department of Census and Statistics

Annual Health Bulletin - 2016 5

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 5

Demographic Transition Trends in Age Specific Sex Ratio

Demographic transition is a transition from Sex ratio is the indicator which describes sex
undesirable state of slow growth of population composition of the population.
where mortality and fertility rates are high to a
Sex ratio, defined as number of males per 100
desirable state of slow population growth with
females is 93.8 in Sri Lanka for the year 2016. It
low fertility and mortality levels. As discussed
indicates an excess of females over males, i.e.
above changes in Sri Lankan population size,
population is female biased. When comparing
growth, fertility, mortality and the age structure
the sex ratios in 1981, 2001 and 2016 it shows a
reveal that Sri Lanka is undergoing a phase of
decreasing trend.
demographic transition. Each country
undergoes a period known as a “window of The age specific sex ratios in 2016 are declining
opportunity” during the age structure gradually with increasing age with fluctuations
transition. in some age groups.

Demographic window which is defined by U.N. Sex ratio under 4 years was 101.8 for the year
Population Department as the period when the 2016 which reflects more males among children
proportion of children and youth under less than 4 years of age. According to Registrar
15 years falls below 30 percent and the General’s Department, sex ratio at birth was
proportion of people 65 years and older is 104.5 per 100 females (provisional) for the year
below 15%. Sri Lanka currently has the “window 2016.
of opportunity” or in other words “demographic
dividend” or “demographic bonus” to achieve However, with the increase of age, the sex ratio
rapid economic growth with a larger working shows a decreasing trend indicating more
age population compared to the population in females than males in older age groups.
non- working age population (dependents).

Continuing of aging will lead to decline of

working age population and increase in According to Department of
dependents. According to Department of Census and Statistics, the
Census and Statistics the window of
opportunity for Sri Lanka expected to last about
window of opportunity for Sri
40 years from early 1990’s to early 2030’s. Lanka is expected to last about
40 years from early 1990’s to
early 2030’s

Annual Health Bulletin - 2016 6

6 Annual Health Bulletin 2016

 Table 1-2 : Age Specific Sex Ratio 1981, 2001 and 2016

Age Group in Years Sex Ratio (No of males per 100 females) in Year

19811 20011,2 20163

All Ages 103.9 97.9 93.8

Under 1 104.1 104.5 101.8
1-4 103.8
5-9 103.6 103.1 101.9
10 - 14 104.1 104.5 102.2
15 - 19 102.7 103.6 99.4
20 - 24 100.3 98.0 93.9
25 - 29 99.8 93.8 91.8
30 - 34 102.0 95.4 94.6
35 - 39 100.6 95.2 94.8
40 - 44 106.0 96.6 94.9
45 - 49 102.0 97.1 92.7
50 - 54 111.1 95.9 91.0
55 - 59 110.2 92.8 88.8
60 - 64 116.2 92.7 86.5
65 - 69 111.0 88.0 81.0
70 - 74 115.7 85.0 78.8
75 and Over 107.3 84.6 67.6
1Census of Population & Housing
2 Excludes Northern Province, Batticaloa and Trincomalee districts in Eastern Province
3 Estimated midyear population – RGO

Sex ratio was 93.8 in Sri Lanka for the year 2016. i.e. an excess of females over
males. Up to age 14, sex ratio was over 100, and afterwards all age groups have a
female biased population. In other words, younger age groups and older age groups
have more females.

Annual Health Bulletin - 2016 7

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 7

Population Density shows an increase of 47 percent from 230
persons per square kilometre since 1981.
Population density is defined as number of
persons in a unit area. It is vital to study Population densities among districts show
population density by districts, as overcrowding marked regional variations. Colombo district
might lead to many health hazards. shows the highest density of 3,543 persons per
Population density for the year 2016 was square kilometre in 2016. The next highest
338 persons per square kilometre which density of 1,769 was recorded from the
adjoining district Gampaha.

Over half of the population is

concentrated in the Western,
Central and Southern provinces
which jointly cover less than
one fourth of the total land
area of the country

Figure 1.5: Population Density by District, 2016

Source: Registrar General’s Department

Annual Health Bulletin - 2016 8

8 Annual Health Bulletin 2016

 1.3. Introduction to Sri Lankan specialized allopathic hospitals are by the
Health Sector provincial health authorities. Ministry of Health,
Nutrition and Indigenous Medicine of the
The Sri Lankan health system comprises of central government is also responsible in
different systems of medicine; Traditional, ensuring resources for health such as trained
Western, Ayurwedhic, Unani, Sidha, human resources, drug supply and major health
Homeopathy and Acupuncture. Of these, the infrastructure developments.
western or allopathic medicine is the main
sector catering to the needs of the majority. 1.4. Trends in Life Expectancy
Allopathic medicine is provided through both
public and the private sector, the share of care
Life expectancy is the average number of
being different for inpatients and outpatients.
years a person would live under the current
The public sector provides bulk of inpatient
pattern of mortality
care, providing a safety net to citizens.

More than six million hospitalizations occurred

Life expectancy for both males and females has
in 2016. A total of fifty-three million outpatient
been increased for the past decades. Gender
visits occurred in 2016 in public sector. The
differences can be seen in Sri Lanka’s life
public sector has an extensive network of
expectancy at birth. “Life Tables for Sri Lanka
health care institutions and has a system for
2011 – 2013 by District and Sex” published by
Ayurvedhic care. The private sector provides
Department of Census and Statistics shows that
access to all types of care at a cost while the
life expectancy at birth was 72 years for males
public sector provides the free health facilities.
and 78.6 years for females during the period
2011 - 2013.
The public health sector is organized as two
parallel streams:

- community health services focusing

mainly on promotive and preventive
health
- curative care services ranging from non-
specialized primary care to specialized
care delivered through a variety of
hospitals

Ministry of Health, Nutrition and Indigenous

Medicine of the central government is the
leading agency providing stewardship to health
service development and regulation. The
delivery of care in public sector is decentralized
and management of primary care in some

Annual Health Bulletin - 2016 9

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 9

 90

80

70

60

50
Years

40

30

20

10

Time period

Male Female

Figure 1.6: Life Expectancy at Birth by Sex, 1920 – 2013

Source: Department of Census and Statistics

1.5. Trends in Fertility Rates

Table 1.3 reveals that the TFR declined steadily

Total Fertility Rate (TFR), of a from 2.8 in the year 1987 to 1.9 in the year
population is the average number of 2000, which was below the replacement level of
children that would be born to a
fertility (Replacement level of fertility is defined
woman over her lifetime if she were to
as an average of 2.1 children per woman).
experience the exact current age-
Afterwards it increased to above the
specific fertility rates through her
replacement level of fertility during the period
lifetime and she were to survive from
2003 to 2012. Currently TFR is 2.2 children per
birth through the end of her
woman according to the Demographic and
reproductive life.
Health Survey (DHS) 2016.

Annual Health Bulletin - 2016 10

10 Annual Health Bulletin 2016

 Table 1-3 : Age-Specific Fertility Rates (per 1,000 women) and Total Fertility Rates, 1987 – 2016

Age 2013-2016 CPH 2012 2004-2007 1995-2000 1988-1993 1982-1987

Group DHS 2016 DHS 2006/07 DHS 2000 DHS 1993 DHS 1987
(Years)

15 - 19 21 36 28 27 35 38

20 - 24 86 107 101 83 110 147

25 - 29 143 147 145 118 134 161

30 - 34 115 118 121 98 104 122

35 - 39 55 58 54 40 54 71

40 - 44 10 16 13 8 14 23

45 - 49 1 2 1 1 4 3

TFR 2.2 2.4 2.3 1.9 2.3 2.8

Source: Department of Census & Statistics

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 11

2.Morbidity and Mortality

Morbidity
Morbidity refers to the state of being diseased or unhealthy within a population.
Information on morbidity is one of the main useful information to measure country’s
health condition which reflects the development of the country. Incidence rates and
prevalence rates are major morbidity indicators. Morbidity data is collected according
to the disease type, gender, age and area of hospitalization.

Mortality
In demography, mortality usually refers to the incidence of death or the number of
deaths in a population. It plays a vital role in determining the size, growth and structure
of population. It is considered as the most striking demographic event all over the
world.

Mortality trends reflect health conditions of any country. Mortality statistics are used
in areas such as public health administration to identify health sector needs and to
evaluate the progress of public health programmes in different areas.

Furthermore, collection and analysis of mortality information helps:

a) to identify levels and trends of mortality
b) to identify patterns and trends in the causes of death and their impact on
mortality
c) to observe age patterns of mortality
d) to compare the mortality patterns between sub populations
e) to identify the demographic, social, economic, behavioral and environmental
factors which influence levels and trends in mortality
f) to compare mortality levels between different populations

Various indicators are computed using both morbidity and mortality information such as
Cause-Specific Death Rates, Case Fatality Rates, Crude Death Rate, Maternal Mortality
Ratio, Child Mortality Rate, Standardized Mortality Rates and Age Specific Mortality Rates,
etc.

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12 Annual Health Bulletin 2016

 In Sri Lanka, both morbidity and mortality the International Classification of Diseases (ICD-
information are collected using the IMMR 10 version). Since 2012, MSU has introduced a
(Indoor Morbidity and Mortality Return) in each web-based system called eIMMR to collect
government hospital and processed by the morbidity and mortality data.
Medical Statistics Unit (MSU). This system has
been collecting morbidity and mortality data Hospitals which have computer and internet
since 1985. Since IMMR provide data of only facilities can send their data through eIMMR.
hospital deaths and more than 70% of the Accurate, detailed and timely data collected
deaths occur in the field, mortality information through eIMMR from around four hundred
is also collected from the vital registration hospitals are processed and published in this
system which was established in 1867. report.

The main mortality indicators computed are

age-sex specific mortality rates and number of IMMR collects data only from
deaths. patients admitted to government
western medicine practiced
institutions.
2.1. Hospital Morbidity and
Mortality
In Sri Lanka, morbidity data is available only on 2.2. Hospital Morbidity
patients seeking treatment as inpatients from
government hospitals providing western Data Collection Methodology
medicine. Morbidity data of patients attending
the outpatient departments of government The final diagnosis, as mentioned in the Bed
hospitals are not available. Data from the Head Tickets (BHT’s) of the patients, are
private sector are also not routinely collected. recorded in a formal register, and then
summarized to complete the IMMR return.
All the Ayurveda institutions; both government Hospitals which sent data through eIMMR can
and private sectors are still not absorbed into directly enter the final diagnosis of patient into
the data collection system. There are some the system and system generates the IMMR
other limited information collecting systems report. It is a duty to be performed by a Medical
through surveys and registers maintained by Recording Officer in the hospital record room or
special campaigns and programmes for control the hospital statistics unit. However, since there
of diseases such as TB, Cancer and Leprosy, etc. are limited number of qualified Medical
Recording Officers in the system, other staff
The Indoor Morbidity and Mortality Return categories such as Medical Recording
(IMMR) is the main source of morbidity data. Assistants, Planning and Programming Officers,
This return is collected quarterly by the Medical Planning and Programming Assistants, and
Statistics Unit (MSU) from all government Development Officers are involving in the said
hospitals which have indoor facilities. Since activity.
1996, the IMMR is based on the 10th revision of

Annual Health Bulletin - 2016 13

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 13

Registered/Assistant medical officers or originating in the perinatal period (P00-P96)
sometimes medical officers, also engage in and injury, poisoning and certain other
compilation of inpatient statistics in the consequences of external causes (S00-T98) have
hospitals. Though these officers are mainly experienced a slight increase from 2014.
employed to attend in the patient care, they
perform the statistical activities as an additional Number of cases related to some disease
duty. groups such as certain infectious and parasitic
diseases (A00-B99), diseases of the circulatory
system (I00-I99), diseases of the skin and
In 2016, 6.02% of the live discharges subcutaneous tissue (L00-L99) and congenital
and 10.54% of the deaths are reported malformations, deformations and chromosomal
as undiagnosed or un-coded. abnormalities (Q00-Q99) have reported a slight
decrease from 2014 to 2015 but again it has
It should be noted that repeat visits, transfers been increased in 2016.Cases of, Pregnancy,
and multiple admissions of the same patient for childbirth and the puerperium (O00-O99) have
the same disease are reflected in the morbidity experienced a slight decrease from 2013.
data as additional cases. Therefore, the
In spite of the efforts taken to improve the
morbidity data available in Sri Lanka should be
quality of the final diagnosis in the patient
interpreted with caution, considering the above
records, the group named symptoms, signs and
limitations.
abnormal clinical and laboratory findings not
elsewhere classified (R00-R99), has still
Trends in hospital morbidity and mortality
increased.
Annexure 01: Detailed Table 16, gives trends in
hospital morbidity and mortality by ICD broad For the year 2016, 6,449,753 live discharges and
disease groups for the period 2008 - 2016. 48,020 deaths have been recorded in
government hospitals. 50% out of the live
As shown in the said table, morbidity due to discharges and 59% out of the deaths are
“neoplasm (C00-D48)”, “diseases of the blood & males. (Figure 2.1). As shown in Figure 2.2
blood-forming organs & certain disorders gender difference is high in hospitalizations as
involving the immune mechanism (D50-D89)”, well as in deaths due to traumatic injuries.
diseases of the eye and adnexa (H00-H59)”, When concerning total live discharges due to
“diseases of the ear and mastoid process (H60- traumatic injuries 67 percent are male, and out
H95)” and “diseases of the digestive system of total deaths due to traumatic injuries 77
(K00-K93)” have been continuously increasing percent are male.
from 2010. Endocrine, nutritional and metabolic
diseases (E00-E90), mental and behavioral
disorders (F00-F99), diseases of the nervous
system (G00-G99), diseases of the
musculoskeletal system and connective tissue
(M00-M99), diseases of the genitourinary
system (N00-N99), certain conditions

Annual Health Bulletin - 2016 14

14 Annual Health Bulletin 2016

 70
58.8
60
49.9 50.1
50
41.2
Percentage

40

30

20

10

0
Live Discharges Deaths

Male Female

Figure 2.1: Percentage of Hospital Live Discharges and Deaths by Gender, 2016
Source: Medical Statistics Unit, Ministry of Health

90.0
80.0 76.7
66.8
70.0
60.0
Percentage

50.0
40.0 33.2
30.0 23.3
20.0
10.0
0.0
Live Discharges Deaths

Male Female

Figure 2.2: Distribution of Live Discharges and Deaths due to Traumatic Injuries by Gender, 2016
Source: Medical Statistics Unit, Ministry of Health

Annual Health Bulletin - 2016 15

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 15

Annexure 01: Detailed Table 17 shows the Table 20 presents trends in leading causes of
trends of some selected diseases. Increasing hospitalization during the period 2007-2016).
trend is shown in hospitalizations due to
following diseases over the last six years. Symptoms, signs and abnormal clinical and
laboratory findings which was the third leading
 Ischemic heart diseases (455.4 in 2011 cause from 2003 to 2008, ranked as the second
and 540.5 in 2016 per 100,000 since 2009 until 2016. Diseases of the
population) respiratory system became the third leading
 Anaemias (98.7 in 2011 and 156.9 in cause since 2009 and it was second up to 2008.
2016 per 100,000 population) Hospitalizations due to diseases of the gastro-
 Septicaemia (17.7 in 2011 and 56.1 in intestinal tract became the fourth leading cause
2016 per 100,000 population) from the year 2014 and it was ranked as the
fifth leading cause since 2006.
Leading Causes of Hospitalization During 2016, hospitalizations due to viral
diseases was the fifth leading cause of
There was no change in the first 5 leading hospitalization for the country. However, it was
causes of hospitalization for 2016 compared still the fourth leading cause for Colombo and
with 2015. Neoplasms was ranked as the 11th Galle districts according to statistics given in the
leading cause in 2016 whereas it was the 12th Annexure 01: Detailed Table 22.
leading cause in 2015. Traumatic injuries ranked Diseases of the urinary system are being
as the major cause of hospitalization over the important cause of hospitalization and it is
last ten years as well as in 2016. (Annexure 01: ranked as sixth in 2016. Hospitalizations due to
Detailed Table 18 gives the leading causes of diseases of the eye and adnexa remained the
hospitalization of the country, and Annexure tenth leading cause since 2012.
01: Detailed Table 22 indicates the district Graphical representation of the leading causes
profile of the same. Annexure 01: Detailed of hospitalization is given in Figure 2.3

Traumatic injuries (S00-T19, W54) has been the major cause for
hospitalization with 1,015,426 cases reported in 2016.
Fortunately, the percentage of deaths due to traumatic injuries
is only 0.2%

Annual Health Bulletin - 2016 16

16 Annual Health Bulletin 2016

 Traumatic injuries (S00-T19, W54)

Signs, symptoms and abnormal clinical findings (R00-R99)

Diseases of the resp. system exclu... (J20-J22, J40-J98)

Diseases of the gastrointestional tract (K20-K92)

Viral diseases (A80-B34)

Diseases of the urinary system (N00-N39)

Direct and indirect obstetric causes

Diseases of skin ad subcutaneous tissue (L00-L08,L10-L98)

Disorders of the musculoskeletal system (M00-M99)

Diseases of the eye and adnexa (H00-H59)

Neoplasms (C00-D48)

Intestinal infectious diseases (A00-A09)

0 1000 2000 3000 4000 5000

Male Female
Cases per 100,000 Population

Figure 2.3 : Leading Causes of Hospitalization, 2016

Source: Medical Statistics Unit, Ministry of Health

2.3. Hospital Mortality

Mortality due to neoplasms, certain infectious

and parasitic diseases, endocrine, nutritional
and metabolic diseases, diseases of the skin and
subcutaneous tissue, diseases of the Only 30-40 percent of
musculoskeletal system and connective tissue registered deaths occur in
and injury, poisoning and certain other
government hospitals
consequences of external causes increased in
2016 in comparison with 2015. (Annexure 01:
Detailed Table 16)

It was estimated that only 30-40 percent of

registered deaths occur in government
hospitals.

Annual Health Bulletin - 2016 17

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 17

 Neoplasms ranked as the second leading cause
2.3.1. Leading Causes of Hospital of death since 2010. Higher number of deaths
Deaths associated with neoplasms in Colombo, Kandy,
Galle, Jaffna, Badulla, Kurunegala and
Deaths per 100,000 population for the top ten Anuradhapura districts was a result of cancer
causes are shown in the Figure 2.4. There was a patients being transferred to the Teaching
considerable gender difference in the number Hospitals in Maharagama (Colombo district),
of deaths per 100,000 population according to Kandy, Karapitiya, Jaffna, Anuradhapura and
the figure 2.4. Male deaths were relatively Provincial General Hospitals in Badulla and
higher than corresponding female deaths for Kurunegala where advance facilities for the
major leading causes of deaths. treatments of neoplasms are available.

Ischaemic heart disease (I20-I25)

Neoplasms (C00-D48)

Zoonotic and other bacterial diseases (A20-A49)

Pulmonary heart disease and diseases of the pulmonary

circulation (I26-I51)

Diseases of the resp. system exclu... (J20-J22, J40-J98)

Cerebroavascular disease (I60-I69)

Pneumonia (J12-J18)

Diseases of the urinary system (N00-N39)

Diseases of the gastrointestional tract (K20-K92)

Traumatic injuries (S00-T19, W54)

0 5 10 15 20 25 30

Male Female Deaths per 100,000 Population

Figure 2.4 : Leading Causes of Hospital Deaths, 2016

Source: Medical Statistics Unit, Ministry of Health

Zoonotic and other bacterial diseases grew the year 2014 and fell to be the sixth leading
from the sixth leading cause from 2010 to 2013 cause of death in 2015 and 2016. Leading
to the third leading cause of death from 2014 to causes of death for children in the age group of
2016. Cerebrovascular disease which was the 0 to 4 years are presented in the Figure 2.5.
third leading cause in 2013, ranked as fifth in

Annual Health Bulletin - 2016 18

18 Annual Health Bulletin 2016

 Percentage of total deaths of children age 0-4 years

Slow fetal growth, fetal malnutrition and... (P05-P07)

Other conditions originating in the perinatal period (P00-

P04, P08-P96)

Congenital malformations deformations... (Q00-Q99)

Other bacterial diseases (A20-A49)

Pneumonia (J12-J18)

Diseases of the resp. system exclu... (J20-J22, J40-J98)

Diseases of the nervous system (G00-G98)

Neoplasms (C00-D48)

0.0 5.0 10.0 15.0 20.0 25.0

Figure 2.5 :Leading Causes of Hospital Deaths for Children Aged between 0-4 Years, 2016
Source: Medical Statistics Unit, Ministry of Health
deformations and chromosomal abnormalities
As shown in Figure 2.5, other conditions (Q00-Q99) were second and third leading
originating in the perinatal period (P00-P04, causes of death respectively.
P08-P96) and congenital malformations

The major leading causes of death for children (0-4 years) was slow fetal
growth, fetal malnutrition and disorders related to short gestation and
low birth weight

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 19

2.3.2. Case Fatality Rate
the selected diseases. Other than that case
According to 2016 hospital statistics, septicemia
fatality rates of shigellosis, slow fetal growth,
case fatality rate has been reported as the
fetal malnutrition and disorders related to short
highest rate which was 40.2/100 cases and it
gestation and low birth weight, viral hepatitis
has steadily risen since 2012 (Annexure 1
and liver diseases increased in 2016 compared
Detailed Table 26). Case fatality rate of
to 2015.Graphical representation of the trends
pneumonia is also continuously increasing from
in case fatality rates of some selected diseases
2011. It was remaining as the second highest
are given in Figure 2.6.
case fatality rate from 2014 up to 2016 among

Tetanus
45
40 Slow fetal growth, fetal
malnutrition and disorders
35 related to short gestation
and low birth weight
Diseases of the liver
30
25 Septicaemia

20 Ischaemic heart disease

15
Pneumonia
10
5 Bactrial meningitis

0
Neoplasms
2011 2012 2013 2014 2015 2016

Figure 2.6: Trends in Case Fatality Rates of Selected Diseases, 2012 – 2016
Source: Medical Statistics Unit, Ministry of Health

2.4. Registration of Deaths What is disturbing was the relatively large

number of such causes of death among the
In Sri Lanka 80 percent of registrars who urban deaths, which are predominantly
register deaths, are non-medical registrars. The medically confirmed or at least medically
cause of death given by the non-medical examined.
registrars may not be as accurate as desired.
This was evident by the large number ascribed
to symptoms, signs and ill-defined conditions.

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20 Annual Health Bulletin 2016

 3. Health Related Sustainable Development Goals
(SDG)
promote sustainable agriculture” (Goal 2),
United Nations Member States agreed to the “Ensure inclusive and equitable quality
2030 Sustainable Development Agenda (the education and promote lifelong learning
“Agenda”) which covers economic opportunities for all” (Goal 4), “Achieve gender
development, social inclusion and equality and empower all women and girls”
environmental sustainability in the summit held (Goal 5), “Ensure availability and sustainable
in September 2015. The Agenda includes 17 management of water and sanitation for all”
Sustainable Development Goals and 169 targets (Goal 6). In essence, all SDGs are
which began to be implemented in, 2016. interconnected; therefore, achieving goals
related to SDG 3 is also dependant on achieving
Health status of the country falls under the these other goals.
Sustainable Development Goal 3 (SDG 3) named
as “Ensure healthy lives and promote well-being The Ministry of Health, Nutrition and
for all at all ages”. Indigenous Medicine had several stakeholder
meetings to identify suitable indicators which
The Goal 3 includes 13 targets related to child are practical and capable of achieving the SDG 3
health, maternal health, HIV/AIDS and other targets. This process identified forty four
diseases, focusing mainly on Universal Health indicators, preferred data sources and base line
Coverage (UHC). values to track achieving SDG 3 target of
ensuring healthy lives and promote wellbeing
Achieving SDG 3 is also affected by status of for all at all ages. Out of the 44 indicators, 35
other SDGs such as “End poverty in all its forms are on SDG 3 and the remain 9 indicators are on
everywhere” (Goal 1), “End hunger, achieve other non-health indicators but related to
food security and improved nutrition and health.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 21

There are 13 targets to be achieved in SDG3. They are:

Target 3.1 By 2030, reduce the maternal mortality ratio less than 70/100,000 live births
Target 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age,
with all countries aiming to reduce neonatal mortality to at least as low as 12 per
1000 live births and under 5 mortality to at least as low as 25 per 1000 live births
Target 3.3 By 2030, end the epidemics of AIDS, Tuberculosis, Malaria and Neglected Tropical
diseases and combat hepatitis, water borne diseases and other communicable
diseases
Target 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases
through prevention and treatment and promote mental health and well-being
Target 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic
drug abuse and harmful use of alcohol
Target 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents
Target 3.7 By 2030, ensure universal access to sexual and reproductive health care services,
including for family planning, information and education, and the integration of
reproductive health into national strategies and programmes
Target 3.8 Achieve Universal Health Coverage, including financial risk protection, access to
quality essential health care services and access to safe, effective, quality and
affordable essential medicines and vaccines for all
Target 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination
Target 3.10 Strengthen the implementation of the WHO Framework convention on Tobacco
control in all countries as appropriate
Target 3.11 Support the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health,
which affirms the right of developing countries to use to the full the provisions in
the Agreement on Trade- Related aspects of intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines
for all

Target 3.12 Substantially increase health financing and the recruitment, development, training,
and retention of the health workforce in developing countries, especially in least
developed countries and small island developing states
Target 3.13 Strengthen the capacity of all countries, developing countries, for early warning, risk
reduction and management of national and global high risks

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22 Annual Health Bulletin 2016

 4. Reproductive, Maternal, New-born, Child
Adolescent and Youth Health
4.1. Maternal and Child Health
4.1.1. Maternal Mortality Ratio

A maternal death is defined as the death of a The Maternal Mortality Ratio (MMR) has been
woman while pregnant or within 42 days of very high in the past, fluctuating between 2,650
termination of pregnancy, irrespective of the in the year 1935 and 1,550 in the year 1946 per
duration and site of the pregnancy, from any 100,000 live births. A dramatic fall in the MMR
cause related to or aggravated by the in the post-world war period is observed.
pregnancy or its management but not from According to Registrar General’s Department
accidental or incidental causes. MMR for the year 2014 is 25.7 per 100,000 live
births (provisional).

Maternal Mortality Ratio ( Per 100,000 Live Births)

Infant Mortality Rate ( Per 1,000 Live Births)
1,800 160
149.0
1,600 1,652.0
140

1,400
120
1,200
100
1,000
80
800
57.0
Infant Mortality Rate 60
600 555.0
40
400 Maternal Mortality Ratio 24.2
145.0 14.3 20
200 9.9
42.0 16.3 22.0
0 0

Figure 4.1: Trends in Maternal and Infant Mortality Rates, 1940 – 2014
Source: Medical Statistics Unit, Ministry of Health

Annual Health Bulletin - 2016 23

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 23

 60 55.6
53.4

50
44.3
42
40.2
46.6 38.4 37.7
40
33.8
40 39.3 31.1 32
MMR

30 33.7
33.4 32.5 32.5

20

10

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year

National MMR

Figure 4.2: National MMR 2000 – 2016

Source: Maternal & Child Morbidity & Mortality Surveillance Unit - Family Health Bureau

250

194
200
167 167
160
154
144 146 141
No. of deaths

150 133 134

126
118 119
112 113 112

100

50

0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year

Figure 4.3: Number of Maternal Deaths (2001 – 2016)

Source: Maternal & Child Morbidity & Mortality Surveillance Unit - Family Health Bureau

Annual Health Bulletin - 2016 24

24 Annual Health Bulletin 2016

 Direct Indirect
Maternal Mortality Ratio is the
number of maternal deaths (excluding
accidental or incidental causes) per 56% 44%
100,000 live births for a specified year
Figure 4.4 : Maternal deaths by categories

Family health Bureau is collected maternal

Maternal mortality ratio remains
mortality through the Maternal Death
static over the past few years
Surveillance and Response (MDSR) system.
According to MDSR system MMR is 33.8 per
100,000 registered live births (provisional) for Most of the deaths are due to
the year 2016 Obstetric Haemorrhages and heart
disease complicating pregnancy
According to RHMIS of the Family Health
Bureau, in 2016 there were 112 maternal
deaths in the country.

Out of 112 deaths 65 (56%) were due to direct

causes whereas 47 (44%) were due to indirect
causes.

Figure 4.5 shows the leading causes of maternal

deaths in 2016. According to the figure,
Obstetric Haemorrhages and Heart disease
complicating pregnancy account to highest
number of maternal deaths.

Direct maternal deaths -Deaths resulting from obstetric complications of the pregnant state
(pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment or
from a chain of events resulting from any of the above.

Indirect maternal deaths -Deaths resulting from previous existing disease or disease that
developed during pregnancy and not due to direct obstetric causes but aggravated by the
physiologic effects of pregnancy.

Annual Health Bulletin - 2016 25

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 25

 Obstetric Haemorrhage 18

Heart Disease 13

Sepsis 9

CNS Disease 9

Malignancy 9

Respiratory Disease 8

Hypertensive disorders 8

Amniotic fluid embolism 8

Liver Disease 8

Septic Abortion 5

Dengue Haemorrhagic Fever 4

DVT / Pulmonary Embolism 3

Ectopic Pregnancy 3

Other 7

0 5 10 15 20

Figure 4.5: Leading causes of maternal deaths in 2016

Source: Maternal & Child Morbidity & Mortality Surveillance Unit - Family Health Bureau

Annual Health Bulletin - 2016 26

26 Annual Health Bulletin 2016

 Kilinochichi 81.7
2
Nuwara-Eliya 81.6
8
Mannar 57.3
1
Puttalam 52.6
7
Trincomalee 51.1
4
Badulla 50.6
8
Gampaha 50.1
12
Matale 43.3
4
Kegalle 42.5
4
Anuradhapura 38.9
6
Ampara / Kalmunai 36.9
5
Jaffna 36.3
3
Matara 36.1
4
Batticaloa 32.7
3
Kandy 30.1
8
Kurunegala 30.0
7
Polonnaruwa 28.0
2
Ratnapura 27.5
5
Colombo 24.0
12
Kalutara 21.1
3
Galle 15.9
3
Monaragala 14.9
1
Vavuniya
0
Mullativu
0
Hambantota
0
0 10 20 30 40 50 60 70 80 90

MMR Deaths

Figure 4.6: MMRs and maternal deaths by district

Source: Maternal & Child Morbidity & Mortality Surveillance Unit - Family Health Bureau

Kilinochchi and Nuwaraeliya

districts had the highest
maternal mortality ratio

Annual Health Bulletin - 2016 27

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 27

4.1.2. Still Birth Rate

During 2016, a total of 303,593 live births and In order to reduce the still birth rate from
1,823 still births took place in government 6.4/1000 (births reported from RHMIS system)
hospitals (Annexure 01: Detailed Table 40). This in 2013 to 3.5/1000 total births by the end of
was a decrease of 4.7% in still births when 2025, as given in Every New-born Action Plan
compared with 2015. According to the Medical (WHO 2014), a still birth rate of 4.5/1000 total
Statistics Unit, still birth rate in the state sector births by 2020 must be achieved. Given that the
hospitals of Sri Lanka was reported to be 6.0 per still birth rate showed an annual decline of 4.6%
1000 (total births occurred in government for the period of 2007 – 2013 (SLENAP, 2017), it
hospitals) in 2016. The highest still birth rate appears that the country was on course to
was reported from hospitals in NuwaraEliya achieve the goals for stillbirths.
district, and it was 11.5, which is close to twice
the national figure. This may be due to the fact
that, NuwaraEliya district is different from other
districts in climate, sector distribution and many
other demographic and socio-economic factors. The highest still birth rate was
The lowest still birth rate was from Trincomalee reported from NuwaraEliya
which was 2.8.
district, which was about twice
According to RHMIS, still birth rates have been the national figure
falling over the years.

8
7.1 6.9
7 6.4 6.5
5.9 5.9
6

5
Rate

0
2011 2012 2013 2014 2015 2016
Year
Figure 4.7: Still Birth Rate
Source: RHMIS 2016, Family Health Bureau

Annual Health Bulletin - 2016 28

28 Annual Health Bulletin 2016

 4.1.3. Neonatal Mortality Rate Due to a strong clinical focus, the neonatal
mortality rate (NNMR) has steadily decreased
over the last 5 years.
Early neonatal mortality refers to a death of a
live-born baby within the first seven days of life,
According to the Registrar General’s
while late neonatal mortality covers the time
Department, the NNMR rate recorded for 2015
after 7 days until before 28 days.
was 6.0(Provisional) per 1,000 live births. The
Neonatal Mortality Rate for the year 2015
Early Neonatal Death Rate (ENDR) was
(provisional) produced by the Registrar
compared globally as an important indicator in
General’s Department by districts are given in
Every New Born Action Plan (ENAP). ENDR for
annexure 01 (Annexure 01: Detailed Table 4).
2016, reported by RHMIS, was 4.4 per 1000 Live
Births (Figure 4.8).
According to Demographic and Health Survey –
2016, Neo-natal Mortality Rate is 7 per 1,000
Foeto- infant mortality surveillance by FHB
live births for the year 2016.
collects individual data by each case and
analyse in detail. Surveillance data for 2015
indicate ENDR of 4.8 where as RHMIS system Neonatal Mortality Rate is defined as
for same year has reported 4.9. These the number of neonates (an infant aged
indicators need to be compared with data from 28 days or less) dying before reaching 28
days of age, per 1,000 live births in a
civil registration system.
given year

6.0 5.6
5.1
4.8 4.9
5.0 4.5 4.4

4.0
Rate

3.0

2.0

1.0

0.0
2010 2011 2012 2013 2014 2015 2016 2017
Year

Figure 4.8: Early Neonatal Mortality Rate

Source: RHMIS 2016, Family Health Bureau

Annual Health Bulletin - 2016 29

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 29

In order to achieve the target goal of Every To achieve the targets set for 2030 for,
Newborn Action Plan (WHO 2014) of a Neonatal Neonatal Mortality Rates, and Still Birth Rates,
Mortality Rate of 3.4/1000 Live Births by 2025 it priority packages of interventions have been
is required for the country to reach a Neonatal identified to strengthen care during labour and
Mortality Rate of 4.2/1000 Live Births by 2020. child birth, essential newborn care, care of the
A Time series analysis of Neonatal Mortality sick and small newborn and care beyond
Rates from 1996 – 2012 depict that the country newborn survival.
can achieve the expected target if we continue
to reduce the neonatal mortality with the same
rate of reduction as shown from (1996-2012).

6.6 6.8 6.6

7 6.5
6.2
5.8
6

5
Rate

0
2011 2012 2013 2014 2015 2016
Year

Figure 4.9: Neonatal Mortality Rate

Source: RHMIS 2016, Family Health Bureau

Annual Health Bulletin - 2016 30

30 Annual Health Bulletin 2016

 Table 4-1: Epidemiology of Perinatal Deaths in 2015 as reported from the Foeto -infant Morbidity
and Mortality Surveillance

Specialized Non- Private Hospitals of Number/

hospitals specialized / hospitals Forces Non-weighted
peripheral rate
hospitals

No. of 81 494 11 4 590

Hospitals
Live births 303705 8760 9129 413 322,007

Stillbirths 1694 9 22 3 1,728

Total births 305399 8769 9151 416 323,735

ENND 1540 1 14 Nil 1,555

PND 3234 10 36 3 3,283

Stillbirth rate 5.5 1.0 2.4 7.2 5.3

ENNMR 5.0 0.1 1.5 Nil 4.8

PNMR 10.5 1.1 3.9 7.2 10.1

 ENND – Early Neonatal Deaths

 PND – Perinatal Deaths
 ENNMR – Early Neonatal Mortality Rate
 PNMR – Perinatal Mortality Rate

Source: Foeto -infant Morbidity and Mortality Surveillance System, Maternal & Child Morbidity & Mortality Surveillance Unit -
Family Health Bureau

Annual Health Bulletin - 2016 31

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 31

4.1.4. Infant Mortality Rate

The IMR for the year 2015 (provisional) In 2016, 2,545 infant deaths have been
produced by the Registrar General’s reported with an Infant Mortality Rate (IMR) of
Department by districts are given in Detailed 8.2 for 1000 live births from routine RHMIS.
Table 4 (Annexure 1). IMR for the year 2015 is
8.5 per 1,000 registered live births. According to Out of infant deaths, 55% were due to non-
Demographic and Health Survey – 2016 Infant preventable congenital abnormalities, while
Mortality Rate is 10 per 1,000 live births for the nearly 45% were due to preventable causes:
year 2016. prematurity, asphyxia and neonatal sepsis.
Out of total infant deaths, 1793 (70.5%) were
Infant Mortality Rates of Sri Lanka have reduced due to neonatal deaths. Out of neonatal deaths,
to the level of many high-income countries. 1353 (75%) were early neonatal deaths.

20.0

18.0 17.2

16.0

14.0 13.1

12.0
10.3
10.0 8.8 8.6 9.2
10.1 8.2
8.0
8.5 8.2
6.0

4.0

2.0

0.0
1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

IMR(RG) IMR(RH MIS)

Figure 4.10: Comparison of trends in National IMRs determined from RH – MIS and Registrar
General’s Department
Source: RHMIS 2016, Family Health Bureau

Annual Health Bulletin - 2016 32

32 Annual Health Bulletin 2016

 Congenital Abnormalities 54.5

Prematurity 27.1

Asphyxia 10.1

Neonatal Sepsis 8.3

0 10 20 30 40 50 60

Figure 4.11 : Percentage distribution of cause of infant deaths 2016

Source: RHMIS 2016, Family Health Bureau

4.1.5. Under Five Mortality Rate

The Under Five Mortality Rate is the
Latest information on under-five mortality number of deaths of children less than 5
published by the Registrar General’s years old per 1,000 live births per year
Department is given in Table 4.2 except in the
year 2005, under-five mortality has shown
steadily decreasing trend. The higher rate
reported in the year 2005 reflects the deaths According to Demographic and Health
due to the Tsunami disaster which occurred in Survey – 2016
end of the year 2004. According to
Demographic and Health Survey – 2016 under- - Under Five Mortality Rate
five mortality rate is 11 per 1000 live births. (U5MR) is 11 per 1000 live
births
The Child Mortality Rate (CMR) was defined as
the number of deaths of children between the - Child Mortality Rate (CMR) was
first and fifth birthday, per 1,000 children 1 death per 1,000 children
surviving to age one. According to the surviving to 12 months of age
Demographic and Health Survey - 2016, Child
Mortality Rate was 1 death per1,000 children
surviving to 12 months of age.

Annual Health Bulletin - 2016 33

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 33

Table 4-2: Under Five Mortality Rate per 1,000
Registered Live Births

Year Under Five Mortality Rate

per 1,000 Live Births 26.7
29.1
2001 15.2
2002 13.7
2003 13.5
2004 12.6
2005 19.0
7.8
2006 12.0
1.8
2007 10.4
34.5
2008 11.1
2009 12.1 Accident Congenital abnormalities

2010 12.2 Diarrhoeal diseases Respiratory diseases

2011* 10.9 Other
2012* 10.3
2013* 10.0 Figure 4.12: Percentage distribution of cause
of 1-5-year child deaths 2016
2014* 9.4
Source: RHMIS 2016, Family Health Bureau
2015* 10.1
*Provisional
Source: Registrar General Department

14
11.6
12 10.8
10.4
9.9 9.9
10 9.3

8
Rate

0
2011 2012 2013 2014 2015 2016
Year

Figure 4.13: Under five mortality rate per 1000 live births
Source: RHMIS 2016, Family Health Bureau

Annual Health Bulletin - 2016 34

34 Annual Health Bulletin 2016

 5. Infectious Diseases/ Communicable Diseases

5.1. Dengue Fever (DF) / Dengue Dengue has been recorded for more than a half-
century in our country, mainly in urban and sub-
Haemorrhagic Fever (DHF)
urban areas. There has been a steady outward
Dengue is the most important mosquito-borne distribution into more rural areas since the
viral disease at present worldwide, and an major outbreak in 2009 and resetting of
estimated 2.5 billion people are at risk of being endemic level to about 35,000 cases recorded
infected in countries in the tropical and sub- per year. Year 2015 showed a relatively low
tropical areas where it is a major public health recording of just under 30,000 cases but 2016
problem and Sri Lanka is no exception. It is proved to be otherwise.
estimated by some studies that 390 million
dengue infections occur per year globally, of At the end of 2016, a total of 55,150 cases were
which only 96 million are apparently manifested reported (See Figure 5.1 & 5.3), with an overall
in any level of clinical or sub-clinical severity1. incidence of 262 per 100,000 population. There
This estimation is more than three times the were 97 deaths at a Case Fatality Rate (CFR) of
dengue burden calculated by the World Health 0.17% (Figure 5.2).
Organization2.

60000

50000

40000

30000

20000

10000

Figure 5.1: Annual Trend in Dengue Cases 2000 to 2016

Source: Epidemiology Unit
1
Bhatt S. (2013). The global distribution and burden WHO/HTM/NTD/DEN/2009.1 (World Health
of dengue. Nature. Organization, 2009).
2
World Health Organization. Dengue: Guidelines for
Diagnosis, Treatment, Prevention and Control.

Annual Health Bulletin - 2016 35

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 35

 At the end of 2016, a total of 55,150 cases were reported, with
97 deaths at a Case Fatality Rate (CFR) of 0.17%

Figure 5.2: Dengue incidence according to the districts of the country in 2016

Source: National Dengue Control Unit (NDCU)

Annual Health Bulletin - 2016 36

36 Annual Health Bulletin 2016

 60000 12.0
55150

50000 9.9 10.0

47246
44461

40000 8.0
35095
32063
29777
30000 28473 6.0

20000 4.0 4.0

15463
3.0 11980
2.5 10933
2.3
10000 1.9 2.0
7213 6607
1.2
1.0
0.7 0.6 0.7 0.6 0.17
203 656 0.4 440 0.5 0.5 0.4 0.3
0 0.0

Cases CFR

Figure 5.3: Cases and Case Fatality Ratio (CFR)

Source: NDCU

Case Fatality Rate (Ratio) (CFR) is a measure of the severity of a disease and is defined as the
proportion of reported cases of a specified disease or condition which are fatal within a
specified time. Dengue CFR 0.17% in 2016 means for every 1,000 cases there were less than 2
deaths. Incidentally, CFR for Dengue was highest in 1989 (9.9%) and in 1997 (4.9%). More
recently, in the 2009 outbreak, CFR was 1.0% and thereafter, there is a steady decline in
deaths with improved clinical management and capacity building of health-care institutions.
CFR is conventionally expressed as a percentage

Weekly reporting of dengue cases during 2016

showed the seasonal pattern related to the 2

Annual Health Bulletin - 2016 37

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 37

monsoon periods. (See Figure 5.4). The high pattern was seen during last five years. The first
case reporting in the middle of the year (May- peak from the 23rd to 37th weeks correlates with
July) is attributed to the Southwest monsoon the South West monsoonal rain mainly in the
rains. However, a major flood situation was also wet zone of the country while the 2nd peak from
experienced in densely populated Colombo 35th to 50th week correspond with the North
suburbs and other parts of the Western Eastern monsoonal rain and dry zone of the
province during this period. Similar seasonality country (Figure 5.5).

3000

2500

2015 2016
2000

1500

1000

500

0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Figure 5.4: Weekly reporting of cases in 2016 indicating seasonality

Source: Epidemiology Unit

Annual Health Bulletin - 2016 38

38 Annual Health Bulletin 2016

 Figure 5.5: Weekly reporting of cases over the past five years indicating the seasonality
Source: NDCU

Annual Health Bulletin - 2016 39

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 39

The overall age distribution of dengue patients Dengue Fever (DF), while 13.5% were diagnosed
in 2016 showed a modal age in the 20-24-year- with the more severe Dengue Haemorrhagic
old group (See Figure 5.6) indicating that Fever (DHF) and life-threatening Dengue Shock
dengue is now prevalent among adults as much Syndrome (DSS).
as children where dengue was predominantly
seen among children at the turn of the century. During the year 2016, the Department of
It is noteworthy that over 30% of the reported Virology at Medical Research Institute (MRI)
patients were in the school-going age (between Colombo has tested blood samples of 1,593
5-19 years). patients from all over the country using IgM
capture ELISA test, out of which 652 (41 %)
Out of the total hospitalized dengue patients in samples were found to be serologically positive
2016, the majority of cases (86.5%) had the for dengue.

18%

16%

14%

12%

10%

8%

6%

4%

2%

0%
<4 yrs 5-9 yrs 10-14 15–19 20-24 25-29 30-34 35-39 40-44 45-49 50–54 55-59 >60 yrs
yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs

Figure 5.6: Age Distribution as a percentage of the total cases in 2016

Source: Epidemiology Unit

Dengue is now prevalent among adults as much as children whereas dengue was
predominantly seen among children at the turn of the century

Annual Health Bulletin - 2016 40

40 Annual Health Bulletin 2016

 Integrated Vector Management (IVM) Vector Control

Entomological surveillance Vector control activities including source

reduction (elimination of breeding places),
Entomological surveillance for Dengue is carried biological and chemical vector control are
out under the preview of National Dengue carried out by the health authorities with all
Control Unit by national and sub national relevant stakeholders and the community in
teams. Vector surveillance is important to accordance with the guidelines of the Ministry
forecast impending outbreaks and initiate early of Health. Vector control activities were carried
measures to prevent the occurrence of out on a high-risk approach based on
outbreaks and to limit the spread. Vector epidemiological and entomological parameters.
indices are calculated (Breteau index, premise Facilitating district and divisional level vector
index and container index) for assessment of management staff to perform optimally to
risk and impact of control activities. control dengue vectors by providing training,
equipment, chemicals, technical guidance and
In 2016 a total of 224,596 premises were other resources.
inspected through central level campaigns,
where Aedes larvae were found positive in Figure 5.7 shows the summary of breeding
15,352(6.82%) premises. The types of places according to the island wide
containers are illustrated in Figure 5.7. entomological surveillance data throughout the
year. Majority (33%) accounts for
discarded receptacles, 21% for water
storage containers such as cement
tanks, barrels, buckets etc. and 4 %
each have contributed as ponds or
ornamentals, air conditioners or
Other refrigerators (trays) and natural
31% Discarded
places. Other breeding places
receptacles
33% category (31%) represents collective
percentages for tyres, roof/rain
wells gutters, tube wells, earth pipes,
1% water meters and all the other
Pond & miscellaneous places.
Water storage
ornamentals
containers
4%
15%

A/c
Refrigerators
4% Natural
concrete slab Cement tanks
4% 1% 7%

Figure 5.7 : Summary of Vector breeding sites (2016)

Source: Island wide entomological surveillance data, NDCU

Annual Health Bulletin - 2016 41

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 41

 Key messages and Recommendations:

 Dengue cases showed a rising trend, associated with urbanization and

physical development. Vector indices show majority of vector mosquito
breeding occurs in discarded receptacles. Continuous public awareness
on elimination of breeding places, keeping their own
premises/school/work places/etc. as dengue mosquito breeding free and
implementing feasible sustainable waste management policies are highly
recommended, especially before monsoonal rains in high transmission
risk areas.

 CFR was low due to effective training of health staff in the curative sector
with facilitation of health institutions for patient management. For early
diagnosis, timely treatment seeking behavior and prompt laboratory
investigations of suspected individuals are recommended.

 Facilitation of preventive sector on vector control by the public health

authorities with multi sectorial approach for timely interventions is
recommended. Scaling up of solid waste management in high risk areas
is essential with special emphasis on non-degradable container removal.

 Regular elimination of mosquito breeding places within school premises, public

and private institutions, construction sites, religious places and public places is
mandatory.
Content source: Epidemiology Unit and National Dengue Control Unit
 Provincial coordination committee meetings by the respective higher
authorities with the participation of relevant ministry officials regarding District,
Divisional and Village Committees were conducted.

Annual Health Bulletin - 2016 42

42 Annual Health Bulletin 2016

 5.2. Tuberculosis
In 2016, 8,332 new and relapse cases (40.9/100
Introduction 000 population) were notified to the National
Programme and there was a gap around 4000
Tuberculosis (TB) continues as a public health cases between number notified and the
problem in the country and the estimated estimated.
incidence in 2016, was 65/ 100,000 population.
Around 9,000 cases are reported every year and The observed inadequacies were
the ratio for new pulmonary to new EPTB was  Less referrals from primary health care
2.5 in 2016. settings for sputum investigations
 Inadequate investigation of contacts
There were 17 newly diagnosed Multi Drug
Resistant TB (MDR) patients in the country in Treatment success rate for 9,575 patients
2016 and the number of new HIV cases started treatment in 2015 was 84.1%. Clinical
detected among the TB patients screened at practice has shown late presentation and
DCCS is 5. comorbid factors as main reasons for deaths.

Figure 5.8 : Gap between the estimated TB cases (new & relapse) and notified case
Source: National Programme for Tuberculosis Control & Chest Diseases

Annual Health Bulletin - 2016 43

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 43

 2.5

2.0
Percentages

1.5

1.0

0.4 0.4 0.5

0.5 0.4 0.4

0.0
2012 2013 2014 2015 2016

% Examined of total OPD attendance Estimated percentage to be Examined

Figure 5.9 : Percentage of presumptive TB cases referred for sputum microscopy of total OPD
attendance- 2012-2016
Source: National Programme for Tuberculosis Control & Chest Diseases

4000
3429
3500
Number Detected and Screen

3000

2500 2305
2086
2000

1500
1066
1000
592 686 628
470
500
65 141
0
PTB Bacteriologically PTB Clinically EPTB Retreatment Cases All cases
Confirmed (Positive) Dig.(Negative)

No of Contacts Screened No of Patients Detected

Figure 5.10 : Contacts screening of TB patients, Q4 -2016

Source: National Programme for Tuberculosis Control & Chest Diseases

Annual Health Bulletin - 2016 44

44 Annual Health Bulletin 2016

 100%
6.2 3.9 4.6 4.8 4.5 4.2
90% 5.1 5.5
6.2 5.7 6.9 6.8
80%

70%
45.2 47.1 42.6 43.6
60% 43.7 45.1
RATES

50%

40%

30%

20% 41.7 39.9 40.3 39.6 39.6 39.0

10%

0%
2010 2011 2012 2013 2014 2015

Cured Treatment Completed Died Failure Loss to Follow Up Not Evaluated

Figure 5.11 : Treatment outcome of all forms of TB-2010-2015 (Cured +Treatment completed =
Treatment Success)
Source: National Programme for Tuberculosis Control & Chest Diseases

3.7

29.9

66.5

Not mentioned Continuation phase Intensive phase

Figure 5.12 : Treatment phase of death occurrence- 2015 patient cohort

Source: National Programme for Tuberculosis Control & Chest Diseases

Annual Health Bulletin - 2016 45

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 45

 Recommendations:
 Presumptive TB cases (TB suspects) need to be identified early and referred
for sputum examinations at OPD settings.
 Active screening need to be strengthened among the contacts of TB
patients. Family size in Sri Lanka is 4, therefore at least 3 contacts per patient
should be screened.
 Early diagnosis of patients and management of comorbid factors will prevent
deaths due to complications & comorbidities, improving the treatment
success.

Content Source: National Programme for Tuberculosis Control and Chest Diseases

Annual Health Bulletin - 2016 46

46 Annual Health Bulletin 2016

 5.3. HIV/ AIDS and Sexually
Transmitted Infections (STIs)

Situation of HIV epidemic in Sri Lanka

In addition, stigma and discrimination towards
During 2016, a total of 249 HIV cases were HIV hinders seeking HIV testing services.
newly reported in Sri Lanka. This was the
Since 2011, the proportion of males with HIV
highest number reported in a year since the
has been gradually increasing (Figure 5.13). The
identification of the first HIV infected Sri Lankan
male to female ratio of cumulative reported
in 1987. However, the reported numbers do not
cases up to end of 2016 was 1.8:1. However,
represent all HIV infected people in the country
among newly reported HIV cases during 2016,
as many infected persons may perhaps not be
the male to female ratio increased to 3.1:1.
aware of their HIV status.
.

249
250 228 235

196 188
200 186
167 174
N0. OF HIV CASES REPORTED

146
150 137 129
119 121 120
102 92
100 77 82
65 63 64 66 67 61 61 61
54
39 45 44
50

0
2007

2008

2009

2010

2011

2012

2013

2014

2015

2016
Total Males Females

Figure 5.13 : Trends of reported HIV cases by Sex, 2007- 2016

Source: National Programme for Tuberculosis Control & Chest Diseases

Figure 5.14 shows age and sex distribution of

cumulative reported HIV cases since 1987
(N=2500, age and sex not reported in 57 cases).
Majority of the cases were in 25-49 year age
group

Annual Health Bulletin - 2016 47

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 47

 Male Female
1400 1243
1200
Number of cases

1000
800 686
600
400
135 188
200 48 67 100
33
0
<15 15-24 Age group 25-49 50 +

Figure 5.14 : Cumulatively reported HIV cases by Age Groups (2016)

Source: National STD & AIDS Control Programme

As shown in the Figure 5.15,

Mullaitivu and Colombo had
the highest rate of reported
HIV cases during 2016. Six
other districts showed a HIV
case rate of over 1 per
100,000 population. These
districts were Gampaha,
Kalutara, Galle, Puttalam,
Mannar and Polonnaruwa.

Figure 5.15 : Rate of HIV cases reported in 2016 per 100,000 population
Source: National STD & AIDS Control Programme

Annual Health Bulletin - 2016 48

48 Annual Health Bulletin 2016

 Not reported
11%

Mother to child
1%
Male-Female sex
51%
Male-Male sex
37%

Male-Female sex Male-Male sex Mother to child Not reported

Figure 5.16 : Probable modes of transmission of HIV cases reported in 2016 (N=249)
Source: National STD & AIDS Control Programme

Sexual transmission accounted for 88% of all confirmatory test (Western Blot) is available
cases reported during 2016. However, in 11% of only at the national reference laboratory of
cases adequate data was not available to NSACP. Diversification of testing and service
ascertain the probable mode of transmission. delivery methods were attempted during 2016
(Table 5.1).
HIV testing services in 2016
HIV treatment and care services
HIV testing services are critical in national
response to HIV epidemic in the country. Over Globally there is consensus that activities for
the years the number of HIV tests carried out in HIV prevention and care services need to be
the country has been increased. However, total accelerated to reach the targets of ending AIDS
number of HIV tests done may be by 2030. Early enrollment in ART services
underreported in the private sector as there is contributes significantly to reducing HIV
no formal mechanism established to report all transmission while minimizing morbidities and
the HIV tests. However, all confirmed positive mortality related to HIV/AIDS.
HIV results are reported to NSACP as

Content Source: National STD/AIDS Control Programme

Annual Health Bulletin - 2016 49

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 49

Table 5-1 : Relative Productivity of HIV testing methods and testing details in 2016
Types of blood samples Number Percentage Number Percentage Positivity
screened for HIV tested of samples positive of positives rate (%)

Blood donor screening (NBTS 417,428 37 23 9 0.01

and private blood banks)
Antenatal mothers 323,518 29 11 4 0.003

Private hospitals, laboratories 225,047 20 40 16 0.02

and Sri Jayewardenepura GH
STD clinic samples* 90,271 8 160 64 0.18

Tri-forces 29,236 3 4 2 0.01

Survey sample 23,615 2 1 0 0.004

Prison HIV testing programme 12,776 1 6 2 0.05

TB screening 7,896 1 4 2 0.05

Total 1,129,787 100% 249 100 0.02

*(STD clinic samples include; clinic attendees, symptomatic patients, outreach samples and testing of contacts)
Source: National STD & AIDS Control Programme
In the year 2016, the number of newly Control Programme. In low level HIV epidemics,
diagnosed PLHIV was 249. Of these, 227 (90%) STIs act as a sensitive marker of high risk sexual
were linked to HIV care services. activity.

According to the progress report of WHO SEA Therefore, monitoring STI rates can help to
Region in 2016, the ratio of newly enrolled in identify vulnerability to HIV and also help to
care to newly diagnosed HIV cases was closer to evaluate the success of prevention
1 in Sri Lanka, suggesting strong linkages. programmes. In addition, STI services are
critical entry points for HIV prevention in low–
Situation of STIs during 2016 level epidemics.

Monitoring and evaluation of STD services were Early diagnosis and treatment of STI will
carried out by the Strategic Information decrease related morbidity and reduce the
Management unit of the National STD/AIDS likelihood of HIV transmission.

Annual Health Bulletin - 2016 50

50 Annual Health Bulletin 2016

 Table 5-2 : Number of PLHIV in pre-ART stage as of 2016
Name of clinic Pre- ART stage ART stage Total in care Percentage
1 Colombo 26 581 607 54
2 Ragama 4 131 135 12
3 IDH 2 83 85 8
4 Kandy 4 53 57 5
5 Galle 1 44 45 4
6 Kurunegala 3 26 29 3
7 Kalubowila 3 25 28 2
8 Jaffna 1 21 22 2
9 Anuradhapura 2 16 18 2
10 Kalutara 1 17 18 2
11 Ratnapura 1 17 18 2
12 Chilaw 3 14 17 2
13 Gampaha 1 10 11 1
14 Negombo 1 10 11 1
15 Polonnaruwa 0 8 8 1
16 Kegalle 3 4 7 1
17 Matara 0 4 4 0
18 Matale 0 3 3 0
19 Badulla 1 1 2 0
20 Hambantota 0 0 0 0
21 Batticaloa 0 0 0 0
Grand Total 57 1068 1125 100
Source: National STD & AIDS Control Programme

Table 5-3 : Number of STIs reported during 2016

Diagnosis Male Female Total
No. % No. % No. %
Genital Herpes 1,302 31 1,718 35 3,020 33
Non-gonococcal infections 596 14 1,595 33 2,201 24
Genital Warts 1,152 27 926 19 2,078 23
Syphilis 597 14 337 7 934 10
Gonorrhoea 235 6 66 1 301 3
Trichomoniasis 10 0 55 1 65 1
Other STIs 330 8 200 4 530 6
Total 4,222 100 4,897 100 9,129 100

Source: National STD & AIDS Control Programme

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 51

A total of 21,973 new patients had received Communication) material, conducting review
services from the National STD/AIDS Control meetings and purchasing safe delivery kits.
Programme during 2016 while a total of 65,820
clinic visits were made by all STD attendees. Sri Lanka has achieved the required status in
Among them 9,129 STI diagnoses were made as relation to indicators for validation of EMTCT of
summarized in Table 5-3 above. Genital herpes syphilis by the end of 2016 and is likely to
has been reported as the commonest STI satisfy indicators for EMTCT of HIV by the end
presentation. of 2017.

Elimination of Mother to Child Transmission Condom promotion

(EMTCT) of syphilis and HIV
Condom promotion remains an effective
The elimination of Mother to Child method of prevention of STIs including HIV
Transmission (EMTCT) of syphilis and HIV throughout the world. Use of condoms has the
programme was scaled up to cover the whole added advantage of protection against
country in 2016. During 2016 the EMTCT unnecessary pregnancies. The NSACP promotes
programme was carried out mainly with condoms through its network of STD clinics and
government funds while UNICEF assisted in peer-led targeted intervention programmes
printing IEC (Information Education and among Key populations.

Colombo 48,786
41,311
Kurunegala 31,268
26,200
Kegalle 25,968
23,264
Ampara 18,512
16,420
Kalubowila 13,902
12,800
Chilaw 10,828
Name of STD clinic

7,124
Negombo 5,470
5,060
Monaragala 5,030
5,000
Ragama 4,985
4,338
Matara 3,848
3,830
Matale 3,260
3,055
Balapitiya 2,960
2,830
Mannar 2,550
2,180
Mullaitivu 1,176
935
Kilinochchi 570
447
Kalmunai 430

0 10000 20000 30000 40000 50000

Number of Condoms distributed
Figure 5.17 : Number of condoms distributed by STD clinics during 2016
Source: National STD & AIDS Control Programme

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52 Annual Health Bulletin 2016

 5.4. Vaccine preventable disease

5.4.1. Encephalitis

During the year 2016, 238 suspected cases of The indicator of non-Measles non-Rubella rate
Encephalitis were notified to the Epidemiology for the year was 1 per 100,000 population and
Unit. Out of the total suspected cases, 184 were it is less than the expected rate of 2/100,000
clinically confirmed. The districts notified the population.
highest number of cases were Ratnapura (36)
followed by, Kegalle (22), Gampaha (18), Kandy
(18) and Matara (17). The number of deaths The country has achieved the
due to encephalitis was 14. expected target of zero
endogenous rubella cases for
5.4.2. Mumps 2016
A total of 407 cases of Mumps were reported in
2016 to the Epidemiology Unit and 311 (76.4 %)
were clinically confirmed. The districts reporting 5.4.4. Rubella
the highest number of cases were Kurunegala
(33), Jafna (33), Anuradhapura (29) Galle (28) The non-Measles non-Rubella rate was 1 per
and Kegalle (28). The age category reporting the 100,000 populations and has only achieved half
highest number of cases was 25-50 years (40.9 the expected rate of 2 per 100,000 populations.
%). Out of the suspected cases for measles rubella
(341) and tested at the Laboratory (292), no
cases were positive for rubella IgM antibodies.
5.4.3. Measles In fact, no rubella Laboratory confirmed cases
for 2016.
A total of 341suspected measles and rubella
cases were notified to the Epidemiology Unit in
2016. Out of total 341suspected notified 5.4.5. Congenital Rubella Syndrome
measles and rubella cases, 292 (86%) were (CRS)
tested at the measles rubella National
Laboratory, MRI. A total of 75 cases was A total of 784 blood samples were tested for
measles IgM positive and confirmed as measles Rubella IgM at MRI, sent from hospitals and
cases. Virus isolation samples have not been specialized units taken from babies with
done during 2016. congenital abnormalities, from mothers with a
history of fever and rash during pregnancy and
Out of the total lab confirmed measles cases 13
from samples of TORCH screening.
(17%) were among less than 9 month age group
and 45 cases (60%) were above 15 years of
Out of the blood samples tested, three were
age. Thus measles incidence for the year 2016
positive for rubella IgM. These three samples
was 0.1 per million population.

Annual Health Bulletin - 2016 53

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 53

were taken from babies more than nine months The indicator of timely stool collection rate was
of age and identified as due to post vaccination 81.5% in 2016. Polio virus type 2 withdrawal
of MMR. Thus, all were excluded as non- plan was underway as per Global Polio
congenital rubella infection or non-congenital Eradication Initiative. Inactive Polio Vaccine
rubella syndrome. (IPV) one dose was introduced in 2015, and
subsequently changed on to two fractional
In par with regional measles rubella and Inactive Polio Vaccine (fIPV) doses (0.1ml intra-
congenital rubella syndrome strategic plans, Sri dermal). This change was done in response to
Lanka has set the elimination targets as below: the global shortage, and as a measure for
 Zero endogenous measles cases by continuation of the programme.
2020
 Zero endogenous rubella cases by 2020
 Zero congenital rubella syndrome cases
/100,000 live births by 2018.

5.4.6. Poliomyelitis

Since 1993 Sri Lanka has been free of

Poliomyelitis. Surveillance of Acute Flaccid
Paralysis (AFP) was carried out with the
objective of identifying any potential
poliomyelitis case which may present as AFP. A
total of 65 non-polio AFP cases were notified to
the Epidemiology Unit in 2016. The non-polio
AFP rate was 1.2 per 100,000 population for
those under 15 years Polio eradication
programme strategies were successfully
implemented in the country to maintain polio
free status in the country.

Since 1993 Sri Lanka has been

free of Poliomyelitis

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54 Annual Health Bulletin 2016

 5.5. Leptospirosis

A total of 4018 cases of leptospirosis were Leptospirosis is a zoonotic disease of great

notified to the Epidemiology Unit in 2016. public health importance in Sri Lanka. Recent
Throughout the past years the case incidence surveillance data received at the Epidemiology
rate has been fluctuating with slight downward Unit indicate that paddy farming was the major
trend. Reporting of leptospirosis cases has source of exposure, and increased reporting
shown an annual seasonal pattern with peaks was observed during the rainy seasons which
during the two monsoons (Figure 5.18 & 5.20). coincide with the ‘Yala’ and ‘Maha’ paddy
cultivation seasons. Therefore, to control and
There were 62 deaths due to leptospirosis in prevent Leptospirosis, activities were
2016, indicating a Case Fatality Rate of 1.5 per conducted at Medical Officer of Health (MOH),
100 cases (Figure 5.19). Deaths due to District and Central levels to increase
leptospirosis have also been declining. The age community awareness, strengthen intersectoral
distribution of patients shows that the majority coordination and provide chemoprophylaxis to
of people with leptospirosis were between 25- the identified high-risk individuals.
49 years (50.2 %).

Figure 5.18 : Leptospirosis incidence rate per 100,000 population

Source: Epidemiology Unit

Annual Health Bulletin - 2016 55

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 55

 250 3.5

2.9
2.8 3
2.7
200
207
2.5
2
No. of Deaths

150
1.8 2

CFR %
145 1.6
1.5 1.5
123 1.3 1.5
100
100
1
80
71
50 62
52 0.5
41

0 0
2008 2009 2010 2011 2012 2013 2014 2015 2016
Year

No of Deaths CFR (%)

Figure 5.19 : Leptospirosis deaths and CFR from 2008 – 2016

Source: Epidemiology Unit

Figure 5.20: Leptospirosis seasonality

Source: Epidemiology Unit

Annual Health Bulletin - 2016 56

56 Annual Health Bulletin 2016

 5.6. Influenza Respiratory tract Infections (SARI)
surveillance.
 Influenza surveillance in humans had  ILI surveillance has been established in
been established complementary to the 19 sentinel sites and surveillance was
influenza surveillance among animals carried out at the OPD. SARI
by the Department of Animal surveillance has been established in
Production and Health (DAPH) as a part four sentinel sites and carried out
of the pandemic preparedness activities among in-ward patients.
initiated in the country the early  110,642 ILI visits reported in 2016,
warning system for a possible which was 2.4% of the total OPD visits.
Avian/Pandemic Influenza outbreak in  The 4 sentinel sites reported 816 SARI
the country. visits, which was about 1% of total
admissions.
 The human influenza surveillance was
conducted in selected sentinel hospitals Virological surveillance was done at the Medical
by the Epidemiology Unit of the Research Institute which is the national
Ministry of Health , Nutrition & Influenza Centre (NIC) in Sri Lanka for human
Indigenous Medicine. Human Influenza influenza surveillance. Data management was
surveillance comprises of 2 done through ‘Flusys’, an on-line data
components; Influenza like illness (ILI) management system. Accurate and timely data
surveillance and Severe Acute is important for early recognition of an
outbreak.

Figure 5.21 : Distribution of ILI patients as reported by the sentinel sites by month in 2015 & 2016
Source: Epidemiology Unit

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 57

5.7. Food Borne Diseases
The declining trend in reported cases of three However, inter-district disparity was evident, as
food borne diseases, continued in 2016. some districts have not benefitted from these
Dysentery, enteric fever, and viral hepatitis declines. These districts are in Table 5.4
showed a reduction of 14%, 19% and 46%
respectively, compared to 2015 (Figure 5.22). It was evident that community water supply
schemes were the main source of drinking
These improvements could be attributed to; water in these districts and tested water
samples from these sources shows
 Continuous monitoring of water bacteriological contamination.
sources and food establishments by
public health staff
Preserving catchment areas of water sources,
 Improvement of general living condition purification of water sources, and strict law
enforcement for food establishments could
 Provision of purified water help to further reduce the food borne diseases
in Sri -Lanka.
 Improved awareness about hygienic
practices among general population

Figure 5.22 : Reported Food Borne diseases to the Epidemiology Unit from 2009-2016
Source: Epidemiology Unit

Annual Health Bulletin - 2016 58

58 Annual Health Bulletin 2016

 Table 5-4 : Districts with high prevalence of food borne diseases
Enteric Fever Food Poisoning Dysentery Hepatitis A

Jaffna Batticaloa Ratnapura Ratnapura

Vavunia Hambanthota Kurunegala Monaragala

Nuwaraeliya Jaffna Batticaloa Badulla

Kegalle Kalmunei Jaffna Hambanthota

Colombo Kegalle Colombo Trincomalee

Source: Epidemiology Unit

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 59

5.8. Malaria
At this juncture, it is imperative to continue to
vigilant case surveillance for imported cases and Sri Lanka obtained WHO certification
vigilant vector surveillance. Currently, the
biggest threat to the elimination efforts is the as a malaria free country on 5th
risk of resurgence due to imported malaria and September 2016
the persistence of malaria vectors. Over the
past six years, most of the imported malaria
cases were reported from foreign travelers or
Risk of Re-introduction of malaria is
Sri Lankan nationals returning from malaria- continuing due both high
endemic countries. In 2016, with enhanced vulnerability and receptivity
parasitological surveillance, 41 imported cases
were reported.

Table 5-5 : Number of malaria cases investigated and treated during 2016
Case investigation No. (%)
Confirmed malaria cases received first-line antimalaria treatment
according to national policy at;
Public sector health facilities 29 (70.73)
Private sector sites 12 (29.23)
Confirmed cases fully investigated and classified 41 (100.0)
(Imported/Indigenous)
Source: Anti-Malaria Campaign

100
90
80
70 No of Malaria cases,
No of Malaria cases,
2014, 49
No. of cases

60 2016, 41
50
40
30
20 No of Malaria cases,
10 2015, 36

0
2013 2014 2015 2016

Year

Figure 5.23 : Trend of imported malaria cases during 2013 - 2016

Source: Anti-Malaria Campaign

Annual Health Bulletin - 2016 60

60 Annual Health Bulletin 2016

 2% Other

42% Asia

56% Africa

Africa Asia Other

Figure 5.24 : Imported malaria cases by region of origin in 2016

Source: Anti-Malaria Campaign

Annual Health Bulletin - 2016 61

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 61

 Vavuniya

Trincomalee
2016
Ratnapura

Puttalam 2015

Polonnaruwa

Nuwara Eliya

Mullative

Moneragala

Matara

Matale

Mannar

Maho

Kurunegala

Kilinochchi

Kegalle

Kandy

Kalutara

Kalmunai

Jaffna

Hambantota

Gampaha

Galle

Colombo

Batticaloa

Badulla

Anuradhapura

Ampara

0 10000 20000 30000 40000 50000 60000 70000 80000 90000

Figure 5.25 : Microscopic screening for malaria by Regional Malaria Clinics in the years 2015 and
2016
Source: Anti-Malaria Campaign

Annual Health Bulletin - 2016 62

62 Annual Health Bulletin 2016

 Figure 5.26 : Distribution of Malaria vectors by Regional Malaria Clinics in 2016
Source: Anti-Malaria Campaign

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 63

 Key messages
 Sri Lanka obtained WHO certification as malaria free country on 5th
September 2016 - a remarkable public health achievement in the
history of Sri Lanka
 Risk of re-introduction of malaria is continuing due to Sri Lanka’s high
vulnerability from imported malaria cases and receptivity from the
climate and other vectors
 Efforts to prevent re-introduction include:
o vigilant malaria surveillance (case surveillance, parasitological
and entomological surveillance) and Training & awareness
programmes
o Provision of preventive medicine and advice to travelers to
malaria endemic countries free of charge

Recommendations
 Vigilance in surveillance and preventive medicine must be maintained
sustain the malaria-free status
 Resource allocation for the malaria prevention of re-introduction
programme is important
 Multi-sectoral collaboration is required to keep Sri Lanka malaria-free

Content Source: Anti Malaria Campaign

Annual Health Bulletin - 2016 64

64 Annual Health Bulletin 2016

 5.9. Filariasis

Although Sri Lanka received WHO certification and in three provinces (Western, Southern &
as Lymphatis Filariasis-free status in 20163, 5.27),
North Western provinces) (Figure 5.28),
Lymphatic Filariasis was still endemic in eight primarily due to rapid and unplanned
districts (Colombo, Kaluthara, Gampaha, Galle, urbanization, increased population density and
Matara, Hambantota, Kurunegala & Puttalam) the mosquito-suitable climate.

Sri Lanka received the declaration of

elimination of Lymphatic Filariasis as
a public health problem by World
Health Organization (WHO) on 21st
July 2016

Figure 5.27 : Filariasis endemic districts in Sri Lanka

Source: Anti-Filariasis Campaign

3
Elimination status was defined as microfilaria rate
of <1%.

Annual Health Bulletin - 2016 65

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 65

5.10. Leprosy New case detection rate of Leprosy in the
country

Case detection rates have been relatively flat

since 2003, at about 10 per 100,000 population.
The number of new cases detected in 2016 was
1832, or 8.6/100,000 population.

 Sri-Lanka achieved the The highest number of new leprosy cases were
elimination target in 1995 detected in Colombo district followed by
Gampaha & Kaluthara districts.
 Over the past decade, the new
case detection rate has been
stagnating around 8-10 per
100,000 population, or about The highest number of new
2,000 new cases per year leprosy cases were detected in
Colombo district while the
 High number of child cases, late
presentation and high number of
highest new case detection rate
Multi bacillary type of leprosy are was seen in Polonnaruwa
the key problems currently faced
by the country
district in 2016

 Stigma and discrimination due to Leprosy new case detection rates in the
the disease was identified as a districts
major problem in controlling the
diseases The highest new case detection rate for 2016
was seen in Polonnaruwa district (19.29 per
100,000 population) followed by Batticaloa and
Ampara district (16.91 & 15.33 per 100,000
population). Lowest new case detection rate of
1.07 per 100,000 population was reported from
Nuwara Eliya district (Figure 5.30).

Annual Health Bulletin - 2016 66

66 Annual Health Bulletin 2016

 18 17

16 15
14
14
New case detection rate
12 12
12 10.6 10.4
10 10
9.5
10 9 9 8.6
8.3 8.3
8

6 7
4

0
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Year

Figure 5.28: New Case Detection Rates of Leprosy per 100,000 Population 1990 -2016
Source: Anti-Leprosy Campaign

Colombo 252
231
Kalutara 174
106
Kurunegala 106
105
Batticaloa 93
83
Polonnaruwa 82
79
Matara 72
68
Districts

Anuradhapura 67
50
Ampara 41
38
Jaffna 33
32
Matale 26
23
Kandy 23
19
Vavuniya 9
8
Kilinochchi 6
3
Mannar 3
0 50 100 150 200 250 300
Number of new cases

Figure 5.29: Number of New Leprosy Cases Detected on District Basis 2016
Source: Anti-Leprosy Campaign

Annual Health Bulletin - 2016 67

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 67

 Polonnaruwa 19.29
16.91
Ampara 15.33
14.73
Kalutara 13.80
13.76
Hambantota 12.40
11.81
Gampaha 9.74
9.53
Ratnapura 9.30
8.52
Puttalam
District

8.49
7.93
Anuradhapura 7.40
6.32
Trincomalee 5.69
5.48
Matale 5.12
4.95
Kilinochchi 4.92
3.75
Mullaitivu 3.16
2.83
Kegalle 2.19
1.60
Nuwara Eliya 1.07
0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00 20.00
per 100,000 population

Figure 5.30 : New Leprosy Case Detection Rate per 100,000 population by Districts in 2016
Source: Anti-Leprosy Campaign

Percentage of Grade – 2 deformity of Leprosy

in the country

Percentage with grade-2 deformities at the time

of diagnosis have been relatively flat since
2009, with an increase in 2015, perhaps due to
the new “Patient File” which was designed to
show the increase in deformities. In 2016, the
percentage fell 7.5%, perhaps due to improved
leprosy control activities, such as active case
finding, leading to early case detection
(see Figure 5.31).

Content Source: Anti Leprosy Campaign

Annual Health Bulletin - 2016 68

68 Annual Health Bulletin 2016

 12.00
10.01
10.00 9.00
8.00 7.98
G2D percentage

7.09 7.37 7.10 7.5

8.00 7.00 6.66 6.73
6.00 6.00 6.35
5.60
6.00

4.00

2.00

0.00
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Figure 5.31 : Grade 2 deformity percentage at the time of diagnosis among leprosy cases from
2002-2016
Source:Anti-Leprosy
Source: Anti-LeprosyCampaign
Campaign

Leprosy among Children in the country Multi-bacillary percentage

Child case percentage among new leprosy cases The percentage of leprosy cases diagnosed as
has been fluctuating around 10% from 2002- multi-bacillary (MB) has gradually over the past
2011. In 2012, it has dropped to 7.64% and 10 years, indicating that the disease was still
after that it shows an increasing trend. In 2016, being transmitted among the population.
child percentage dropped to 8.6 % (Figure
(Figure 5.33).
5.32).

11.00 11.00 11.28

12.00 10.72
10.00 10.30 9.87
9.7
10.00 9.17
8.6
7.64
Child Percentage

8.00

6.00

4.00

2.00

0.00
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Figure 5.32: Child case percentage among new leprosy cases from 2002-2016
Source: Anti-Leprosy Campaign

Annual Health Bulletin - 2016 69

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 69

 60 53.5
47.63 49.34
47.01
50 43.9 44.81
41.3
37.4
MB Percentage

40 34.6

30

20

10

0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year

Figure 5.33: Multi-Bacillary percentage at the time of diagnosis among leprosy cases from 2002 -
2016
Source: Anti-Leprosy Campaign

Epidemiological profile by province The table below shows the provincial detection
indicators of the country for the year 2016

Table 5-6 : Provincial detection indicators of the country for the year 2016
Province Population1 Leprosy NCDR2 MB Child Grade 2
Cases deformity
New % No. % No. % No. %
cases
Central 2690000 57 3.11 2.12 33 57.89 01 1.75 05 8.77
Eastern 1645000 207 11.29 12.58 129 62.32 21 10.14 14 6.76
Northern 1107000 54 2.94 4.88 37 68.52 05 9.26 09 16.67
North Central 1330000 149 8.13 11.2 89 59.73 13 8.72 11 7.38
North Western 2477000 174 9.49 7.02 98 56.32 11 6.32 12 6.9
Sabaragamuwa 2009000 125 6.82 6.22 74 59.2 08 6.40 13 10.4
Southern 2584000 256 13.97 9.91 126 49.22 22 8.59 14 5.47
Uva 1333000 70 3.82 5.25 39 55.71 07 10.00 07 10.0
Western 6028000 740 40.39 12.28 355 47.97 71 9.59 53 7.16
1 Population source: Department of Census and Statistics
2 NCDR – New Case Detection Rate
Source: Anti-Leprosy Campaign

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70 Annual Health Bulletin 2016

 5.11. Leishmaniasis 5.12. Rabies

The number of notified cases of Leishmaniasis Twenty-one lab confirmed cases of human
in 2016 was 1,256, of which 1,091 were rabies were reported in 2016. The districts
clinically confirmed. Hambanthota had the reported higher numbers of cases were
highest number (390) reported, followed by Kalutara (05), Kurunegala (04), Puttalam (03)
Anuradhapura (277), Mathara (197), and Jaffna (02). Districts of Anuradhapura,
Polonnaruwa (137) and Kurunegala (111). The Batticaloa, Badulla, Mullathivu, Matale,
age group of 25-50 years had the largest Monaragala & Trincomalee reported one case
percentage of notified cases (47.8%). each .

120

100

80
No. of cases

60

40

20

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Figure 5.34 : Human rabies cases reported to the Epidemiology Unit from 2000-2016
Source: Epidemiology Unit

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 71

6. Non-communicable Diseases (NCD)

6.1. Major Non-Communicable

Diseases Key messages

According to Indoor Morbidity and Mortality  Nearly 50% of the total

government hospital deaths in
Return (IMMR) data for 2016, 48.83% of the
Sri Lanka in 2016 were due to
total deaths in the government hospitals in Sri
major non-communicable
Lanka was due to major non communicable
diseases1
diseases such as cardiovascular disease, cancer,
chronic respiratory diseases and diabetes  Over 50% of total deaths in Sri
mellitus. Lanka, reported through vital
registration, were due to major
According to the 2016 IMMR data, chronic non-communicable
proportionate mortality for ischemic heart disease2
disease was 14.1%, neoplasms 12%, diseases of
the respiratory system (excluding pneumonia,  Ischemic heart disease has
upper respiratory illnesses, influenza) was 8.3%, been the number one leading
cerebrovascular disease accounted for 8.2% cause of hospital deaths for
while 1.5% and 1.8% were due to hypertensive more than a decade.
diseases and Diabetes Mellitus respectively.

1
Source: Medical Statistics Unit, based on IMMR data
2
Source: Registrar General Department, based on vital
statistics 2013

Table 6-1 : Number of deaths among all ages due to major NCDs in government hospitals in Sri
Lanka - 2016

Major NCD ICD code No. of deaths

Cardio vascular diseases I00-I99 14,134
Cancer C00-C97 5,016
Chronic respiratory diseases J30-J98 3,529
Diabetes Mellitus E10-E14 773
Source: Registrar General Department

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72 Annual Health Bulletin 2016

 Table 6-2 : Number of deaths among all ages due to major NCDs in Sri Lanka - 2013
Major NCD ICD code No. of deaths
Cardio vascular diseases I00-I99 31,842
Cancer C00-C97 12,895
Chronic respiratory diseases J30-J98 9,149
Diabetes Mellitus E10-E14 10,093

Source: Medical statistics unit, Ministry of Health

Non-Communicable Diseases among women

attending Well Women Clinics

The problems detected among the women

screened at WWCs for different NCDs are given
in the table below.

Table 6-3 : Clinic attendance and morbidities detected at Well Woman Clinics 2012 – 2016
Activity 2012 2013 2014 2015 2016

Number of 35-year old cohort attending 62,833 73,359 74,871 94,089 111,798
clinics
Percentage of 35-year old cohort attending 42.7 52.8
clinics (%)
35-year cohort coverage with pap smear 28.9 33.9 34.6 41.8* 50.5
screening (%)
First time attendees
Under 35 years (%) 8.0 6.0 6.1 9.3 3.23
35 years (%) 46.3 51.7 53.9 58.1 66.7
Above 35 years (%) 45.6 42.3 40.0 32.5 30.0
Diabetes Mellitus detected (%) 2.0 2.0 1.8 1.6 2.2
Hypertension detected (%) 3.7 4.1 3.6 3.4 3.8

Source: MCH Quarterly return - H 509 Family Health Bureau

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 73

6.2. Chronic Kidney Disease
Chronic Kidney Disease of Uncertain Aetiology
CKDu

The Epidemiology Unit launched surveillance of The National Renal Registry (NRR) is expected
Chronic Kidney Diseases in Sri Lanka in October to serve as the national database on renal
2013 as a sentinel surveillance covering areas diseases. It captures socio-demographic
known to report Chronic Kidney Disease of information and all clinical details. The primary
Uncertain Aetiology (CKDu). The primary data entering is done at sentinel site hospitals.
objective of the surveillance was to assess the It further facilitates continuation of follow up in
disease burden, socio-demographic factors and curative care settings and also in field
co-morbidities associated with CKDu. preventive care settings through Medical
Officers of Health. (Source: Epidemiology Unit)
Later on, the scope of the surveillance was
broadened. The sentinel sites were expanded to
collect nationwide representative data. The
initial paper-based system was converted to a
real time online data reporting system. In
parallel to above changes, surveillance was
renamed as the National Renal Registry.

7000
6093
6000

5000
Number of Patients

4198
4005
4000 3445
3081
3000
2046 2219
2000 1620

1000

0
2013 2014 2015 2016
Year
Male Female

Figure 6.1: No. of CKDu patients as reported to the National Renal Registry
Source: National Renal Registry, Epidemiology Unit

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74 Annual Health Bulletin 2016

 6.3. Injuries inward care. As government hospitals usually
Traumatic injuries admit about 25 – 30% from all victims attending
to hospitals for inward care, the total number
• Injuries were the number one cause of of victims received inward as well as outpatient
hospitalization over the last two care may be more than the reported number.
decades Further, as a considerable number of victims
• More than 1 million people were
attend to health care facilities delivered by
hospitalized in 2016 due to injuries
• It was the 10th cause of hospital deaths other sectors (private sector, Ayurvedic etc)
in Sri Lanka in 2016 other than government hospitals and also as
• Lives of 1675 victims admitted for some victims who need medical attention seek
inward care following traumatic injuries home remedies without attending any health
were lost in 2016 facility, the number of victims due to injuries
• National injury surveillance was started
may be even more than the reported numbers.
in 2016, and specific injury related data
Due to the scarcity of injury related
have been obtained since 2014 through
this system information, Non-Communicable Disease (NCD)
• National injury policy, which was Unit has started obtaining specific information
pending cabinet approval, will address related to injuries from base and above
most of the aspects of injury prevention hospitals (base hospitals, district general
in Sri Lanka hospitals, provincial general hospitals, and
teaching hospitals) since 2014. Although this
Injuries were the number one cause of
does not provide all details, it provides burden
hospitalization in Sri Lanka for last 2 decades. In
of injuries by specific injury mechanism in the
each year, more than 1 million people were
country.
hospitalized due to injuries. For last 10 years,
To fulfil the national requirements, in 2016,
traumatic injuries accounted for about 15 - 19
National Injury Surveillance system was
% of total admissions to government hospitals.
launched as a sentinel site surveillance. In the
However, over last 5 years, mortality due to
first step, it was implemented in base and
traumatic injuries remained low accounting
above hospitals. In 2016, only a very few
around 3.7% of all deaths, and it was the 10th
hospitals reported injuries through the system.
cause of mortality among hospitalized patients.
It will be gradually introduced to all health care
In 2016, 1675 lives were lost due to traumatic
institutions in Sri Lanka, not only for
injuries (Total number of deaths excluding
government sector institutions, but also for
undiagnosed/uncoded occurred in hospitalized
ayurvedic and private sector institutions.
patients in 2016 was 42,961)
To streamline and strengthen all activities
related to injury prevention, an injury policy
The true picture could be totally different from
was prepared, and the draft of injury policy has
what is reported through IMMR since IMMR
been finalized by NCD unit and awaiting cabinet
reports only details of the patients who had
approval.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 75

 22
19.3
20 18.1 18.4 18.5
17 17 17
18 16.1 16.2
15.6 15.6
16
14
Percentage

12
10
8
6 4 4.6
3.8 3.7 3.7 3.6 3.7 3.3 3.5 3.8 3.9
4
2
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year

Hospitalization Mortality

Figure 6.2 : Trend of hospitalization and mortality due to traumatic injuries (2006 – 2016)4
Source: Medical Statistics Unit

4Note:1. Hospitalisations due to Single spontaneous delivery (O80), False labour(O47) and those admitted and discharged before delivery,
Persons encountering health services for examinations, investigation and for specific procedures of health care (Z00-Z13,Z40-Z54) and
Undiagnosed / Uncoded hospitalizations are excluded when calculating Total Hospitalisations.

2. All deaths excluding undiagnosed / uncoded are considered when calculating the percentage.

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76 Annual Health Bulletin 2016

 6.4. Cancer

Public awareness and screening

programmes The most prevalent caner in females
National Cancer Control Programme (NCCP)
was breast cancer while the most
carried out awareness programmes targeting prevalent cancers in males were lip,
possible change agents for risk factor oral cavity and pharynx cancers
prevention including teachers, religious based
organizations and university students. The
awareness programmes together with
screening programmes were carried out
targeting high risk groups (community groups
prone to have higher prevalence of risk factors)
including estate workers, office workers, prison
inhabitants and regionally identified high risk
communities.

Cancer Prevention & Control Activities at

Provincial Level

The Provincial Directors of Health Services and

Regional Directors of Health Services were the
focal points at provincial and district levels
respectively for cancer control activities. It is
expected to coordinate these activities through
establishment of district cancer control
committees headed by the Regional Director of
Health Services and with the participation of
MO/NCD, MO/MCH, RE, RDS, MOOH,
consultants in curative & preventive sector etc.

Cancer screening and early detection

In addition to the Well Women Clinics

conducted under the patronage of Family
Health Bureau and by Medical Officers of
Health, screening for common cancers were
supplemented by the National Cancer Control
Programme through the Cancer Early Detection
Centre, Narahenpita and through mobile clinics
organized under Suwa Udana Programme and
other programmes.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 77

Table 6-4 : Screening for common cancers conducted by National Cancer Control Programme - 2016
Suwa Udana Other National Total
Clinics Mobile Cancer Early
organized Clinics Detection
by the attended Centre
Ministry through
invitation
No. of clinics held 30 89 244 333
Total no. of clinic attendees 1077 2252 2879 6208
Breast No. examined 1077 2252 2562 5891
Examination No. of abnormalities 149 349 1086 1584
detected
Vaginal No. examined 592 1148 810 2550
Examination No. of abnormalities 47 84 122 253
detected

Pap Smears No. of PAP smears 505 1138 780 2423

taken
No. of PAP smear 291 1123 9615 2375
reports received
No. of abnormalities 65 275 210 550
detected
No. of reports with CIN 4 15 21 40
stages
Oral No. examined 1077 2252 2879 6208
Examination No. of abnormalities 15 24 33 72
detected

Thyroid No. examined 1077 2252 2575 5904

Examination No. of abnormalities 11 13 30 54
detected
No of Mammographies done - - 243 243
No of colposcopy examinations done - - 57 57
No of referrals made 143 254 478 875

5 Including pap smears taken in the previous year

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78 Annual Health Bulletin 2016

 Table 6-5 : Clinic attendance and morbidities detected at Well Woman Clinics 2012 – 2016
Activity 2012 2013 2014 2015 2016

Number of 35-year cohort attending clinics 62833 73359 74871 94089 111,798
Percentage of 35-year cohort attending 42.7 52.8
clinics (%)
35-year cohort coverage with pap smear 28.9 33.9 34.6 41.8 50.5
screening (%) -
First time attendees
Under 35 years (%) 8.0 6.0 6.1 9.3 3.23
35 years (%) 46.3 51.7 53.9 58.1 66.7

Above 35 years (%) 45.6 42.3 40.0 32.5 30.0

Cervical smears reported as high and low- 0.2 0.3 0.2 0.3 0.4
grade lesions (%)
Cervical smears reported as malignant 0.02 0.04 0.03 0.02 0.03
(Carcinoma) (%)
Cervical smears reported HPV (%) 0.1 0.1 0.2 0.2 0.1
Breast abnormalities detected (%) 1.4 1.8 1.5 1.5 1.6

Source: MCH Quarterly return - H 509 Family Health Bureau

Cancer Surveillance

One of the main functions of the National  There may an over-reporting of

Cancer Control Programme is the maintenance number of cases since some patients
of the National Cancer Registry. Cancer might get registered in more than
incidence data collected from nine provincial one cancer treatment centre. For
cancer treatment centres are used for this example after removing all
purpose. Cancer incidence data for the year duplicates, the correct number of
2010 was published in 2016.
new cases for 2009 was 16,888 vs.
the 20, 538 in Table 6.6 and for 2010
In addition, since 2012, population-based
cancer registry has been initiated for the it was 16, 963 vs. 21,517 noted as
Colombo District. These data are yet to be Table 6-6”
analysed.
 Provincial Cancer Treatment Center
in TH Battiacaloa commenced
functioning in 2009.
Source: National Cancer Control Programme

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 79

Table 6-6 : No. of newly registered cancer patients at Government Cancer Treatment Centres
Cancer Year
Treatment
Centre
2008 2009 2010 2011 2012 2013 2014 2015 2016

NCI - 11,163 11,756 11,513 12,403 12,550 12,689 13,247 13,890 14,248
Maharagama

TH-Kandy 3,648 3,634 4,046 5,042 3,717 3,516 4,000 4,023 3,877

TH -Karapitiya 1,764 1,866 1,793 2,193 2,158 2,455 2,479 2,394 2,595

TH -Jaffna 412 479 659 1,055 1,048 1,061 1,032 1,100 1,099

TH - 712 551 641 698 803 850 1,114 1,300 1,131

Anuradhapura
PGH - Badulla 753 794 858 1,430 2,152 2,203 1,527 2,285 2,225

TH – Batticaloa6 - 169 565 727 1,094 932 897 900 1,325

TH - Kurunegala 538 804 806 1,174 1, 122 1,042 1,238 1,680 1,863

PGH – 319 485 636 735 808 767 807 902 1094
Rathnapura
Total 19,309 20,538 21,517 25,457 25,452 25,515 26,341 28,474 29,457

Source: National Cancer Control Programme

6
Provincial Cancer Treatment Center in TH Battiacaloa commenced functioning in 2009

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80 Annual Health Bulletin 2016

 Trend in deaths due to neoplasms 1985 – The age-standardized mortality rate is a
2010 weighted average of the age-
specific mortality rates per 100,000
Among males 6438 deaths due to cancer persons, where the weights are the
were reported during 2010 with an Age proportions of persons in the
Standardized Death Rate of 70.9. For corresponding age groups of the WHO
females 5398 deaths due to cancer were standard population.
reported with an Age Standardized Death
Rate of 53.5.

Male Female

80.0
70.9
Age standardized death rates per 100,00 population

70.0 67.6
65.4
63.6

60.0 57.3 57.0

52.1 52.2 53.6

50.0 53.5
52.0
48.7 48.8
40.0 45.8
44.0
39.9 38.6 39.6
30.0

20.0

10.0

0.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Figure 6.3 : Age standardized death rates due cancer 2001 - 2010
Source: National Cancer Control Programme

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 81

Trends of types of cancers from 2001 to 2010

The top 10 cancers reported among females & males respectively from 2001-2010 are given
below.
Table 6-7 : Top ten cancers reported in females 2001 to 2010
New cases detected – Female
Cancer Site 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Breast 1548 1580 1580 1746 1859 2101 1914 2220 2293 2401
Cervix uteri 744 753 753 816 881 936 732 858 879 847
Ovary 466 539 539 627 596 671 529 637 698 680
Thyroid 337 451 451 555 592 683 656 815 816 832
Oesophagus 498 490 490 554 524 610 534 617 608 496
Lip, oral cavity & 369 364 364 414 377 390 398 477 520 534
pharynx
Colon & rectum 245 258 258 310 353 372 405 508 517 516
Leukaemia 218 241 241 265 257 267 275 285 310 290
Lymphoma 223 144 144 230 243 257 257 288 252 275
Uterus 168 177 177 201 237 251 263 397 397 386
Total number of 5901 6351 6445 7009 7314 7875 7279 8816 9030 8970
cases
Source: National Cancer Control Programme
Table 6-8 : Top ten cancers reported in males 2001 to 2010
Number of new cases detected – Male
Cancer Site 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Lip, oral cavity & 1234 1137 1024 1201 1240 1427 1415 1630 1773 1888
pharynx
Trachea, bronchus & 516 519 600 633 666 691 723 814 875 806
lungs
Oesophagus 420 416 449 461 498 486 530 664 656 574
Colon & rectum 241 280 278 354 388 371 409 477 489 567
Lymphoma 231 285 301 298 360 369 363 434 408 419
Larynx 284 303 262 290 324 341 343 393 393 384
Leukaemia 274 300 321 350 313 329 332 344 378 354
Prostates 250 297 259 273 303 321 305 369 381 480
Unknown primary site 282 276 319 232 257 303 326 423 404 436
Bladder 131 153 163 147 171 196 164 138 149 269
Total number of 5262 5283 5437 5624 6058 6205 6356 7695 7858 7993
cases
Source: National Cancer Control Programme

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82 Annual Health Bulletin 2016

 Trends in cancer crude incidence rates cases detected per 100, 000 population per
1985- 2010 year

The trend of Crude Incidence Rate of

Content Source: National Cancer
cancers is given in the graphs below. Crude
Control Programme
Incidence Rate is the number of new cancer
.

Figure 6.4 : Crude Cancer incidence rate for Top five cancer sites in females 1985 – 2010
Source: National Cancer Control Programme

Figure 6.5: Crude Cancer incidence rate for Top five cancer sites in males 1985-2010
Source: National Cancer Control Programme

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 83

Table 6-9 : Distribution of cancer incidence by geographical area - 2010
Province District Male Female Total
No % No % No %
Central
Kandy 655 8.2 835 9.3 1490 8.8
Matale 191 2.4 170 1.9 361 2.1
Nuwara Eliya 192 2.4 219 2.4 411 2.4
Eastern
Trincomalee 50 0.6 101 1.1 151 0.9
Baticaloa 133 1.7 173 1.9 306 1.8
Ampara 123 1.5 165 1.8 288 1.7
Northern
Vavuniya 32 0.4 58 0.6 90 0.5
Mullativu 6 0.1 12 0.1 18 0.1
Kilinochchi 16 0.2 26 0.3 42 0.2
Mannar 11 0.1 28 0.3 39 0.2
Jaffna 149 1.9 207 2.3 356 2.1
North Central
Anuradhapura 237 3.0 294 3.3 531 3.1
Polonnaruwa 131 1.6 123 1.4 254 1.5
North Western
Kurunegala 562 7.0 530 5.9 1092 6.4
Puttlam 187 2.3 214 2.4 401 2.4
Sabaragamuwa
Ratnapura 276 3.5 346 3.9 622 3.7
Kegalle 325 4.1 351 3.9 676 4.0
Southern
Galle 515 6.4 592 6.6 1107 6.5
Matara 317 4.0 379 4.2 696 4.1
Hambantota 190 2.4 233 2.6 423 2.5
Uva
Moneragala 75 0.9 84 0.9 159 0.9
Badulla 345 4.3 373 4.2 718 4.2
Western
Colombo 885 11.1 1192 13.3 2077 12.2
Gampaha 784 9.8 916 10.2 1700 10.0
Kalutara 375 4.7 548 6.1 923 5.4
Total 7993 100.0 8970 100.0 16963 100.0

Source: National Cancer Control Programme

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84 Annual Health Bulletin 2016

 6.5. Mental Health
Suicides remain a significant
public health problem in Sri
6.5.1. Suicides Lanka

4000
3526 3455
3500
3144 3058 3025
3000
Number of Suicides

2500

2000

1500

1000

500

0
2012 2013 2014 2015 2016
Year

Figure 6.6 : Suicides have shown a gradual decrease over the past few years
Source: Directorate of Mental Health

3000 2721 2703

2484
2500 2389 2339
NUmber of Suicides

2000

1500

1000 805 752 660 669 686

500

0
Male Female Male Female Male Female Male Female Male Female
2012 2013 2014 2015 2016
Year

Figure 6.7: Suicides among males has shown a gradual decrease over the past few years
Source: Directorate of Mental Health

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 85

Sri Lanka had a crude suicide rate of 14.27 per
100,000 population in 2016, when the regional Actions taken
and global suicide rate were 12.9 and 10.7 per
 Stakeholder awareness was created
100,000 respectively (WHO, 2017). This was a
including media on suicide prevention.
significant reduction from the 1995 crude
Capacity building of health staff on life skill
suicide rate of 47 per 100,000 and can be
building of youth and adolescents, good
attributed to the activities of the Presidential
parenting and counselling for teachers were
Task Force established in 1997, which focused
carried out in high prevalent areas.
mainly on the prevention of suicides due to
pesticide ingestion.
 Studies have shown that almost half of the
males who committed suicide were
 Suicides among females has shown a slight
addicted to alcohol (Abeyasingh R, 2008).
increase in 2016 when compared to 2015
Therefore, Ministry of Health is in the
process of implementing actions proposed
 Nearly 20% of the suicides were due to
in the National Policy on Alcohol Control
marital disharmony, 12.65% of the suicides
which was launched in 2016 mainly
were due to the presence of chronic
targeting the youth and adolescents and
diseases and disabilities and 8% of the
those who are addicted. Many programs
deaths were due to mental disorders in
were conducted to strengthen multi-
2016. More than a third (35.3%) of the
stakeholder collaboration and to educate
causes for suicides was not available.
the general public with the aim of reducing
alcohol use in the community.
 More than half of the suicides (52%) were
due to hanging and 28.9% were due to the
 Additional support has been provided with
ingestion of insecticides and pesticides in
increases in the availability of more
2016. There were no marked differences
professionals for inpatient and outpatient
between the methods used for suicides in
mental health services
2015 compared to methods used in 2016
(i.e. 49.5% by hanging and 30.0% due to
 IEC campaign was designed to raise
ingestion of insecticides and pesticides in
awareness on suicide prevention with the
2015)
aim of promoting mental health awareness
(Data source: Statistics unit- Sri Lanka Police) among the general public.

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86 Annual Health Bulletin 2016

 Recommendations
Preparation of a strategic plan for the prevention of suicides in Sri Lanka. process has
been started and several focus group discussions were conducted to garner input on
suitable strategies for the prevention of suicides in Sri Lanka. The new strategy is mainly
based on a life cycle approach and will focus on development of life skills for both
children and adults, effective utilization of mental health services and responsible media
coverage. An apex body will be formulated for the implementation and finalization of
the strategy

6.5.2. Mental health issues

There is an overall increase in admission to This rise could be actual increase of mental
state sector hospitals, due to mental & illnesses or due to ncreased awareness on
behavioural disorders during past years (IMMR, mental disorders improving health seeking
Medical Statistic Unit). This increase might be behavior among the community.
due to improvement of diagnostic facilities as
well as increased reporting.

Mental disorders were in the rise in

Sri Lanka

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 87

 18,000

16,000
Dementia (F01,F03)

14,000
Mental and behavioural
disorders due to use of alcohol
(F10)

12,000 Mental and behavioural

disorders due to other
psychoactive substance use
(F11-F19)
Schizophrenia, schizotypal and
Number of cases

10,000
delusional disorders (F20-F29)

Mood (affective) disorders

8,000 (F30-F39)

Neurotic, stress-related
somatoform disorders (F40-
6,000
F48)

Mental retardation (F70-F79)

4,000

Behavioural and emotional

disorders with onset usually
2,000 occuring in childhood and
adolescence (F90-F98)
Other mental and behavioural
disorders (F04-F09,F50-
F69,F80-F89,F99)
0
14
15
04
05
06
07
08
09
10
11
12
13
20
20
20
20
20
20
20
20
20
20
20
20

Figure 6.8 : Admissions due to mood (affective) disorders have almost doubled from 2004-2015
Source: Directorate of Mental Health

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88 Annual Health Bulletin 2016

 Actions taken: 3. Out patients’ clinics were
increased to cover all MOH
1. Funds were mobilized from the divisions in the country
national budget to strengthen 4. Consumer and carer societies
acute psychiatric inpatient and were strengthened to facilitate
outpatient care for mentally ill rehabilitation process.
patients. 5. Management Information
2. Human resources were system on Mental Health was
strengthened with cadre revised to obtain more accurate
increase and new recruitment and good quality data on timely
for psychiatric units to provide manner.
multi-disciplinary care.

Recommendations

1. Increase allocation of funds to provide acute psychiatric inward care in all

districts
2. Increase allocation of cadre of medical officers to mental health.
3. Regularize allocation of para medical care for mental health care.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 89

7. Oral Health
7.1. Oral Disease Trends

The fourth National Oral Health Survey by the

Ministry of Health, in collaboration with World Sri Lanka continues to experience
Health Organization, was completed in 2016. improvements in prevalence and
This survey indicates overall improvements in severity of dental carries and
the prevalence and severity of dental caries and
improvements in periodontal health despite
improvement in periodontal health
prevailing a substantial problem among all age
groups (Table 7-1, 7-2)

Table 7-1 : Prevalence and Severity of Dental Caries

Age group Prevalence & 1993/94 1994/95 2002/03
Severity

6 years Prevalence (%) 78.0 76.4 65.5 (5yrs)

DMFT 4.4 4.1 3.6 (5yrs)
12 years Prevalence (%) 67 53.1 40.0
DMFT 1.9 1.4 0.9
35-44 years Prevalence (%) 92 91.1 91.5
DMFT 9.2 10.1 8.4
Source: National Oral Health Survey; Deputy Director General (Dental Services) Division

Table 7-2 : Prevalence of Healthy gums in 12 years and 35-44 year olds
Age group 1983/84 1994/95 2002/03
Prevalence (%) Prevalence (%) Prevalence (%)

12 years 12.0% 13.3% 27.2%

35-44 years 6.5% 2.1% 10.1%

Source: National Oral Health Survey; Deputy Director General (Dental Services) Division

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 Teeth present and prosthetic treatment Use of Oral Health Care Services
need
According to the third National Oral Health
According to the third National Oral Health Survey report 2002/2003, adults aged 35-65
Survey report 2002/2003, mean number of years and children aged 13 years were the
deciduous teeth present among 5-year-old major consumers of dental services when
children was 19.5 and mean number of compared the other index age groups.
permanent teeth present among 35-44
years was 26.36 and it was 12.15 among 65- Furthermore, 5 and 12 year old school
74 years. Edentulousness rate among 65-74 children visited mostly School Dental Clinics
years was 21.8. (7.3% & 35.8% respectively) on their last
visit. Majority of adults (44.19%) aged 35-44
Oral Health Related Behaviours years visited hospital dental clinic and
General Dental Practice (33.59%).
According to the third National Oral Health
Survey report 2002/2003, use of fluoridated The most frequent type of treatment
tooth paste and tooth brushes was high received was tooth extraction, among all
(around 75%) among all age groups except index age groups, with the highest level of
among elderly. about 75% among the 65-74 age group.

Content Source: Division of Deputy Director

General (Dental Services)

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Risk Factors
 8. Risk Factors
This chapter concentrates on factors that 8.1. Food and Nutrition Related Risk
work together or individually to act on Factors
individual health as well as the health of
communities. In Sri Lanka indicators of under nutrition are
currently stagnant while overweight and
Special attention is required to the contents obesity is rising. Availability, accessibility
of this chapter as there are many factors and affordability of food directly affects
that determine the disease burden of the dietary intake. Therefore, strengthening
country. multi-sectoral partnership to upgrade food
production, distribution and wastage
In addition to the risk factors discussed in minimization is essential to maintain
this chapter it is vital to pay attention on sustainable food systems.
effect of other risk factors such as Air
Quality, Food Safety on determining the Further, strong monitoring and evaluation
disease burden. system at all levels is mandatory to
streamline the nutrition interventions
thereby to achieve the SDG targets in 2030.

 Improving food security via strengthening multi-sectoral

partnership is crucial in addressing National Nutrition problems

 Inter-district disparity is evident in progress of nutrition problems

over the years; hence district specific measures are needed to
overcome nutrition issues

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 93

Figure 8.1 : Transition of stunting among under five-year-old children: district rank from 2006-
2012
Source: Nutrition Coordination Division

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94 Annual Health Bulletin 2016

 Actions Taken

1. Implementation of District Nutrition

Action Plan – District level priority
nutrition problems were identified in
joint collaboration of National and Recommendations
district level nutrition programme
managers. Targeted evidence based 1 Mechanism to ensure sustainability
interventions (such as) to improve of targeted interventions is needed.
nutrition status were implemented. 2 Special attention is needed to
assess reach of targeted
2. Implementation of evidence based interventions to specific vulnerable
maternal and child nutrition groups.
interventions island wide as an 3 Effective monitoring and evaluation
integrated package through the system is needed for
maternal and child health programme implementation of multi sector
action plan.
3. Implementation of multi sector action
plan - village, district and provincial
level committees with multi-sectoral
representation were established and
regular discussion on nutrition
problems were conducted at each level.
At village- level, families with nutrition
problems were identified and remedial
actions were taken to strengthen
supportive mechanisms.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 95

 29% of adults 18-69 years belong Only 27% of adults consume
to overweight /Obese category fruits and vegetables adequately*
6%
15% Female

23%
Underweight Male
Normal
0 20 40 60 80
56% Overweight
Consumption equal or above 5 servings
Obese
Consumption below 5 servings

Source: STEPS survey 2015 * According to WHO guidelines

Source: STEPS survey 2015

Figure 8.2 : Body Mass Index and unhealthy food habits

Source: STEPS Survey 2015

Table 8-1 : Overweight (BMI ≥25) and obesity (BMI≥30) among adult population (Age 18 – 69) of
Sri Lanka

Percentage of persons with Percentage of persons with Obesity

Overweight (BMI ≥25) (BMI≥30)
2007 2015 2007 2015
Female 30.4 34.3 - 8.4
Male 19.6 24.6 - 3.5

Both sexes 25.0 29.3 - 5.9

Source: STEPS Survey 2015

Consumption of fruits and

vegetables is unsatisfactory
among adults

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96 Annual Health Bulletin 2016

 Actions Taken 8.1.1. Maternal and Child Nutrition
Related Risk Factors
Introduction of Nutrition month themes
“Shape your meal to shape your body”-
Anaemia in pregnancy
food plate composition was defined and
disseminated via national and regional level
Maternal nutrition is an important associate
nutrition programme managers. Relevant
of the birth weight of the new born which
IEC material was developed and distributed
in turn affect the child’s nutrition. Pregnant
among target groups
women with nutritional deficiencies should
be identified as early as possible to mitigate
the effects on foetus.
Recommendations:
Out of every four pregnant women one is
1. A more strategic approach to
found to be an anaemic (Hb< 11g/dl). This
disseminate the message in a increase was evidence may be due to
more sustainable manner is improved screening services in the field.
needed. According to the National Nutrition and
2. The message has to be linked Micronutrient Survey of Pregnant Women
to behavior change approaches in , Sri Lanka (2015) conducted by Medical
in work sites and household Research Institute , Ministry of Health, the
level prevalence of anaemia in Sri Lankan
3. Need to strengthen supportive pregnant women was reported as 31.8% .
environments in worksites,
such as implementing this
composition of food plate and
to reduce consumption of Out of every four pregnant
sugar in worksite canteens women one is found to be an
anaemic
Content Source: Directorate of Nutrition, Family Health
Bureau & Nutrition Coordination Division

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 97

 30
25
25
21.4

20 18.5
16.2 16.8
15.7
Percentage

15

10

0
2011 2012 2013 2014 2015 2016
Year

% of pregnant mothers with aneamia

Figure 8.3 : In 2016, 25% of pregnant women are found to be anaemics (Hb< 11g/dl)
Source: Family Health Bureau

Categorisation of anaemia showed that

majority (74% of anaemic women) were mildly Recommendation
anaemic , with another 26% being moderately
anaemic . No cases of severe anaemic was not Multi sectoral, long-term programme
found in survey population. National surveys with further causal analysis is
conducted during past have shown gradual required to combat the increasing
improvement of maternal anaemia over the prevalence of anaemia in pregnancy.
time. However, in-depth causal analysis is
essential to interpret this finding further. Improve compliance with iron folic
acid supplementation implemented
through the MCH programme

Inter-district variations have been

observed in nutritional status, such as
anaemia, BMI status among pregnant
women. Therefore, it is essential to
investigate the underlying factors and
develop plans and programmes at sub
national level to improve the
maternal nutrition status in the
country.

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98 Annual Health Bulletin 2016

 BMI in Pregnancy

30
24.6 23.8 24.3 23.7
25 23
21.3
20
20 16.2 17.2
Percentage

15.2
20.2 18.8
15

10

0
2011 2012 2013 2014 2015 2016
Year

Mothers with low BMI at clinic visit before 12 weeks

Mothers with BMI > 25 at clinic visit before 12 weeks

Figure 8.4 : There is a significant increase in number of mothers with BMI more than 25 (before 12
weeks) visiting antenatal clinics over the last five years
Source: Family Health Bureau

During the last three years there is a significant District distribution of low weight birth rate is
increase in number of mothers with BMI more illustrated in Detailed Table 40 (Annexure 01).
than 25 (before 12 weeks) visiting antenatal
clinics, while decrease in the number of Nuwara Eliya district reports the highest low
mothers who are normal or underweight. weight birth rate and it is 24.4 per 100 live
births. Mannar has the lowest low weight birth
rate of 10.1 followed by Kilinochchi and
Among pregnant mothers Hambantota districts respectively.
visiting antenatal clinics, during
the last three years, there is a Nuwara Eliya district reports the
rise in mothers who are either highest low weight birth rate and it
overweight or obese is 24.4 per 100 live births

Low Birth Weight among new born

Low birthweight shows a slight reduction over

the years.

According to MSU data, low weight birth rate in

Sri Lanka is 15.5 per 100 live births in 2016.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 99

 18 16.7 16.7
16.3 16 16
15.5
16

14 13.3
12.6 12.4 12.2
11.4 11.5
12

10

0
2011 2012 2013 2014 2015 2016

LBW reported by H509 LBW reported to MSU

Figure 8.5 : Low birth weight shows a slight

reduction over the years
Source: Family Health Bureau

8.1.2. Risk Factors Related to Nutrition Even with a high assessment coverage (94%)
during nutrition month, the reported
status of children under the age of five
malnutrition rates are very much lower
years compared with DHS 2016, which reports rates
for stunting 17.3%, underweight 20.5%, wasting
Infant and Child Nutrition 15.1% and overweight/obesity 2%.

According to WHO population cut offs Sri Lanka Sri Lanka has achieved these relatively low
is a low prevalent country with regard to figures through a lot of effort over the years by
chronic under nutrition among children under implementation of all relevant nutrition specific
five years since prevalence of stunting is below evidence-based interventions island wide by the
20%. Ministry of Health to address malnutrition.
Growth monitoring with regular assessment of
Yet stunting rates has been static over past weight and length/height and promotion of
years. Inability to bring about a declining trend breastfeeding and appropriate complementary
over the recent past is a matter of concern. feeding through infant and young child feeding
Decline in prevalence of underweight is counselling is the main strategy to address
similarly negligible. Over the years hardly any malnutrition in addition to micronutrient
improvement is observed regarding prevalence supplementation and other supportive
of wasting (acute under nutrition). interventions.

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 25

19.8
20

15.3 15.6
15 13.6
Percentage

11.3
12.8
10 11.3
9.2

0.76 0.5
0
2011 2012 2013 2014 2015 2016
Year

Underweight Stunting Wasting Overweight

Figure 8.6: Malnutrition among under five children from 2011 to 2016
Source: Family Health Bureau

Recommendations

 Extensive effort should be taken targeting

improvement of quality and the coverage of these
evidence-based nutrition specific interventions which
should include increasing cadre, human resources, their
capacities to provide nutrition interventions and
providing required facilities for quality service provision
from grass root level upwards.

 For nutrition-specific interventions implemented by the

Ministry of Health to be successful, a supportive
environment should also be created by the non –
health sector. This inter-sector collaboration should
encompass implementation of nutrition sensitive
interventions such as ensuring food security, poverty
alleviation and support for proper child care. Content Source:
Family Health Bureau

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 101

8.1.3. Malnutrition among School
Children

During SMIs students are assessed for their

nutritional status. Stunting is assessed in grades
1 and 4 only. Body Mass Index (BMI) of all
students in grade 10 is assessed and necessary
nutritional interventions are done during the
nutrition month each year.

25 23.5
21.7
20.2
20
16.4

15

10 8.7
6.7
5.8 5.2
5 4.1
2.4

0
Grade 1 Grade 4 Grade 7 Grade 10

% Stunting % Wasting % Overweight

Figure 8.7 : Percentages of school children in different Grades with stunting, wasting and
overweight in 2016
Source: School Health Return- H 797) RHMIS, Family Health Bureau

6.6 27.8 28.1 28.4

7.0 30.0 26.5
6.0 25.0
4.8 5.0 4.9 21.3
5.0 4.3
5.4 20.0
4.0 20.7 19.9 20.0
4.1 4.2 15.0 18.4
3.0 3.8
15.0
3.1 10.0
2.0
5.0
1.0
0.0
0.0
2012 2013 2014 2015 2016
2012 2013 2014 2015 2016

Male Female Male Female

Figure 8.8 : Percentages of Grade 10 children with Figure 8.9 : Percentages of Grade 10 children
overweight BMI 2012-2016 with low BMI 2012-2016
Source: Nutrition Month Survey, Family Health Bureau

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102 Annual Health Bulletin 2016

 Action Taken

In 2016, 8.7% and 6.7% of children in 1. To address persistent under-nutrition which

grades 1 and 4 were stunted is mainly due to micronutrient deficiency
(e.g. childhood wasting and iron deficiency
respectively
anaemia), there is a school midday meal
programme and weekly iron folate
Wasting was higher compared to supplementation programme for school
stunting in the respective grades while Children
the highest rate of wasting was reported
2. To address obesity, the school health unit of
among children in grade 1 (23.5%)
the Ministry of Health obtained approval
for the Cabinet paper on the prevention of
obesity among School Children with the
Prevalence of both overweight and obesity has following suggestions:
increased among grade 10 students according
to the Nutrition Month Survey 2016. Sri Lanka is  Allocate compulsory half an hour for
experiencing the demographic and nutrition physical activity per day in schools
transition and is facing all the challenges of
socio economic development and related  Ban sponsorship for school sports activities
changes in lifestyle and the food environment. by food industry producing unhealthy food
Hence it is imperative that overweight/obesity
prevention is targeted for all school children  Screen all advertisements of foods that
across the country. specifically target children before
telecasting
Another unique problem encountered by the
students in our country is the persistence of  Establish physical activity promoting
under nutrition in this same environment even outdoor/ play areas in all townships and
though there is a slight reduction in the year housing projects to promote physical
2016. (Figure 8.9) activity of children which can include the
family

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 103

 Recommendations

1. Overweight/obesity is caused by many factors and

therefore all aspects of this problem should be addressed
through successful prevention strategies.

2. The implementation of the cabinet paper should be made

a priority among responsible authorities

3. Control selling of unhealthy food items, 100 meters from

school boundary

4. Take policy decisions to limit the production of unhealthy

food

5. Labelling and stating the nutritional value of the food

items should be made compulsory

6. The upper sugar limit of the yellow colour code should at

least be reduced to 6%, which at present is 11%

7. Prevent school children from appearing in media

advertisements, which promote food items containing
high levels sugar, salt and oil

8. Prohibit serving unhealthy food items in programmes in

which school children are participating

Content Source: Family Health Bureau

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104 Annual Health Bulletin 2016

 8.2. Adolescence Health Risk Factors

Teenage Pregnancies
Out of the teenage pregnancies that were
There is a reduction of percentage of Teenage
reported in 2016 almost 80% of pregnancies
pregnancies reported over last five years
were reported in the age group of 18 and 19.

7.0
6.1 6.0
6.0
% of teenage pregnancies

5.3 5.2
4.9 4.8
5.0

4.0

3.0

2.0

1.0

0.0
2011 2012 2013 2014 2015 2016
Year

Figure 8.10 : Teenage pregnant mothers out of all registered pregnancies

Source: Family Health Bureau

90.0 80.0 79.9

80.0
70.0
60.0
Percentage

50.0
40.0
30.0
17.4 17.5
20.0
10.0 2.6 2.6
0.0
2015 2016
Year and Age Groups

<16 16-17 18-19

Figure 8.11 : Percentage of teenage pregnancies among pregnant mothers by age group in 2016
Source: Family Health Bureau

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 105

Life Style Related Risk Factors among 4. Sexual behavior:
adolescents and youth

National Youth Health Survey 2012-2013 One third of the total sample and one fifth of
conducted in a nationally representative sample the unmarried youth reported in engaging in
of 8820 of Sri Lankan youth of 15-24 years some sexual activities during the preceding year
obtained a profile of Sri Lankan youth in terms with higher proportions among the urban and
of selected aspects of their health, personal, rural youth
home and environmental factors affecting their
health.
8.3. Gender based violence
Following are some of the lifestyle related risk
factors for Sri Lankan youth: Gender-based Violence is the major negative
consequence of gender inequality which results
1.Physical inactivity: in great negative health impacts.
Half of the males and three quarter of females Gender Based Violence (GBV) is recognized as a
had not done manual work in the preceding major health issue with a wide range of
week. Approximately 44% of total youth were consequences to the survivors creating a
spending five or more days in the preceding negative impact on children, and acting as an
week as “screen time” with a higher female inhibiting factor towards the family wellbeing.
preponderance. Male youth were prominently Although this is a common problem, it is also
engaged in formal exercise (17%) compared to considered a hidden problem as most of the
4.5% of females. women do not reveal about their sufferings due
to reasons such as culture, fear of reprisal, and
2. Diet: concern over children, shame and internalizing
the violence. GBV is also an ever-increasing
Over 50% boys had consumed carbonated /cola burden to the health care services. The social
drinks during the preceding week verses 36% of and economic burden to the country due to
females. One fifth consumed pre-cooked food Domestic Violence/GBV is estimated to larger
like sausages while one fourth had taken food than that due to malignancies.
with high salt. Nearly 6% of youth were taking Gender Based Violence during pregnancy is a
energy formulas. Only half of the youth, have common occurrence and leads to many
heard about the BMI concept negative pregnancy outcomes including
miscarriages, still births and maternal deaths.
3. Tobacco, alcohol and other substance use: Also, GBV in one generation can influence the
behavior of the next generation by a process of
Ever and current smoking rates were 30.5% and learned behavior. When children are exposed
17.6% for males and 1.6% and 0.7% for females to violence between their parents, boys learn
respectively. Significantly, more non-schooling violence as a mean of achieving control and
males (23.9%) had smoked during the preceding eventually have a greater chance of being a
week compared to schooling males (4.3%). perpetrator. On the other hand, girls learn to
Betel chewing during the preceding week was accept violence as an inevitable helplessness
6.3% with male and rural strata predominance. and have a higher chance of being victims in
Significantly, more non-schooling males adult life.
reported of alcohol ever use (43.4%) as well as
current use (13.8%) compared to schooling
males (17.0% and 2.6%).

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106 Annual Health Bulletin 2016

 Figure 8.12 : Reported cases of gender-based violence by RDHS areas, CMC & NIHS

Source: Family Health Bureau

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 107

8.4. Risk factors for Non
Communicable Diseases

8.4.1. Prevalence of behavioural and

intermediate risk factors for NCD

The below table compares the prevalence of

behavioral and intermediate risk factors among
adults (age between 18 to 69 years) for Non
communicable in 2015 as compared to year
2007.

Table 8-2 : Prevalence of behavioural and intermediate risk factors for NCD in 2007 & 2015

Risk factor 2007 2015

Male Female Both sexes Male Female Both sexes

Smoking 22.8% 0.3% 11.5% 19.9% 0.0% 10.2%

Alcohol 26.0% 1.2% 13.5% 34.8% 0.5% 17.9%

physically 31.9% 17.9% 25.0% 22.5% 38.4% 30.4%

inactive
Inadequate 81.4% 83.3% 82.4% 73.1% 72% 72%
fruits and
vegetables
overweight 19.6% 30.4% 25% 24.6% 34.3% 29.3%
(BMI ≥25)
Obese 3.6% 5.9% 4.7% 3.5% 8.4% 5.9%
(BMI≥30)

Source: STEPs Survey

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 8.4.2. Prevalence of risk factors among
the screened population at HLCs

Non-Communicable Disease has taken an The target group to screen at Healthy Life Style
initiative to establish Healthy Life Style Centres centers is 40 – 65 years. Main objective of
(HLCs) throughout the island to screen people screening is to identify behavioural and
who are not suffering from any NCD. intermediate risk factors and to intervene early
to prevent an CVD event.

Table 8-3 : Numbers and proportions of targeted population screened in Sri Lanka with
behavioural or intermediate risk factors, 2013–2015
Behavioural or Number (%) of screened population with risk factor
intermediate risk factor 2013a 2014b 2015c 2016d
Fasting blood glucose 37,980 (11.58) 48,853 (12.75) 41,372 (10.57) 33,845
>126 mg/dL (10.79)
Raised blood pressure 69,400 (21.16) 91,805 (23.96) 89,862 (22.97) 74,387
(systolic ≥140 mmHg (23.71)
and/or diastolic ≥90
mmHg)
Overweight (BMI ≥25 90,686 (27.65) 100,618 (26.26) 99,873 (25.53) 78,695
kg/m2) (25.09)
Obese (BMI ≥30 kg/m2) 29,255 (8.92) 29,043 (7.58) 32,300 (8.26) 24,955 (7.96)

Current tobacco smoker 18,170 (5.54) 25,557 (6.67) 26,826 (6.86) 21,356 (6.80)

Current drinker 40,604 (12.38) 28,775 (7.51) 29,836 (7.63) 25,339 (8.08)

Smokeless tobacco user 21,089 (6.43) 53,604 (13.99) 53,651 (13.71) 45,230
(14.42)
With 10-year CVD risk 1,836 (0.56) 1,724 (0.45) 2,268 (0.58) 908 (0.29)
≥30%
BMI: body mass index; CVD: cardiovascular disease.
a:88 554 men screened; 239 425 women screened; total population screened: 327 979.
b:110 469 men screened; 272 692 women screened; total population screened: 383 161.
c:108 399 men screened; 282 861 women screened; total population screened: 391 260 (weighted data).
D:85338 men screened; 228361 women screened; total population screened: 313699

Source: Directorate of NCD

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 109

Table 8-4 : Prevalence of Risk Factors among the screened population (by District – 2016)

% of Smokers Detected

% of Tobacco Chewers

% with Blood Glucose

% of BMI 25 - 29.9
Target population

% with CVD >30

RDHS Area

% of Alcoholics
Total Screened

% of BMI > 30

≥126mg/dl
Detected
Ampara 67,115 8,522 9.13 21.83 10.92 32.32 15.95 10.84 0.20
Anuradhapura 225,732 20,304 9.67 20.60 11.50 24.10 7.54 12.30 0.91
Badulla 213,266 30,861 8.72 23.77 12.20 28.30 8.20 13.00 0.54
Batticaloa 146,650 14,736 6.39 12.00 6.00 28.00 11.00 10.00 0.11
Colombo 430,785 17,837 6.26 6.59 7.06 32.74 13.84 14.02 0.10
Galle 268,000 20,254 4.00 8.00 5.00 31.00 8.00 16.00 0.30
Gampaha 592,401 51,446 5.79 10.35 8.19 34.72 13.52 12.86 0.33
Hambantota 156,351 26,947 8.30 16.10 11.20 25.80 6.40 6.50 0.75
Jaffna 154,552 14,668 7.03 12.25 6.86 28.62 7.84 11.33 0.04
Kalutara 249,320 16,608 4.80 14.50 8.80 30.10 9.10 11.00 0.40
Kalmunai 110,887 19,245 6.90 13.20 4.40 31.90 10.70 17.20 0.20
Kandy 367,472 18,586 5.50 11.20 6.90 29.60 10.20 12.60 0.20
Kegalle 259,138 29,974 2.80 7.53 3.86 20.80 6.29 10.86 0.10
Kilinochchi 34,196 9,686 10.73 19.72 11.21 26.50 7.90 18.40 0.76
Kurunegala 402,479 51,326 3.60 11.60 4.60 28.00 6.80 11.80 0.20
Mannar 40,390 8,534 11.62 17.29 11.36 31.79 10.73 8.51 0.19
Matale 127,354 13,084 3.13 8.50 3.94 34.26 3.60 13.40 0.00
Matara 210,829 17,016 3.14 7.85 3.19 27.03 8.30 11.45 1.12
Moneragala 119,614 27,938 8.90 15.09 8.55 19.86 4.85 7.95 0.09
Mullitivu 32,767 6,742 13.90 21.80 13.80 25.20 7.84 7.50 0.38
Nuwara Eliya 208,148 17,343 14.21 31.29 23.10 38.25 18.49 18.73 0.80
Polonnaruwa 110,954 17,366 7.01 15.63 8.58 20.95 6.28 8.97 0.34
Puttlam 199,928 27,866 4.90 12.70 6.20 27.20 8.90 19.20 0.00
Rathnapura 274,516 32,548 5.47 24.02 9.49 24.36 11.33 10.63 0.16
Trincomalee 95,335 11,387 7.60 13.60 5.60 23.90 5.60 9.00 0.60
Vavunia 48,352 9,668 14.21 26.39 15.94 26.25 8.26 15.81 0.11
NIHS 80,627 7,758 4.98 6.28 8.21 32.12 11.52 11.47 0.05
BMI - Body Mass Index
CVD - Cardiovascular Diseases
Source: Directorate of NCD

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110 Annual Health Bulletin 2016

 8.4.3. Alcohol Consumption

Table 8-5 : Prevalence of alcohol consumption

Prevalence (%) in 2007 Prevalence (%) in 2015

Female 1.2% 0.5%

Male 26.0% 34.8%
Both sexes 13.5% 17.9%
Source: STEPs Survey

50
45.5
45
39.6
40 37
34.8
35

30
percentage

25

20

15

10

0
National Alcohol Survey National Alcohol Survey STEPS survey 2015 DHS Survey 2016
2007 2012
survey

Figure 8.13 : Trend in alcohol consumption among males

Source: Directorate of Mental Health

There is a decrease in the prevalence of alcohol use among males in

2015 (34.8%) when it compared with the last survey done in the year
2012. (39.6%). The latest DHS survey shows this figure as 37%

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 111

Actions taken Recommendations

National Policy on Alcohol control was Development of National strategic plan

formulated by the Directorate of Mental Health on Alcohol Prevention
and launched in 2016. The policy aims to
eliminate all forms of promotion of alcohol Establishment of at least one Alcohol
products, to enforce pricing, trade and Rehabilitation Centre per district
investment policies related to the different
aspects of alcohol trade, to reduce availability Strengthen collaboration to implement
and accessibility to alcohol and to strengthen multi-sector action plan on alcohol
supportive services and rehabilitation with prevention and control
assistance from the community.

National Alcohol Summit 2016 was held in

collaboration with National Alcohol and
Tobacco Authority (NATA) and the theme was
“Towards an Alcohol Free Sri Lanka”.

Training of health staff in several districts was

carried out in alcohol prevention & control and
clinical management of addicted patients.
Establishment of an Alcohol Rehabilitation
centre (ARC) at Rambukkana and renovation of
Mawathagama ARC.

Content Source: Directorate of Mental Health

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112 Annual Health Bulletin 2016

 8.5. Physical Environment

8.5.1. Water 8.5.2. Sanitation

According to the Demographic and Health According to demographic and health survey,
Survey – 2016, one in ten households still conducted in 2016, 91 percent of households
receive their drinking water from an have improved toilets and 7 percent have a
unimproved source in the country and six out of shared improved toilet facility. The most
ten households do so in the estate sector. common type of toilet is an unshared,
pour/flush toilet (72 percent). Only 2 percent of
households do not have access to any toilet
facility, though this percentage is as high as 4
percent in the estate sector. (DHS report 2016,
page no: 15)

Figure 8.14 : Percentage of Households with improved source of drinking water by residence

Source: Demographic and Health Survey – 2016

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 113

Figure 8.15 : Percentage of Households with improved, not shared, sanitation facilities by sector
Source: Demographic and Health Survey – 2016

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114 Annual Health Bulletin 2016

Service Coverage
9.Health Service
Coverage
Ministry of Health is responsible for providing 9.1.2. Antenatal Care coverage
health services for all the citizens of the
country. The goal is to provide a sufficient The registration of pregnant mothers has been
quality service to people in need of promotive, more than 90% over the years and in 2016 it
preventive, curative, rehabilitative or palliative was 99.1%. Out of them, over 78.5% registered
healthcare that would achieve potential health for care before 8 weeks of amenorrhea and this
gains. number has been rising over the last few years
Indicators of service coverage, which is defined from 72% to 78%. Protection for Rubella with
as the proportion of people in need of a service immunization before pregnancy, protection for
that receive it, regardless of quality, are more Tetanus, antenatal screening for Syphilis and
commonly measured than effective coverage testing for blood group at the time of delivery
indicators which require the measurement of has achieved almost universal coverage.
intervention effectiveness of the service
provided. The assessment of the service
coverage indicators is a critical dimension to
tracking performance. In 2016, 99% of all pregnant
mothers registered for antenatal
9.1. Reproductive, Maternal, New-
care services
born, Child, Adolescent and Youth
Health (RMNCAYHP) services
coverage

9.1.1. Pre-pregnancy care In 2016, 49% of primi mothers

attended at least one session
Sri Lanka is one of the countries in the region to of pre-conception care
commission a pre-pregnancy Care Package
which was initiated in 2012. The Care Package
includes creating awareness, health promotion,
screening and other appropriate interventions
to reduce risk factors that might affect future
pregnancies of the reproductive aged women.
In 2016, out of all primi mothers registered by
PHMs, 48.7% have attended at least one
session of pre-conception care and 26.6% have
attended both sessions.

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116 Annual Health Bulletin 2016

 Table 9-1 : Pregnant mother registration and care received through National Programme has been
improving over the past five years (2012- 2016)

Indicator 2012 2013 2014 2015 2016

Pregnant mothers registered by PHMs out of estimated 94.0 90.0 91.2 93.5 99.1
pregnancies
Pregnant Mothers registered before 8 weeks 75.2 75.4 76.2 77.1 78.5

Pregnant Mothers registered between 8-12 weeks 18.3 17.7 17.4 16.5 14.9
Pregnant mothers protected with Rubella at registration 96.8 97.0 98.2 97.6 96.6

Pregnant mothers tested for VDRL at the time of delivery 99.3 99.7 98.1 98.7 99.9

Pregnant mothers blood group tested at the time of 100.0 99.9 97.8 99.0 99.9
delivery
Pregnant mothers protected for Tetanus out of reported 99.9 99.9 97.8 99.3 99.9
deliveries

Source: Demographic and Health Survey – 2016

In 2016, 90.3% of registered pregnant women were visited at least once at home by the PHM, and
94.7% of them attended at least one field clinic visit.

Table 9-2 : Antenatal Service coverage by Public Health Staff has been consistently over 90% for
the past five years (2012-2016)

Indicator 2012 2013 2014 2015 2016

Registered pregnant mothers visited at 90.2 91.3 90.2 88.5 90.3
least once at home by PHM

Registered pregnant mothers attending 95.2 94.8 95.5 94.6 94.7

at least one field clinic visit

Source: (MCH Quarterly return - H 509) RHMIS, Family Health Bureau

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 117

 9.1.3.Peri-Natal
9.1.3. Peri-Nataland
andPost
PostNatal
NatalCare
Care Duringthe
During theimportant
importantpostpartum
postpartumperiod,period,
Coverage approximately85%
approximately 85%ofofmothers
motherswere werevisited
visitedatat
Coverage
homebybyPHMs
home PHMsatatleast
leastonce
onceduring
duringthe
thefirst
first1010
days,and
days, and66%
66%during
duringthe thefirst
firstfive
fivepostpartum
postpartum
Pregnancyoutcome
regnancy outcomewas wasreported
reportedfor for94.5%
94.5%ofof days.On
days. Onaverage,
average,most
mostmothers
mothersreceived
receivedtwotwo
pregnanciesregistered
pregnancies registeredwith
withthe
thePHM.
PHM.Almost
Almostallall postpartumhome
postpartum homevisits.
visits.
reporteddeliveries
reported deliveriesinin2016
2016hadhadtaken
takenplace
placeinin
institutions,and
institutions, andthe
thepercentage
percentageofofhomehome
deliverieshas
deliveries hasdecreased
decreasedtoto a avery
veryminimum
minimum Almostall
Almost allreported
reporteddeliveries
deliveries
level(0.1%)
level (0.1%)over
overthetheyears.
years.The
Thecaesarean
caesarean
sectionrate
section ratehas
hasgradually
graduallyincreased
increasedtoto36.3%
36.3%inin
hadtaken
had takenplace
placeininhealthcare
healthcare
2016.In-depth
2016. In-depthanalysis
analysisisisneeded
neededininthe thefuture
future institutionswhile
institutions whilefour
fourout
outofoften
ten
totoidentify
identifythe
theunderlying
underlyingreasons.
reasons.Due Duetoto reporteddeliveries
reported deliverieswere
were
obstetrictransition,
obstetric transition,indirect
indirectmaternal
maternalmortality
mortality caesareansections
sections
caesarean
causesand
causes andover-medicalisation
over-medicalisationhave havebeen
been
recognizedasasemerging
recognized emergingissues
issuesininmaternal
maternalcare.
care.

Table9-3
Table 9-3: :Pregnancy
Pregnancyoutcome
outcomeand
andpostpartum
postpartumcare
carefor
formothers
mothersregistered
registeredduring
during2012
2012- -2016
2016
Indicator
Indicator 2012 2013
2012 2013 20142014 2015
2015 2016
2016

%%ofofpregnancy
pregnancyoutcome
outcomereported
reportedout outofofregistered
registered 88.8
88.8 91.5
91.5 93.7
93.7 95.8
95.8 85.0
85.0
pregnancies
pregnancies
%%ofofdeliveries
deliveriesreported
reportedout
outofoftotal
totallive
livebirths
birthsregistered
registered 89.8
89.8 87.7
87.7 91.6
91.6 96.2
96.2 93.7
93.7

%% ofof deliveries
deliveries reported
reported outout ofof total
total estimated
estimated76.9
76.9 76.7
76.7 75.3
75.3 78.4
78.4 91.4*
91.4*
pregnancies
pregnancies
%% ofof institutional
institutional deliveries
deliveries out
out ofof total
total reported
reported 99.8
99.8 99.9
99.9 99.7
99.7 99.9
99.9 99.9
99.9
deliveries
deliveries
Numberofofhome
Number homedeliveries
deliveries 312
312 336
336 525
525 280
280 222
222

%%ofofHome
Homedeliveries
deliveriesout
outofoftotal
totalreported
reporteddeliveries
deliveries 0.1
0.1 0.1
0.1 00.09 0.09
00.09 0.09 0.07
0.07

Postpartummothers
Postpartum mothersreceiving
receivingatatleast
least11visit
visitbybyPHM
PHM 77.3
77.3 80.6
80.6 79.3
79.3 73.6
73.6 76.2
76.2
during1st
during 1st1010days
daysout
outofofestimated
estimatedbirths
births
**
Postpartummothers
Postpartum mothersreceiving
receiving11visit
visitbybyPHM
PHMduring
during1st
1st - - -- -- 67.2
67.2 66.1
66.1
55days
daysout
outofofestimated
estimatedbirths
births

%%Caesarean
Caesareansections
sectionsout
outofoftotal
totalinstitutional
institutionalreported
reported 28.728.7 31.8
31.8 32.1
32.1 33.8
33.8 36.3
36.3
deliveries
deliveries
Average number
Average number ofof home
home visits
visits during
during first
first 1010 1.7
1.7 2.0
2.0 1.7
1.7 1.7
1.7 1.7
1.7
postpartumdays
postpartum days

Source:(MCH
Source: (MCHQuarterly
Quarterlyreturn
return- H
- H509)
509)RHMIS,
RHMIS,Family
FamilyHealth
HealthBureau
Bureau
*Outofoflive
*Out livebirths
birthsregistered
registeredbybyRGD
RGDfor
forthe
theyear.
year.

AnnualHealth
Annual HealthBulletin
Bulletin- -2016
2016 118
118

118 Annual Health Bulletin 2016

 registered (100%) have been seen by a MOH in
9.1.4. Infant and Child care service their clinics (Table 9-4).
coverage
The percentage of infants weighed was 88% and
in 1-2-year age group it was 79%. Among 2-
Coverage of infant and child care services by 5year group 80.5 % had been weighed. More
field staff attention should be paid to increase the
weighing coverage of the 1-2 and 2-5-year age
The PHM should register infants for domiciliary groups by field staff.
and clinic care which includes immunization,
growth assessment and development. In 2016, Approximately three fourth of children in each
more than 95% of infants have been registered targeted age groups received their dose of
by PHMs, and out of registered infants, 53% Vitamin A. Efforts should be made to increase
have been visited by PHM at least once with an the coverage further in all age groups, Vitamin
average of 7 visits per infant. All the infants A supplementation is provided.

Table 9-4 : Most of the indicators on infant and childcare provided by the field staff is improved
over the last five years

Indicator 2012 2013 2014 2015 2016

Infants registered by PHMM 88.2 91.7 90.6 89.3 95.3*

% Infants having at least 1 home visit after 42 days out 69 63.9 58.0 53.7 53.4
of registered infants
Average number of home visits per infant 7.1 7.4 7.5 7.0 7.2
Weighing
% of infants weighed 83.2 85.7 84.3 88.2 88.4
% of young children (1-2 years) weighed 76.1 79.3 77.1 80.2 79.2
% of 2 - 5 years children weighed 78.8 77.8 63.0 78.7 80.5
Clinic attendance
% of infants making at least one clinic visit (of 100 99.6 99.1 100 100
registered infants)
Average number of clinic attendance for an infant 5.3 5.2 5.3 4.5 4.7

Vitamin A supplementation
% of estimated infants given Vitamin A at 6 months 76.4 68.9 68.8 71.6 80.5
% of estimated children given Vitamin A at 18 months 74.7 70.7 71.9 74.9 80.6
% of estimated children given Vitamin A at 3 years 78.8 71.4 73.1 74.5 90.5

Source: (MCH Quarterly Return - H 50) RHMIS, Family Health Bureau

*calculated out of first visits by PHM

Annual Health Bulletin - 2016 119

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 119

 students in grades 1, 4, 7 and 10 are examined
9.1.5. Coverage of School Medical annually.
Inspections There were 10,162 schools and 1,650,370
children to be examined out of the enrolled
4,143,330 children. The SMIs were conducted in
School medical services include School Medical 9,579 schools resulting in overall school
Inspection (SMI) of children and making coverage of 94.3%. The coverage of schools
relevant referrals. In small schools (with less with less than 200 and more than 200 students
than 200 students) all the children are were 98.8% and 94.5% respectively. (Figure
examined once a year, while in the larger 9.1). Follow up visits by the PHI for the students
schools (with more than 200 students) all identified with correctable defects were closely
monitored at the monthly MOH conferences.

12000
9826 10144 10162
10000 9114
8497 8544
9802 9579
8000 9107
No. of schools

8521
8063 8099
6000

4000

2000

0
2011 2012 2013 2014 2015 2016
Year

SMI Completed Total Number of Schools

Figure 9.1 : Total number of schools and number of schools where SMI were conducted
increased over the last five years (2011 to 2016)

Source: (School Health return- H 797) RHMIS, Family Health Bureau

Overall school coverage was

94.3%

Annual Health Bulletin - 2016 120

120 Annual Health Bulletin 2016

 700000

586226 590221
600000 568136
522388 86%
500000
No. of cases

400000
62% 57%

300000 45%

200000

100000

0
2013 2014 2015 2016
Year

No of defects Corected

Figure 9.2 : Progress of the SMI follow up 2013 – 2016

Content Source: Family Health Bureau

9.1.6. Immunization coverage

(Please see Annexure II;
National Immunization Programme of Sri Lanka
is one of the best performing public health
 Table 6: Incidence of Expanded
programmes in the region and globally. Due to
Programme of Immunization (EPI)
the high coverage of all EPI vaccines, delivered
Target Disease 1955-2016;
through the Expanded Programme on
 Table 7: Immunization Coverage by
Immunization (EPI), there has been a low
(RDHS) area, 2016; and
incidence of Vaccine Preventable Diseases
 Table 8: Number of Selected Adverse
(VPD).
Events by Vaccination in 2016
(for further information)

Content Source: Epidemiology Unit

Annual Health Bulletin - 2016 121

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 121

9.1.7. Well women service coverage In order to reach women who have never been
screened, in 2016 the MOH added Pap
screening for women aged 45. This supplement
The target age group for Well Women Clinic the current policy of screening women aged 35,
services are women aged 35- 60 years (i.e. in place since 2007, However, the other women
nearly a 25 percent of the population in Sri aged 35-60 years who voluntarily request
Lanka). The WWC services are implemented screening are also provided services at WWCs.
through a network of over 800 clinics in The coverage of attendance of 35- year age
community as well as in hospital settings. cohort of women to the WWCs in 2016 was
52.8% (n= 111,798).

90.0

79.8
80.0 77.9
76.4
73.6
69.5
70.0 66.1 66.6

60.8 61.9
60.0 58.2 57.656.4 56.4
54.3 53.9
49.548.2 49.0
50.0 47.2
45.5
Percentage %

38.938.939.6
40.0 36.9
31.7
30.0
21.5
19.9
20.0
12.6
10.0

0.0

Figure 9.3 : Well Women service according to Health regions in Sri Lanka
Source: Family Health Bureau

Content Source: Family Health Bureau

Annual Health Bulletin - 2016 122

122 Annual Health Bulletin 2016

 Demographic and Health Survey 2016 the
9.1.8. Reproductive Health contraceptive prevalence rate for currently
married women aged 15 – 49 is 65%.
Contraceptive prevalence rate
A consistent decline in the unmet need for
Percentage of current users of any family family planning is observed in the recent past (a
Planning method among eligible families is the 15% decline since 2011). However, the overall
working definition for contraceptive prevalence contraceptive prevalence seems to be
rate. Contraceptive prevalence rate for 2016 is fluctuating. In order to improve this situation,
67.1%. Of these most families were using new strategies like targeting special groups and
modern family planning methods (prevalence involvement of the private sector are being
57.6%). However, according to the explored.

Contraceptive prevalence rate is the percentage of women who are currently using, or
whose sexual partner is currently using, at least one method of contraception, regardless
of the method used. It is usually reported for married or in-union women aged 15 to 49
(WHO).

80.0

70.0 65.3 65.8 65.3 67.1

64.6 64.9

60.0

50.0

40.0

30.0

20.0

10.0 7.4 7.3 7.1 6.8 6.6 6.3

0.0
2011 2012 2013 2014 2015 2016

% of current users of any FP method among eligible families % Unmet need

Figure 9.4: Consistent decline in the unmet need for family planning is observed in the last five
years (2011-2016)

Source: (MCH Quarterly return - H 50) RHMIS, Family Health Bureau

Eligible families – as reported by the PHM in H 509

Annual Health Bulletin - 2016 123

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 123

 Women with unmet need are those who are fecund and sexually active but are not using
any method of contraception, and report not wanting any more children or wanting to delay
the next child. The concept of unmet need points to the gap between women's
reproductive intentions and their contraceptive behaviour (WHO).

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0

LRT

IUD

Injectables

Oral Contraceptive Pills

Condoms

Implant

Vasectomy

2012 2013 2014 2015 2016

Figure 9.5: Modern family planning methods used by eligible families 2012-2016

Source: (MCH Quarterly Return - H 509) RHMIS, Family Health Bureau

The prevalence of modern family planning good method mix. However, the steady
methods shows a pattern similar to the decline of the prevalence of permanent
overall contraceptive prevalence rate. The methods, especially the male method of
prevalence of modern methods indicates a permanent contraception, needs attention.

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124 Annual Health Bulletin 2016

 9.2. Non-Communicable diseases NCD screenings include blood pressure, BMI,
Blood sugar and Cholestrol and screening for
Service Coverage lifestyle risk factors such as tobacco smoking and
alcohol consumption. For women, some HLCs
9.2.1. NCD Screening at Healthy are equipped to conduct breast and oral cavity
Lifestyle Centres examinations and PAP smear tests. The WHO/
ISH risk prediction chart is used and if necessary,
interventions are offered.
NCD screening is carried out by 880 Healthy Life
Style Centres (HLC) established at primary care
In 2016, there were 267 Medical Officer of
Settings. In 2016, HLC screened 23% of the above
Health areas with more than 2 HLCs.
40 years target group. However, it is noteworthy
that male participation at HLCs was poor.

100.00%
90.00%
80.00%
70.00%
60.00%
Percentage

50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
2013 2014 2015 2016 2017
Year

Target Achievement

Figure 9.6 : Percentage of Medical Officer of Health areas with at least two healthy lifestyle
centers (HLC)
Source: Directorate of NCD

In 2016, there were 267 Medical

Officer of Health areas (out of 342)
with more than 2 HLCs

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 125

9.2.2.Diabetes
Diabetes treatment coverage

According to the STEPS 2015 report, only 69%

of adults with self-reported high blood sugar
(65.7% for males and 73.1% for females) were
estimated to be taking medicine. Among those
previously diagnosed as having high blood
sugar, 12.3% were on insulin (13.5% for males
and 11.3 % for females).

9.2.3. Hypertension
Hypertension treatment coverage

The STEPs 2015 report estimated that only 58%

of adults with elevated blood pressure were on
medication (62.3% for males and 55.1% for
females).

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126 Annual Health Bulletin 2016

Health System
10. Organization of the Healthcare Delivery
System
Health care in Sri Lanka is delivered through universities in other countries and they are
government and private providers. The recruited by the Ministry of Health and
government health system has been partially deployed on an all-island basis in the
decentralized down to the Provincial Councils government health service.
since 1989.
The Ministry of Health has several other
The Ministry of Health Nutrition and Indigenous training institutes throughout the country such
Medicine at central level is responsible for as nurses’ training schools and the National
maintaining the health services of the country, Institute of Health Sciences which are directly
and is the leading agency providing stewardship under its management. These institutes provide
to health service development and delivery. Its basic, post basic and in-service training to all
main function is formulating public health policy categories of health staff engaged in curative
and regulating services for both public and and preventive services.
private sectors. It is also responsible for directly
Technical units and campaigns under the
managing several large specialized hospitals
Ministry of Health (such as Family Health
(National Hospital of Sri Lanka, Teaching
Bureau, Epidemiology Unit, NCD Unit, anti-
Hospitals, Specialized Hospitals, Provincial
malaria campaign) provide technical guidance
General Hospitals and selected District General
to RDHS in carrying out disease control
Hospitals), whilst the nine Provincial Ministries
programmes in the district level.
are responsible for effective implementation of
the services in their respective provinces. The
Another important function of Ministry of
Military (Sri Lanka Army, Navy and Air force)
Health is the central procurement of drugs.
and Sri Lanka Police have their own hospitals
Drugs provided through the government health
which are managed through their
services are provided free of charge to patients
administrative structure.
and drugs provided through government
franchised pharmacy outlets (Osu Sala), make
There are nine provinces and 26 health districts
drugs available at reasonable cost.
called Regional Director of Health Services
(RDHS) in the country. RDHS areas are similar to The State Pharmaceutical Corporation is the
administrative districts except in Ampara where procurement agency for drugs and medical
the district is subdivided into Ampara and supplies for the Ministry of Health. It follows
Kalmunai RDHS areas. national procurement guidelines and other
stringent procedures for evaluation and
The Ministry of Health is also responsible for selection of drugs and medical supplies for
training of some of the health human resources. government health facilities.
Doctors are trained in the eight State
universities and recognized medical

Annual Health Bulletin - 2016 128

128 Annual Health Bulletin 2016

 The State Pharmaceutical Manufacturing responsible for organizing, managing and
Corporation is the Governments’ sole ensuring smooth delivery of services within the
manufacturer of drugs. Public private administrative district.
partnerships too are being considered to
expand production capacities. Other registered
private suppliers both local and international, 10.1. Achievements for 2016
follow the government procurement
procedures to supply drugs and medical  National Drug Regulatory Authority was
devices. established in 2015, and in 2016 it has
introduced a pricing formulary to
The Medical Supplies Division (MSD) is the main reduce the prices of 48 essential drugs.
distribution agency. It is also responsible for
forecasting the annual requirements. Once  Sri Lanka was certified as malaria free
drugs are procured, the distribution is done by World Health Organization on 6th
according to requirement of the main hospitals September 2016
under the central ministry and to the regional  Japanese government donated medical
(district level) MSDs to meet the district level equipment worth 610 million rupees to
requirements. the Ministry of Health on 2nd March
2016.
The National Health Policy also recognizes the
role of civil society organizations and other non-  Seventy haemo-dialysis machines and
governmental organizations. Their involvement nine vans were provided to health
is promoted to achieve health goals. institutions in Central, Eastern,
Northern, North Central and Southern
Health, being a partially devolved subject under provinces to strengthen the services
the 13th amendment of the constitution, provided for the patients with kidney
provincial councils and local governing bodies disease
are entrusted with playing a decisive role in
provision of health services.  Ministry of Health decided to provide
Provincial administrations are entrusted with Intraocular lenses free of charge for
healthcare delivery of majority of preventive patients undergoing cataract surgeries
services and primary curative care services and and allocated 1200 million rupees to
a substantial proportion of secondary care. provide free lenses for 120,000 cataract
surgeries from 2016.
Provincial health administration functions under
 Ministry of Health started to provide
the Provincial Health Minister. Chief Secretary
free stents to patients with ischemic
and Health Secretary functions under the
heart diseases and allocated 324 million
Ministers. Administration of health services of
rupees from 2016.
the province is under a Provincial Director
appointed from the pool of senior grade  In order to control the burden of NCDs,
medical administrators of the health service. government has initiated steps to
Regional Director Health Services (RDHS) strengthen the laboratory services to

Annual Health Bulletin - 2016 129

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 129

 provide a wide range of essential
diagnostic tests through the
government health facilities.

 Government has launched an

emergency pre- hospital medical care
Ambulance service in partnership with
the Government of India

 69th session of the World Health

Organization Regional Committee for
South East Asia was held in Sri Lanka in
2016 with around 200- 250 official
delegates

 The first comprehensive review of the

National Family Planning Programme of
Sri Lanka was conducted by an external
consultant.

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130 Annual Health Bulletin 2016

 Medical Statistics Unit (MSU)
Medical Statistics Unit has been established in will have the sophistication to cater for
the Ministry of Health around 1960s.The vision numerous analytical requirements and will also
of this unit is to provide accurate unbiased, function as a disease surveillance system. The
reliable and timely statistics related to the health recurrent costs incurred for data collection will
sector in Sri Lanka. Medical Statistics Unit significantly be reduced due to the reduction in
collects, compiles and publishes statistics printing, postage and logistical costs.
mentioned below. The web based surveillance, (eIMMR) system
resulted in improved accessibility, timeliness and
1. Maternal Statistics therefore, the efficient usage of more
2. Dental Statistics centralized database at lesser cost with
3. Indoor Morbidity and Mortality Statistics enhanced administrative potential. The system
4. Out Patient Statistics was piloted in Lady Ridgeway Children’s
5. Clinic Statistics Hospital, Castle Street Womens Hospital, De
6. Bed Strength Soyza Hospital, Sri Jayawardenepura Hospital,
7. Statistics on Specialists Base Hospital - Panadura and Rehabilitation
8. Staff Statistics Hospital - Ragama. At the end of the piloting
phase, a user satisfaction survey and a
MSU is also responsible for providing data for comparison study was done to find the
various user requirements, conduct effectiveness of the eIMMR system. The
training/awareness programmes to all the staff secretary of Health has issued a general circular
who are handling data in hospital record rooms mentioning the guidelines for implementation of
and carry out hospital reviews to identify data eIMMR.In 2012, Medical Statistics Unit initiated
lapses.In addition, MSU prepares the population the implementation of the electronic version of
estimates for all Medical Officer of Health (MOH) Indoor Morbidity and Mortality Reporting
areas. The unit also maintains a list of health system (eIMMR). At the end of 2016, system is
institutions and updates it every year. being used in about 73 percent of total hospitals
Since 1960, MSU has collected data using manual in the country. It is also important to note that
systems and published Annual Health Bulletins 81 percent of IMMR data is now being produced
from 1980 to 2016 continuously. through eIMMR. It has helped to reduce the time
In 2010, Medical Statistics Unit has taken a taken for publication of Annual Health Bulletin.
initiative to develop Electronic Indoor Morbidity The implementation of the eIMMR was selected
and Mortality System (eIMMR). eIMMR is a web as two of the nine Disbursement Linked
based system designed to facilitate collection, Indicators (DLI) of the second Health Sector
storage, analysis and dissemination of inward Development Project (HSDP) of the World Bank.
patients statistics which will improve efficacy, The targets given for 2016 were satisfactorily
efficiency and accuracy of the manual system. achieved during the year. Scaling up of the
Introduction of eIMMR is expected to ensure the system was expedited with the funds coming
timely publication of the Annual Health Bulletin from the second Health Sector Development
with accurate and validated data. This system Project.

Annual Health Bulletin - 2016 131

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 131

11. Curative Care Services

By end of 2016 there were 629 curative care All the districts in Northern, Eastern and North
hospitals in government health services. The Central provinces have reported higher rates of
distribution of these institutions according to beds per 1,000 population compared to the
the standard categorization is detailed in national figure, while lower rates are reported
Annexure 01: Table 7. from all the districts in North Western and
Sabaragamuwa provinces. (Annexure 01:
Specialized care is provided through Base, Detailed Table 7)
District General, Provincial General, Teaching
and some selected specialized hospitals. Number of government health institutions and
patient beds in Sri Lanka over the period from
With few exceptions the Divisional Hospitals 2011 to 2016 are presented in the following
and all the Primary Medical Care Units are table (Table 11-1).
served by non-specialist medical officers. There
are occasional outreach clinics conducted by
specialists from nearby larger hospitals. There is
a recent trend to deploy Specialists in Family It is noteworthy that any Sri Lankan can
Medicine to some of the larger divisional get the free curative health care services
hospitals providing primary curative care. from any government hospital of Sri
Lanka irrespective of his place of
residence
11.1. Distribution of Beds and Bed
Strength

The total bed strength in the government

health institutions was 81,580 in 2016, and 3.8
beds per 1,000 population is available for
patient care island wide.

The highest hospital bed strength was recorded

in Colombo (14,162) followed by Kandy
Regional Director of Health Services Area
(7,139). Mullaitivu Regional Director of Health
Services Area recorded the lowest bed strength
(510) followed by Kilinochchi with a bed
strength of 560.

The highest number of beds per 1,000

population is reported to be 7.3 from Mannar
and the next highest is from Colombo which is
5.9. The lowest rate was reported from Kalutara
(2.4) followed by Gampaha and Puttalam (2.5).

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132 Annual Health Bulletin 2016

 Table 11-1 : Number of Health
Table Institutions
11-1 : Number and Hospital
of Health Beds,and
Institutions 2011 - 2016 Beds, 2011 - 2016
Hospital
Item Item 2011 2012 2013
2011 2014
2012 2015
2013 2016
2014 2015 20

Hospitals 1 Hospitals 1 638 621 638624 621622 624631 622629 631

Hospital Beds 1 Hospital Beds 1 73,939 76,087 73,939
78,243 76,087
80,105 78,243
80,581 80,105
81,580 80,581 81
Hospital Beds per 1,000
Hospital Beds per 1,0003.5 3.8 3.53.8 3.83.9 3.8 3.8 3.9 3.8 3.8
Population Population
Inpatient Beds per 1,000 3.3
Inpatient Beds per 1,000 3.5 3.33.5 3.53.6 3.5 3.5 3.6 3.5 3.5
Population Population
Central Dispensaries/Primary 459
Central Dispensaries/Primary 487 459461 487475 461473 475480 473
Medical Care Units Medical Care Units
MOH Areas MOH Areas 327 337 327334 337338 334341 338342 341
1 1
Includes Primary Medical CarePrimary
Includes Units and Maternity
Medical Care Homes Source:
Units and Medical
Maternity Statistics
Homes Unit
Source: Medical Statistics Unit
Distribution of hospital beds by of
Distribution type of institution
hospital beds byistype
illustrated in the is
of institution following table.
illustrated in the following table.

Table 11-2: Availability

Table of Hospital
11-2: Beds by
Availability ofType of Institution,
Hospital Beds by Type2016of Institution, 2016
Type of Institution Type of Institution
Total Hospital
TotalBeds Average
Hospital Beds Number of
Average Number o
Number of (Range) Number of (Range) Number of Hospitals
Number of Hospitals
Institutions Institutions Hospital Having Less
Hospital Having Le
Beds thanBeds than
Average Average
Number of Number o
Hospital Hospital
Beds Beds
Teaching Hospitals*Teaching Hospitals* 16 274 - 163,336 274 1,257 - 3,336 101,257 10
Provincial General Hospitals 3
Provincial General Hospitals 1,318 - 31,9791,318 1,597 - 1,979 21,597 2
District General Hospitals
District General Hospitals19 211 - 191,178 211 627- 1,178 10 627 10
Base Hospital Type Base
A Hospital Type A 24 144 - 24 790 144 369- 790 13 369 13
Base Hospital Type Base
B Hospital Type B 47 24 - 47 378 24 166- 378 27 166 27
Divisional Hospital Type A Hospital Type 50
Divisional A 39 - 50 228 39 108- 228 26 108 26
Divisional Hospital Type B Hospital Type135
Divisional B 9 - 116 9
135 68 - 116 70 68 70
Divisional Hospital Type C Hospital Type298
Divisional C 2 -
298 68 2 29 - 68 151 29 151
Primary Medical Care Unit and
Primary Medical Care Unit12 and 9 - 12 20 9 13 - 20 7 13 7
Maternity Homes Maternity Homes
Other Hospitals * Other Hospitals * 25 8 - 251,455 8 218- 1,455 20 218 20
* Teaching hospitals of cancer, Mental
* Teaching andofDental
hospitals cancer,are categorized
Mental underare
and Dental “Other Hospitals”
categorized and“Other
under Military, Police and Military, Po
Hospitals”
and Prison Hospitals are
andincluded under “Other
Prison Hospitals Hospitals
are included under “Other Hospitals
Note: Average number of hospital
Note: Averagebeds was calculated
number of hospital based on the
beds was numberbased
calculated of institutions from which
on the number of institutions from which
data is received. data is received.
Source: Medical Statistics Unit
Source: Medical Statistics Unit

Annual Health Bulletin

Annual - 2016
Health Bulletin - 2016 133 133

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 133

11.2. Service Utilization reported, rather than the actual number of
patients).

11.2.1. Attendance to Out Patient There were 53,620,249 OPD visits in the year
Departments (OPD) of Hospitals 2016, and the highest number is reported from
Colombo district. Lowest number of OPD visits
is reported from Mullaitivu district. The average
Outpatient attendance showed a slight decline
number of OPD visits per RDHS area is
in the last two years in the number of
2,062,317, and there are 10 RDHS areas above
outpatients, as well as in the rate (given the
this average, which are all districts in Western
limitation of the current hospital data collection
province, Kandy, Galle, Kurunegala,
system, only the number of OPD visits were
Anuradhapura, Badulla, Ratnapura and Kegalle.

Outpatients (per 1000 population) Inpatients (per 1000 population)

3000 350

300
2500

250
2000

200
1500
150

1000
100

500
50

0 0

Out Patient In Patient

Figure 11.1 : Inpatient and Outpatient Attendance in Government Medical Institutions, 1984 –
2016
Source: Medical Statistics unit

Annual Health Bulletin - 2016 134

134 Annual Health Bulletin 2016

 11.2.2. Attendance to Curative Care
Health Clinics

There were 27,317,886 clinic visits in 2016,

which continues to show an increasing trend.
(Annexure 01: Detailed table 36).

Teaching hospitals experienced more clinic

visits (Detailed Table 34). As shown in Annexure
01: Table 36, the most visits were for medical
clinics (44%), followed by Dental (12%) and
Gynaecology & Obstetrics clinics (6%). It is
noteworthy that, since most of the hospitals
were conducting medical clinics only, patients
who should have been attending clinics
belonging to different sub-specialities, were
also attending general medical clinics.

11.2.3. Maternal Services

Table 11.3 illustrates the maternal services

provided by different types of government
health institutions. Total number of 2016
deliveries taken place in the government
hospitals was 302,408.

Annual Health Bulletin - 2016 135

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 135

Table 11-3 : Maternal Services by Type of Institution, 2016
Type Outcome of Delivery Total Deliveries Method of Delivery

Number % Normal Forceps Caesarean

Single Deliveries

Other Deliveries
Twin Deliveries
(Vaginal)
Number %

Teaching 85,288 992 35 86,315 28.5 53,050 1,224 32,041 37.1

Hospitals
Provincial 27,096 295 9 27,400 16,450 146 10,804 39.4
General Hospitals 9.1
District General 81,757 827 9 82,593 51,567 669 30,357 36.8
Hospitals 27.3
Base Hospitals 60,278 469 5 60,752 39,215 327 21,210 34.9
Type A 20.1
Base Hospitals 37,269 256 7 37,532 25,475 333 11,724 31.2
Type B 12.4
Divisional 1,931 3 - 1,934 1,923 - 11 0.6
Hospitals Type A 0.6
Divisional 3,672 23 - 3,695 3,694 - 1 0.0
Hospitals Type B 1.2
Divisional 1,991 12 - 2,003 1,995 1 6 0.3
Hospitals Type C 0.7
Primary Medical 184 - - 184 185 - - -
Care Units and 0.1
Maternity Homes
Total 299,466 2,877 65 302,408 193,554 2,700 106,154 35.1
100.
0
Source: Medical Statistics Unit

Out of total deliveries in government hospitals 65% occurred in Teaching, Provincial

General Hospitals and District General Hospitals
Caesarean rate is 35.1% out of total deliveries occurred in government hospitals

Annual Health Bulletin - 2016 136

136 Annual Health Bulletin 2016

 Figure 11.2: Distribution of Hospital Live Births by place of occurrence in Sri Lanka, 2016
Source: Medical Statistics unit

Hospitals in Colombo district has highest number of live births followed by Kurunegala,
Gampaha and Kandy districts

Annual Health Bulletin - 2016 137

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 137

 400,000
400,000

350,000
350,000

300,000
300,000
No. of Births
No. of Births

250,000
250,000

200,000
200,000

150,000
150,000

Year
Year

Registered
RegisteredLive
LiveBirths
Births Live
LiveBirths
BirthsininGovernment
GovernmentHospitals
Hospitals

Figure
Figure11.3
11.3: :Registered
RegisteredBirths
BirthsVs
VsHospital
HospitalBirths,
Births,1992-2016
1992-2016
Source:
Source:Registrar
RegistrarGeneral’s
General’sDepartment
Departmentand
andMedical
MedicalStatistics
StatisticsUnit
Unit

Fig
Fig11.3
11.3shows
showsthe thechanging
changingpattern
patternofofthe
the
registered
registeredlivelivebirths
birthsand
andgovernment
governmenthospital
hospital
Average
AverageDuration
DurationofofStay
Stay- Average
- Average
live
livebirths,
births,bybytime.
time.InIn2016,
2016,91.7%
91.7%ofoflive
livebirths
births number
numberofofdays
daysa apatient
patientstay
stayininthe
the
occurred
occurredininthe thegovernment
governmenthealth
healthinstitutions.
institutions. hospital
hospital(excluding
(excludinghealthy
healthynewborns).
newborns).

Bed
BedOccupancy
OccupancyRate
Rate- The
- Thepercentage
percentage
1.2.4.
1.2.4.Utilization
UtilizationofofMedical
MedicalInstitutions
Institutions ofofinpatient
inpatientbeds
bedsoccupied
occupiedover
overa agiven
given
period.
period.

AAproper
properreferral
referralsystem
systemisisnot
notenforced
enforcedininSriSri Bed
BedTurnover
TurnoverRateRate-The
-Thenumber
numberofof
Lanka.
Lanka.Hence,
Hence,patients
patientsbypass
bypasssmall
smallmedical
medical times,
times,a ahospital
hospitalbed,
bed,ononananaverage
average
institutions,
institutions,particularly
particularlythose
thoseininthe
therural
ruralareas
areas changes
changesoccupants
occupantsduring
duringa agiven
given
that
thathave
haveonly
onlyminimal
minimalfacilities
facilitiesfor
forpatient
patient period
periodofoftime.
time.
care.
care.This
Thisleads
leadstotounderutilization
underutilizationofofsmall
small
institutions
institutionsandandovercrowding
overcrowdingininthe thebigger
bigger
institutions.
institutions.Several
Severalindicators
indicatorsare
areused
usedtoto Average
Averageduration
durationofofstay
stayisissignificantly
significantlyhigh
highinin
measure
measurethe theutilization
utilizationofofmedical
medicalinstitutions.
institutions. the
thespecialized
specializedhospitals
hospitalssuchsuchasasMental,
Mental,Chest,
Chest,
Leprosy
Leprosyand andRehabilitation
Rehabilitation(Annexure
(Annexure1:1:
Detailed
DetailedTable
Table38).
38).ItItvaries
varieswith
withthe
thetype
typeofof
hospital
hospitalandandaccordingly,
accordingly,average
averageduration
durationofof
Those
Thoseare,
are, stay
stayisisusually
usuallyhigher
higherininTeaching
TeachingHospitals
Hospitalsand
and

Annual
AnnualHealth
HealthBulletin
Bulletin- -2016
2016 138
138

138 Annual Health Bulletin 2016

 Provincial General Hospitals than other hospital over crowded in 2016. The lower limit of the
categories, except the said specialized hospitals. bed occupancy rate of Base Hospitals is 25% in
In general, Average Duration of Stay in Teaching 2016.
Hospitals varied around 3 to 4. As indicated in
the Detailed Table 38, Leprosy Hospitals has the Some of the Divisional Hospitals recorded bed
highest duration of stay followed by Mental occupancy rates below 1% in contrast to some
Hospitals and the Rehabilitation Hospitals. The were over crowded. Some of the Prison
lowest duration of stay is reported from all Hospitals and Rehabilitation Centres were also
types of Divisional Hospitals. over crowded.

Bed occupancy rates over the types of hospitals Colombo South Teaching Hospital also reports
are slightly fluctuated and it is somewhat lower the highest bed turnover rate among Teaching
in Divisional Hospitals. Hospitals, which is 122.39. As in 2015, Jaffna is
the other Teaching Hospital with a bed turnover
In 2016, in general bed occupancy rates of
rate over 100. Sri Jayawardanapura Teaching
Teaching Hospitals were beyond 50% but less
Hospital has the lowest bed turnover rate
than 100%. In 2016, among Teaching Hospitals,
among the Teaching Hospitals. Most of the
Colombo South Teaching Hospital has recorded
Provincial General Hospitals and District
the highest bed occupancy rate which is 92.03%
General Hospitals have higher bed turnover
while Sri Jayawardanapura Hospital has the
rates. Mental Rehabilitation Centers, Leprosy
lowest bed occupancy rate, which is 53.85%.
Hospitals and some Divisional Hospitals have
the lowest bed turnover rates.
All Provincial General Hospitals have reported
bed occupancy rates more than 70% in 2016
Fig 11.4 shows the bed turnover rate (BTR), bed
while Bed occupancy rates of District General
occupancy rate (BOR) and average duration of
Hospitals varied around 20% and 95%.
stay (ADOS) by types of hospitals. However, the
“other” hospital category is having big
Bed occupancy rates of some Base Hospitals
variations. Even though all the “other” hospitals
such as Thambuttegama, Mawanella, Dambulla,
are categorized under one category it cannot be
Pulmodai, Dickoya and Awissawlla are more
reasonably compared among those hospitals by
than 100% which means these hospitals were
this categorization.

Annual Health Bulletin - 2016 139

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 139

 Bed Turnover Rate (BTR) and Average Duration
Bed Occupancy Rate (BOR) of Stay
140.00 10.00
9.00
120.00
8.00
100.00 7.00
6.00
80.00
5.00
60.00
4.00

40.00 3.00
2.00
20.00
1.00
0.00 0.00
TH PGH DGH BHA BHB DHA DHB DHC Other

BTR BOR ADOS

Figure 11.4 : Utilization of Medical Institutions, 2016

Source: Medical Statistics Unit

Annual Health Bulletin - 2016 140

140 Annual Health Bulletin 2016

 12. Public Health Services (Preventive Health
Services)
Community health services are organized into The main responsibilities are performed
health units and most of them share the through the directorates of the concerned
boundaries of the Divisional Secretariat areas subject areas.
geographically. These are commonly known as
Medical Officer of Health (MOH) areas. There 1. Epidemiology Unit
are 342 MOH areas in Sri Lanka and each is 2. Directorate of Environment Health,
headed by a Medical Officer responsible for a Occupational Health & Food Safety
defined population. The MOH is supported by 3. National STD, AIDS Control Programme
field public health staff. The average population (NSACP)
for a MOH is approximately 60,000. Each 4. National Programme for Tuberculosis
member of health staff (Public Health Nursing Control and Chest Diseases (NPTCCD)
Sister, Supervising Public Health Inspector, 5. Anti-Malaria Campaign (AMC)
Supervising Public Health Midwife, Public 6. Anti Filaria Campaign (AFC)
Health Inspector and Public Health Midwife) is 7. Anti Leprosy Campaign (ALC)
also responsible for a sub divided area and a 8. Public Health Veterinary Services (PHVS)
respective population. 9. Quarantine Unit
10. Principal Public Health Inspector (PPHI)
The overall responsibility for management of 11. National Dengue Control Unit (NDCU)
community health services lies with the 12. Chronic Kidney Disease Unit (CKDU)
Provincial Health Authorities.

The scope of public health is divided among two 12.1.1. Epidemiology Unit
Deputy Director Generals at the line Ministry
level. Epidemiology Unit in Ministry of Health is the
focal point for the National Immunization
12.1. Deputy Director General Programme (NIP) and surveillance of
– Public Health Services I communicable diseases in the country.
(DDG – PHS I) In addition, surveillance of Chronic Kidney
Disease (CKD) is also carried out by the
Main responsibilities of the DDG PHS I include Epidemiology Unit.
leading and managing public health system of The Epidemiology Unit is a training centre for
the country related to communicable diseases. medical postgraduates and health staff on
However, some responsibilities in Non- activities related to communicable disease
Communicable Diseases are also among the control and the National Immunization
designated scope. Programme. The unit too functions as a WHO
collaborative centre for training on

Annual Health Bulletin - 2016 141

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 141

immunization activities in the South-East Asia maintenance thus ensuring vaccine quality of
Region. higher standard.

In 2016 the Web Based Immunization

Disease surveillance Information System (WEBIIS) fully replaced the
paper-based system and transformed the paper
The disease surveillance carried out by the unit based quarterly EPI return fully into the online
through the system of routine notification of system.
notifiable diseases, special surveillance
procedures for selected diseases such as The National Immunization policy has been
vaccine preventable diseases (VPD), approved by the Cabinet of Ministries of the
leptospirosis, human rabies and dengue fever. Democratic Socialist Republic of Sri Lanka on
Moreover, the sentinel site surveillance is being 16th October 2014. (Available at:
carried out for influenza like illness and severe www.epid.gov.lk)
acute respiratory illness which are potential to
be endemic. The Unit acts as the emergency
response unit for disease control activities in
12.1.2. Directorate of Environment
disasters, emergencies and handles outbreak
Health, Occupational Health and Food
investigation and control.
safety
National Immunization Programme
The Directorate is technically responsible for all
With regard to the National Immunization environmental health activities including
Programme (NIP) the Epidemiology Unit is hospital waste disposal and treatment,
responsible for developing the Immunization occupational health and food safety. These
Policy and strategies for new vaccine activities are carried out with the support of the
introduction, coordinating supply of vaccines, other relevant ministries, provincial councils,
provision of logistics, injection safety items and local governments, other directorates of
close monitoring and regular evaluation of the Ministry of Health, respective hospital
NIP. National Immunization Programme of Sri administration and the public health teams in
Lanka is one of the best performing public MOH offices.
health programmes in the region and globally as
well and has an excellent record with extremely Food Safety
low incidence of VPD which are covered by the
Expanded programme on Immunization (EPI)  Food Safety activities through the
and high coverage of all EPI vaccines. directorate of EOH & FS are aimed at
ensuring the availability of safe and
The Epidemiology Unit continuously ensures wholesome food to consumers.
efficient cold chain maintenance at national,  The relevant food legislation is the Food
district and divisional levels. An electronic Act No.26 of 1980 with its related
monitoring system is in place in addition to regulations published in terms of
other monitoring devices for cold chain section 32 of the Food Act.

Annual Health Bulletin - 2016 142

142 Annual Health Bulletin 2016

  The Food Advisory Committee (FAC)  The following regulations were
established in terms of the Act advises published in 2016:
the Hon. Minister of Health on policy
matters relating to food safety. 1 Food (colour cording for sugar
 The following committees facilitate the levels) regulation
functions and the activities of the FAC 2 Food (sweeteners) regulation
3 Food (amendment of shelf life of
1 Regulation Formation Sub import food items) regulation
Committee  The directorate conduct food inspection
2 Health claims Sub Committee in imports and exports, register bottle
water manufacturing premises and
3 Food Advisory Technical Sub issue permits for common salt.
Committee
4 National Codex committee
Enhance the Knowledge, Skills and Attitudes of
 The directorate is responsible to carry Authorized Officers
out awareness programmes on food
safety for health workers, consumers, Six 5 days training programmes to update the
food manufacturers and food handlers food safety for PHI/SPHI was conducted with
through the network of authorized over 300 participants. It is planned to complete
officers for food safety in the country. the training for the rest of the food safety
 Actions have been taken to strengthen authorized officers in 2017.
the linkage with other line ministries,
provincial authorities, international Export inspection Activities
agencies and NGOs to bring about
effective, sound management Export certificates for food consignments are
conducive for food safety and hygiene issued as follows in 2015 and 2016.
during the year of 2016.

Table 12-1 : Export Inspection Activities 2015 & 2016

Activities 2015 2016

Number of health certificates issued 8222 9868

Number of food factories registered _ 76

Total number of factories registered as an export food factory at FCAU 672 748

Number of factories visited 63 35

Source: Directorate of Environmental Health, Occupational Health & Food Safety

Annual Health Bulletin - 2016 143

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 143

Registration of Bottled of Packaged Water
Manufacturing Premises

Table 12-2 : Registration of Packaged Water Manufacturing Premises

Activities 2015 2016

Total number of Manufacturing Premises 120 133

Number of bottle drinking water premises newly registered 03 13

Number of mineral water premises newly registered 00 00

Number of bottle drinking water premises renewed registration 39 50

Number of mineral water premises renewed registration 00 02

Number of Manufacturing Premises visited by the unit 39 52

Source: Directorate of Environmental Health, Occupational Health & Food Safety

Issue of permits for common salt

Table 12-3 : Issue of Permits for Common Salt

Activities 2015 2016

Number of new permits issued 14 20

Number of factories registered at FCAU 14 20

Number of factories visited 14 20

Number of factories newly registered _ 06

Source: Directorate of Environmental Health, Occupational Health & Food Safety

Despite a cadre of 30 Food and Drug Inspectors

(FDI), only 15 are available to carry out food meets the standard and is safe for human
control activities at national level including the consumption.
sea port, airport, Grey line 1, Grey line 2 and
RCT (Rank container Terminal).

Despite the shortage of staff, the FDI’s continue

the Inspection of documents,

Inspection of foods and food sampling done

according to the sampling plan by the staff at
the entry points to ensure food imported

Annual Health Bulletin - 2016 144

144 Annual Health Bulletin 2016

 Activities of Food Inspection

Table 12-4 : Activities of Food Inspection at RCT, Gary Line 1 and 2

Activities 2015 2016

Number of consignments inspected (FCL) 35096 36520

Number of consignments rejected 01 33

Number of consignments released to ware house 425 3551

Total number of samples sent to laboratories 8349 6809

Number samples sent to Atomic Energy Authority 6315 4783

Number samples sent to ITI 363 177

Number of samples sent to National Institute of Health Sciences 1091 1673

Total number of samples found unsatisfactory 04 76

Source: Directorate of Environmental Health, Occupational Health & Food Safety

Table 12-5 : Activities of Food Inspection at Airport

Activities 2016
No of consignments received 3595
No of consignments inspected 3595
No of consignments referred to FCAU 00
No of samples sent for analysis 42
No of satisfied analysed samples 42
Source: Directorate of Environmental Health, Occupational Health & Food Safety

Table 12-6 : Activities of Food Inspection Unit at Seaport

Activities 2015 2016
No of consignments registered 1415 1188
No of samples taken 60 19
Source: Directorate of Environmental Health, Occupational Health & Food Safety

Annual Health Bulletin - 2016 145

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 145

National codex committee Total number of health 13,844
education programme
National Codex Committee of Sri Lanka actively conducted
participated in the International Food Standard (For food handling establishment
Setting (Codex) meetings in 2016. owners, field officers, consumer
societies, and school and staff
Special meeting was held on preparing the students)
delegates prior to attend the CCSCH in India.
Comments on proposed draft standard for The directorate has identified that the food
Black, White, Green pepper were submitted. premises registration as mandated in the food
act should be implemented early to ensure that
 SPS notifications were notified to the all food manufacturing, food sales and storage
WTO from Sri Lanka in 2016. facilities meets a basic standard and will work
 Number of notifications received from towards bringing this important regulation to
WTO - over 500 enforcement early. There are also a few
regulations which are being revised which need
 Number distributed to relevant
to be completed early.
organization - 70
Food safety requires the support of various
stakeholders to work in partnership to ensure
Food Enforcement activities at District level –
the entire process of the food chain from “Farm
to Plate” is safe. For this Good Agriculture
There are 41 Food and Drug Inspectors at
Practices (GAP) and Good Manufacturing
district level and around 1800 Public Health
Practices (GMP) should be ensured.
Inspectors ensuring food enforcement activities
throughout Sri Lanka. They are involved in
There is a network of 5 food laboratories which
taking food samples, prosecution and seize
continued to support in ensuring that food
when necessary under food act and regulations
samples for surveillance and contamination are
and conducting awareness programmes to
tested. The Government Analyst, City analyst
relevant parties. Performance of authorized
Colombo, food laboratory at the Medical
officers attached to RDHS and Municipal
Research Institute (MRI), Food laboratory at
councils can be summarized as following.
National Institute of Health Sciences (NIHS)
*Data of the returns from Gampaha and
Anuradapura districts are not received for the year of Kalutara and Food laboratory at Anuradhapura.
2016. Microbiological samples are tested at
Microbiology laboratories at MRI and NIHS. The
Total number of samples taken 16,563 provincial food laboratory at Kurunegala and
Total number of unsatisfactory 3,970 City analyst Kandy are in the process of being
samples identified as additional approved food
laboratories. Despite the above network of
Total number of prosecuted 3,111
laboratories, an external assessment with the
under the food act
support of the World Health Organization in
Total number of convicted 5,541
2016, has identified the areas which need
Total number of items seized– 28,124
further strengthening in the network of

Annual Health Bulletin - 2016 146

146 Annual Health Bulletin 2016

 laboratories. These recommendations will be In the reference laboratory of NSACP, new
discussed at the food advisory committee for testing with real time PCR technology for
further action in 2017. Chlamydia, Gonorrhoea and HSV was
introduced in year 2016. In addition, to
12.1.3. National STD/AIDS Control facilitate HIV management at peripheral level,
Programme two CD4 machines were provided to Kandy and
Galle STD clinics while two automated real time
PCR machines for viral load testing were
The National STD/AIDS Control Programme introduced to Galle and Anuradhapura.
(NSACP) of the Ministry of Health is the focal
point for the prevention and control of sexually Multi-sectoral collaboration
transmitted infections (STI) including HIV. As a
specialized public health programme under the This programme area has its focus mainly on
Ministry of Health, NSACP is responsible for the activities conducted aiming the vulnerable
coordinating, planning, implementation, groups which has been identified in the
monitoring and evaluation of the national National HIV Strategic plan 2013-2017. It
response to the control and prevention of STI oversees, coordinates and provides technical
including HIV. support for advocacy, capacity building,
awareness and internalization of STI and HIV
At the end of 2016, NSACP has been providing prevention activities of the multi-sectoral
both preventive and curative services through institutions.
31 full-time STD clinics and 23 branch clinics
distributed throughout the island. National STD/AIDS Control Programme
developed the Policy on prison HIV prevention,
The expansion of antiretroviral treatment (ART) treatment and care. During 2016, a total of
services to 21 centers is an important 12,776 prison inmates underwent voluntary HIV
achievement made during 2016. In addition, the testing and counseling in the prisons situated
government of Sri Lanka took over funding the island-wide. Of them, six (6) were HIV positive.
antiretroviral treatment programme using The sero-positive rate among the prison
domestic resources from 2016. inmates in 2016 was 0.05%.

HIV prevention programmes in armed forces,

Laboratory services
police sector, youth sector, education sector,
migrant Sector and tourism sector continued
NSACP continued to introduce of new tests
during 2016.
related to STI and HIV while improving the
quality of the existing tests. All the peripheral
laboratories are planned to be equipped with
ELISA technique for HIV screening. This was
addressed in 2016 with the distribution of 10
ELISA machines to the peripheral clinics.

Annual Health Bulletin - 2016 147

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 147

Global Fund supported activities in 2016

The Global Fund to fight AIDS, Tuberculosis and

Malaria (GFATM) has been working with the
National STD/AIDS Control Programme (NSACP)
closely for many years. The NSACP received a
grant of US$ 5,323,102 for the period of 2016-
2018 under the New Funding Model proposal
for the HIV component where the NSACP act as
the Principal recipient-1 (PR1)

Annual Health Bulletin - 2016 148

148 Annual Health Bulletin 2016

 Table 12-7 : Performance by planned interventions/major activities under GF grant in 2016

Details of activities and their targets Status of

Progress

Rapid assessment of drug use patterns in order to inform risk reduction and harm Advancing
reduction interventions conducted

National coordination and collaboration strengthened with National Dangerous Completed

Drug Control Board.

Action plan for tailored harm reduction interventions and service package for Not Started
PWUD/PWID developed

Action plan for tailored interventions targeting PWUD/PWID rolled-out Not Started

900 prison peer educators trained among prisoners to provide BCC (quarterly) Completed

Routine quality assurance and quality control (QA/QC) of ARVs Advancing

Routine Data Quality Assessment system (RDQA) rolled-out nationally Completed

Preparation not done/not completed' Guidelines, checklists and tools for RDQA Completed
developed and included as annexes to the National Monitoring and Evaluation Plan

Rapid Situation Assessment of Transgender Persons in Sri Lanka conducted Completed

National HIV Testing Policy developed Completed

Prison HIV Policy developed Completed

A sub-committee of the Steering Committee for Prison HIV/AIDS Prevention Completed

Program established

30 STI clinics receive 1 supervision visit/year Advancing

Source: National STD/AIDS Control Programme

Annual Health Bulletin - 2016 149

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 149

 health sector and other governmental and non-
12.1.4. National Programme for
governmental organizations. NPTCCD carries
Tuberculosis Control and Chest
out training of medical and paramedical staff
Diseases engaged in TB care and carries out public
awareness through various channels of
The responsibility of control of TB in the country communication. The Government of Sri Lanka is
falls under the National Programme for the main source of funding for the NPTCCD. In
Tuberculosis Control and Chest Diseases. The 2016, Rs. 319.5 million were allocated from the
services are provided through the 26 District government (including the Second Health
Chest Clinics, one sub chest clinic and branch Sector Development Project) funds. In addition,
clinics. Diagnostic culture facilities were Global Fund for AIDS, Tuberculosis and Malaria
available at National Reference Laboratory, (GFATM) provides financial assistance to carry
Regional culture laboratories at Ratnapura and out TB control Activities Island wide. World
Kandy. Health Organization (WHO) too provides
technical and financial assistance to the
Central Drug Store (CDS) of the NPTCCD is programme.
responsible for estimation, procurement and
supply of anti TB drugs. Fixed Dose
combinations of anti TB drugs are procured 12.1.5. Anti-Malaria Campaign
directly from Global Drug Facility to CDS.
Distribution of anti TB drugs to District Chest
The Anti Malaria Campaign (AMC) of the
Clinics is carried out on quarterly basis. Ministry of Health, Nutrition and Indigenous
medicine, is responsible for the Malaria
In addition, NPTCCD is responsible for the Elimination and Prevention of Re-introduction
formulation of policies and guidelines for Programme. The activities of Anti Malaria
control of TB and other respiratory diseases and Campaign is according to the National Malaria
for planning, implementation, monitoring and Strategic Plan for Elimination and Prevention of
evaluation of the TB control activities carried Re-introduction 2014–2018. Anti Malaria
out in the entire country. Surveillance of TB is Campaign is having public health service
network through regional malaria offices and
another main activity carried out by the
linkages with curative health sector for the
NPTCCD. It also acts as a coordinating body treatment services.
between the central ministry and provincial

Table 12-8 : Financial Allocation and Expenditure for Anti Malaria Campaign - 2016
Source of fund Allocation Expenditure

GoSL  SLR 130,716,826.74  110,938,551.37(84.87%)

 Funds from provincial ministries  Provincial expenditures
GFATM  USD 3,201,500  USD 775,574 (24% )
(2016-2018)
WHO  SLR 810,761.24  SLR 810,761.24
 Direct funding for training persons
Source: Anti Malaria Campaign

Annual Health Bulletin - 2016 150

150 Annual Health Bulletin 2016

 12.1.6. Anti-Filariasis Campaign 12.1.7. Quarantine Unit

Anti Filariasis Campaign (AFC) of Ministry of The main responsibility of this unit is to protect
Health, Sri Lanka collaborates with other Sri Lanka by the prevention of the spread of
partners such as the WHO, Gates Foundation, diseases into the country and to protect,
Liverpool School of Tropical Medicine-UK, prevent and control of international spread of
University of St. Louise-USA and National diseases and other public health risks, specially
Institute of Health, USA. the Public Health Emergency of International
Concern (PHEIC), while avoiding unnecessary
Major Activities Implemented in 2016 interference with international Traffic and
Trade. The legal frameworks supporting the
 Conducted routine and special night blood activities are Quarantine and Prevention of
filming programmes in endemic areas Diseases ordinance of 1897, and International
 Provided treatment for microfilaria (mf) Health Regulations (IHR) - 2005.
positive and clinically suspected cases
 Managed lymphoedema patients and Sri Lanka is also legally bound to comply and
educated them and caregivers on obliged to implement the IHR -2005 with the
morbidity management measures to other member states in accordance with the
prevent complications and disabilities purpose and scope to protect, prevent and
 Conducted vector surveillance and control control of international spread of diseases as
activities in endemic areas well public health risks, especially the PHEIC.
 Conducted awareness programmes for
health staff and general public Quarantine unit and Epidemiology Unit of
 Conducted training programmes for Ministry of Health had been designated as IHR
medical, paramedical and post graduate Co-National focal points to be accessible at all
students times with WHO IHR focal points. Activities
 Progress of regional activities were related to implementation of IHR- 2005 in Sri
reviews at monthly progress reviews with Lanka are being carried out by both units in
Regional Medical Officers (Filariasis), collaboration with each other.
patients and annual progress reviews with
the staff attached to Regional Anti World Health Organization assesses thirteen
Filariasis Units (RAFU) and corrective core capacities through the Annual
measures taken Questionnaire for monitoring the progress of
 Conducted research activities to implementation of IHR Core Capacities in State
implement evidence-based strategic Parties. The Figure 12.1 shows the comparison
interventions of core capacities of IHR (2005) of Sri Lanka for
 Conducted mass drug administration the years 2015 and 2016. In 2016, more
programme in 11 Medical Officer of stakeholders in Sri Lanka were involved in filling
Health Areas in Galle District where there this questionnaire. Hence, values of most of
was evidence of ongoing transmission core capacities were higher in 2016.

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 Highlights in 2016

 Strengthen the implementation of International Health Regulations (IHR)-2005

in Sri Lanka
 prevent and control of international spread of diseases and other public health
risks specially the Public Health Emergency of International Concern (PHEIC)
 Implementation of inbound health assessment for vulnerable population and
long stay (more than 6 months) visa applicants with the involvement of
Quarantine unit of Ministry of Health and International Organization for
Migration.
 Strengthening of public health offices at ports and airports and central
quarantine unit with adequate human resources and logistics in order to
achieve IHR core capacities
 Amendment of Quarantine and Disease prevention act of Sri Lanka of 1962 in
order to strengthen implementation of IHR -2005

120
Value for each core capacity (%)

100

80

60

40

20

Core capacity

Year 2015 Year 2016

Figure 12.1: Core capacities of IHR (2005) assessment in 2015 and 2016
Source: Quarantine Unit

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152 Annual Health Bulletin 2016

 Activities done in 2016

 National IHR Steering Committee was

established to improve the coordination
of IHR related activities under the
chairmanship of Director General of
Health Services.
 The Cabinet of Ministers have approved
the amendments to quarantine and
disease prevention act in 2016.
 Trained staff of port and airport health
offices on personal protective
equipment (PPE) and preparedness
plans and provided personal protective
equipment to staff of port and airport
health offices.
 Conducted desktop drill to review
public health contingency plan for BIA
 Introduced regular quarterly review
system for quarantine unit
 Strengthened IHR core capacities at
point of entries.

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 Recommendations Puttalam & Kalutara districts as a
prevention method
 Strengthen Implementation of  Conducting House-to-house surveys,
international Health Regulations (2005) Community surveys and Ring surveys in
in Sri Lanka considering the gaps all districts with special attention to
identified in Joint External Evaluation high endemic districts
(JEE) with the active multi sectoral  Strengthening the disease surveillance
participation. by expansion of satellite clinics, mobile
 Prepare the five-year National Action clinics and special skin clinics
Plan for Health Security to fulfil the
gaps identified in JEE
 After the amendments, Quarantine and Recommendations
Disease Prevention act need to be
passed in parliament.  Establishing a wide range of
programmes for early case detection,
active case surveillance and strengthen
of passive case detection system
12.1.8. Anti-Leprosy Campaign  Social marketing campaign to increase
awareness, advocacy and behavioural
In 1954, the vertical structure, Anti Leprosy change in the communities
Campaign (ALC) was started as the national  Programmes to address the stigma and
programme for leprosy control activities discrimination
including diagnosis management, rehabilitation  Explore the possibility of Leprosy post
and control activities. exposure prophylaxis (LPEP)
 Special case investigation for child cases
Leprosy control activities implemented through and disability cases
the vertical organization ALC, were integrated  Strengthening the online web-based
into General Health Service in 2001. reporting system
 Develops and launch an App based GIS
Activities done in 2016 system to identify hotspots
 Developing innovative IEC material to
 Development of National Strategic Plan address stigma, discrimination,
2016-2020 - “Accelerating towards a importance of self-referral, treatment
Leprosy free Sri-Lanka” compliance and prevention of
 Launching of Anti-Leprosy Campaign disabilities
Website in 2016
 Online web database for disease
surveillance activities and mapping
 Continuation of Leprosy post exposure
prophylaxis (LPEP) pilot study in

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 12.1.9. National Dengue Control Unit • A series of mass scale premises inspection
programmes were continued targeting
National Dengue Control Unit is the focal point houses, schools, institutions, public and
for the dengue control programme in the religious places and bare lands etc. A Civil-
Ministry of Health in Sri Lanka. It was Military Cooperation (CIMIC) activity
established in the year 2005 as a decision taken involving approximately 50,000 personnel
by the Ministry of Health following the major from Tri forces, Civil Defence Force, Police
DF/DHF outbreak in 2004. Initially it functioned and Health services was conducted during
only as a Coordination Unit, but once dengue the year.
illness increasingly poses a socio-economic and
public health burden, in 2011 it was upgraded
• This emergency Dengue control programme
was targeted mainly at the GN divisions in
to a directorate as National Dengue Control
selected high risk Medical Officer of Health
Unit (NDCU) with an annual budget allocation.
(MOH) areas based on epidemiological data
During 2016, curative health care personal were in the districts of Colombo, Gampaha,
trained on clinical management of dengue Kalutara (including Colombo MC and NIHS
patients based on National guidelines in Kalutara) and other provinces. This activity
collaboration with the Epidemiology Unit and was primarily aimed at detection of
Education, Training and Research unit of mosquito breeding sites and their
Ministry of Health. Case Management was elimination through source reduction on
further enhanced by providing equipment for site augmented by health education, other
54 existing High Dependency Units of hospitals vector control methods such as larviciding
by NDCU, which includes high dependency and fogging when needed and enforcing
beds, Infusion pumps, Micro haematocrit legal action when necessary.
centrifuges etc. (Annexure II Table 11, 12 & 13)
• Seventeen successful mass scale premise
inspection were conducted during 2016 in
Emergency Response western province and outside. Activities are
summarised in (Annexure II Table 14).
• Weekly reporting of data revealed that
• Two National Mosquito Control Weeks
highest number was reported in 25th week
were declared prior to the anticipated
(1915 cases) of which more than 60% were
monsoonal seasons. Extensive media
from the Western Province (WP) in 2014. In
coverage focussing behavioural outcome
order to curtail this outbreak situation
for specific breeding places were
promptly, an emergency dengue control
disseminated to empower the community
programme was initiated in WP as per the
(Annexure II Table 09).
decision taken at the Presidential Task
Force on Dengue Prevention (PTFD)
meeting held on 9th June 2014.

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12.2. Deputy Director General –
Public Health Services II (DDG PHS II) FHB has several units that covers the different
components of the RMNCAYH programme.
Deputy Director General Public Health Services
II is mainly assigned public health areas outside These include:
the scope Communicable Diseases. These work
• Maternal Health
is performed through different directorates
• Maternal and Child Morbidity and
under the DDG PHS II.
Mortality Surveillance
Directorates under DDG (PHS) II • Intrapartum and New-born care
• Child Health, Development and Special
1. Maternal and Child Health (FHB) Needs
2. Health Education and Publicity (HEB) • Child Nutrition
3. Directorate of Nutrition • School Health
4. Nutrition Coordination Unit • Adolescent and Youth Health
5. Directorate of Nursing (Public Health • Gender and Women’s health
Services) • Family Planning
6. Directorate of Estate and Urban Health • Planning, Monitoring and Evaluation
(EUH) • Oral Health
7. Directorate of Youth, Elderly and • Research and Development
Disability (YED)
Each of these units is headed by a Consultant
Community Physician (a public health
12.2.1. Maternal and Child Health specialist), who is the national programme
manager for areas under the unit’s purview.
(Family Health Bureau)
Each unit possesses a separate staff responsible
Family Health Bureau (FHB), is the central level for advocacy, policy and strategic analysis,
institution in the Ministry of Health that is programme development, technical guidance,
responsible for planning, implementing, evaluation and supervision related to the
monitoring, and evaluating the Reproductive, respective programme components. Figure 12.2
Maternal, New-born, Child Adolescent and shows the administrative and technical
Youth Health programme (RMNCAYH). guidance pathways that facilitate the
FHB provides technical guidance for provincial organization and implementation of RMNCAYH
health care system on its implementation. In programme activities through the national
addition, FHB advocates the Ministry of Health health system.
on matters related to policy, finance,
infrastructure, human and other resource The red and blue lines in the diagram depict the
requirements relevant to RMNCAYH administrative and technical supervision
programme. Quality control, monitoring and pathways relevant to different levels of health
evaluation of the RMNCAYH programme also system that are involved with the RMNCAYH
come under the purview of FHB. programme.

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156 Annual Health Bulletin 2016

 Figure 12.2 : Organization of RMNCAYH Programme at Different Levels of Health System
Source: Family Health Bureau

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 157

The diagram also depicts the referral and back • Developing policies, plans and technical
referral pathways available for people guidelines pertaining to health promotion,
confronted by health conditions related to advocacy and communication.
family health (child birth, childhood illness etc.)
in pink lines. The administrative and technical • Communication for public awareness and
guidance relevant to the RMNCAYH programme behavioural changes leading to health
is integrated into the usual multi-tier promotion.
organizational arrangement of the Ministry of
Health. Tiers include, Ministry of Health headed • Development of health education,
by the Secretary of Health, nine Provincial promotion, advocacy and communication
Directors and twenty-six Regional Directors. materials

At Ministry of Health, policy-making and • Capacity building of health care personnel

financial allocation related to RMNCAYH and others involved or interested in health
programme is the responsibility of Secretary to promotion
the Ministry. The overall administration
including logistical supply comes under the • Monitoring & evaluation of health
purview of the Director General of Health promotion programs.
Services (DGHS). FHB is the directorate which
technically guides the RMNCAYH Programme. Furthermore, HEB also actively involves in
FHB provides policy and strategic advocacy to conducting and supporting preventive, control
the Ministry of Health and Provincial and and health promotion activities offered by
Regional directorates. other units in the health and non-health
sectors. HEB also shares its expertise by
providing technical consultations for advisory
committees, workshops, research and surveys
12.2.2.Health Education and Publicity
on request to other public organizations.
(Health Education Bureau)

Health Education Bureau (HEB) has been Major Achievements in 2016

identified as the center of excellence in Sri
Lanka for health education, health promotion Strategic Objective Number1: Developing
and publicity. Empowering and mobilizing policies, plans and technical guidelines
communities for the improvement of their pertaining to health promotion, advocacy and
quality of life through health promotion communication.
principles is the main achievement gained over
the period. Policies, plans and technical guidelines
pertaining to health promotion developed by
HEB conducts activities under main five HEB provide common objectives to be achieved
strategic objectives, by different sectors and technical guidelines in
order to maintain and assure the standards of
health promotion activities.

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158 Annual Health Bulletin 2016

 Following are the major achievements for are to create public awareness about emerging
2016: current health problems, health promotion,
health programs for behavior changes and life
• Implementation of behavioral change style modification towards good health in the
communication (BCC) strategy guide on community. Every year HEB conducts 15 - 20
reproductive health (RH) Communication, media seminars on current health issues and
Family Planning (FP), Well Woman Clinic national and international days on particular
(WWC), Maternal and Neonatal Health health related issues. Media Seminars on
(MNH), Gender Based Violence (GBV) and National Nutrition Month, National
Adolescent Sexual and Reproductive Breastfeeding Week, World Childrens’ Day,
Health (ASRH) in Sinhala, Tamil & English National Oral Health Day and International
Medium. Maxillo-facial Surgeons Day were conducted.
• Mothers’ Support Group Guidelines
printed and distributed for the districts Other than the media seminars following
• Guidelines on Complementary feeding activities were also done for public awareness:
practices were developed, printed and
distributed in all districts. • Production of TV spots on iron
• Conducted Consultative meetings of the deficiency in Sinhala, Tamil and English
Sub-committee on Nutrition languages.
Communication and decisions taken • Production and visualizing of two songs
regarding nutrition communication (Eg. on prevention of Tobacco and alcohol in
IEC material development, social Sinhala and Tamil languages with
marketing etc.) English subtitles.
• Provision of technical guidance on oral • Production and visualizing of a song on
health promotion at consultative health care and empathy among
meetings, research and surveys healthcare workers in Sinhala and Tamil
• Finalized the oral health education languages with English subtitles.
package and Manual for Health Promotion • Production of three Docu-dramas on
Preschools for Sri Lankan Public nutrition promotion of estate sectors.
Furthermore, routinely, HEB provided technical • Conducted a Poster competition on the
consultations for advisory committees, ‘right to smoke free living’ among
workshops, research and surveys on invitation school children
by other public organizations to share its • National Art competition was carried
expertise. out among school children on stroke
prevention
Strategic Objective Number 2: Communication • Conducted two exhibitions in Southern
for public awareness and behavioral changes and Uva provinces.
leading to health promotion In addition, HEB provided technical expertise
for interviews on emerging and current health
HEM conducts continuous awareness programs issues for newspapers, radio and TV.
such as Media seminars and media briefings for
media personnel.The main objectives of these

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 159

 Suwasariya” 24 X 7 round the clock contact centre for the public provides fast and
accurate expert advice by doctors in all three languages. This service is well supported by
a tri lingual web site "www.suwasariya.gov.lk" intended for general public, and contains
articles about health promotion, prevention, common diseases and details about
government health services.

Strategic Objective Number: 3: Development Strategic Objective Number: 4: Capacity

of health education promotion, advocacy and building of health care staff and other
communication materials personals involved or interested in health
promotion
Various types of health education promotion,
advocacy and communication materials, both HEB routinely provides well-structured
printed (posters, wall charts, pennants, leaflets, continuous national level in service training
stickers, booklets) and electronic (short films, programs and orientation programs for health
video clips, power point presentations) were care staff.Following are the activities carried out
produced over the period to address emerging during the year 2016:
and current health issues. Following materials
were developed by the HEB in year 2016 with • Training of SDTs, MOOH, PHMM, PHII,
regard to the above: community groups, preschool teachers,
parents as facilitators for health
• Development and printing of a docket promotion preschool programme
on neonatal and maternal care. • Life skill Programme was conducted for
• Development of NCD prevention middle level health managers in
leaflets, pennants and stickers in Tamil selected areas.
and English language • Conducted Training of Trainers (ToT)
• Preparation for publishing ‘Sepatha’ programs for teachers on school health
magazine in Sinhala medium promotion with regard to substance
• Printing of supportive IEC materials for abuse
preschool programme on health • Training of multi sectoral group for
promotion health promotion in Uva Province in
• A poster on Thriposha was developed relation to a study on Integrating
and distributed. Nutrition Promotion and Rural
• Television spots to promote nutrition Development (INPARD) in Sri Lanka.
and iron consumption was developed. • Provision of training on communication
• Developed and printed a Snake and for MOOH/REE/MOO (MCH) during the
Ladder chart for preschool children rotational visit to HEB, as a part of their
• Developed a documentary for orientation course on Management of
preschool children on health promotion Community Health at NIHS in Kalutara.
• Printing of 2 types of wall charts for • Training of trainers programme on
Chronic Kidney Disease prevention capacity building in Nutrition
Counselling was conducted for Badulla,

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160 Annual Health Bulletin 2016

 Monaragala and Ampara districts. A areas who had the best Mothers’
total number of 21 trainers, 7 from Support Groups were presented at this
each district comprising of the field review meeting. District level best 3
health staff were trained during this 3- Mothers’ Support Groups were
day residential workshop. rewarded.
• Training on health promotion, oral • National Annual Review of health
health promotion for school dental promotion preschool programme
therapists, Regional Dental Surgeons, • Provincial and national Health
Nursing Officers in health education Education and Health Promotion
units in National and District level. reviews were conducted by the Health
• Capacity building programs on school Promotion Unit.
health promotion, hospital health • Periodic (annual) evaluation and
promotion, general health promotion descriptive study on health information
were carried out in several districts in seeking behaviour of “Suwasariya”
the island. contact centre.
• ToT programme on communication
skills of the nursing staff of Chest Establishing “Mother Support Groups” (MSG) at
Hospital, Welisara. village levels is an example for a successful
• ToT programme on communication community-based program conducted under
skills of the nursing staff of Central, the guidance of HEB. These Mother Support
North Western and Western provinces. Groups take leadership and work cordially with
• MOH training programs on other sectors and the community towards the
communication skills improvement of nutritional status and
• SLIDA training programs on Emotional wellbeing of the children and families.
Intelligence for work life success and Developing households and public places such
building positive attitudes as hospital, preschool, school, villages, work
place etc., as health promotion settings is
Strategic Objective Number 5: monitoring & another successful program conducted by HEB
evaluation of health promotion programs which was appreciated by all parties.
Another milestone is planning and linking
Following national, provincial, district and together an e-learning system for public health
divisional (MOH) level reviews were conducted workforce across the country. This program will
during 2016: facilitate to update the knowledge in emerging
health information while utilizing it for public
• District and provincial reviews of health awareness.
promotion programs were carried out.
• Provincial review meetings to review
the activities of Mothers’ Support
Groups were conducted in Uva,
Sabaragamuwa and Western Provinces.
• A 2-day National Review programme
was held and the presentations of MOH

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 6) Circular for healthy canteen in
12.2.3. Directorate of Nutrition workplaces prepared
(Nutrition Division) 7) Infrastructure facilities provided for
nutrition clinics in hospitals
The aim of the Nutrition Division is to provide 8) Information Education &
effective, evidence-based nutrition services to Communication (IEC) materials on food
all strata of Sri Lankan population. Nutrition colour code & food plate for identifying
Division is responsible for overall management healthy food was prepared and
of nutrition services across the country on distributed along with other IEC
behalf of Ministry of Health. This unit is material prepared by the division
responsible for nutrition related policy 9) In service, basic & post basic training
formulation, coordination, monitoring and programmes conducted for Medical
evaluation. Nutrition Division formulates Officers, Nursing Officers, and nursing
guidelines on nutrition related matters which sisters
are translated in to action at grass root level. In 10) Awareness of school community on
addition, this unit carries out in-service training nutrition and healthy life style.
programmes, awareness sessions and other
capacity development activities for health
workers as well as other categories of staff. Targets for 2017
Nutrition Division coordinates with provincial
and other grass root level organizations and 1) To complete pilot study for rice
officers ensuring effective implementation of fortification
nutrition programmes in the country. 2) To complete review of National
Nutrition Policy
Achievements in 2016 3) Sri Lankan nutrient profiling model
developed
1) Landscape analysis of rice fortification 4) Review of responsibilities of Second
with iron & folic acid completed International Conference on Nutrition
2) Review of implementation of National 5) Public health guidelines targeting
Nutrition Policy planned and in the prevention of three major NCDs
process of selecting an external launched and distributed
consultant 6) To establish a mechanism for
3) Adaptation of WHO nutrient profile and coordination between nutrition Division
development of Sri Lankan nutrient and hospital nutrition clinics
profile is in the pipeline 7) To develop & print picture message
4) Recommendations of Second book on healthy diet & life style for
International Conference on Nutrition school children
was adapted 8) To raise awareness on healthy food,
5) Public health guidelines targeting nutrition & life style among health staff,
prevention of three major NCDs were other institutions and general
formulated population

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 12.2.4. Nutrition Coordination Division 6) Preschool teacher training programme
(Nutrition Coordination Unit) on Nutrition- ToT programmes
conducted in six districts in the country
to enable preschool teachers to
Nutrition Coordination Unit Coordinates empower children as changing agents.
nutrition programmes within the Ministry of for nutrition promotion
Health, Nutrition and Indigenous medicine, 7) Assessment of Existing Thriposha
liaising with other ministries, monitor and Supplementation Programme and
evaluate nutritional interventions to uplift the possible product diversification -
nutrition status of the nation. The unit functions Identification of existing gaps in logistics
under the Director (Nutrition Coordination and possibility developing new
Division), and the technical team is headed by a Moderate Acute Malnutrition (MAM)
Consultant Community Physician. product improve divisional level
thriposha storage facilities
Achievements in 2016
Targets for 2017
1) National Nutrition Surveillance System
(NNSS) - Regional review of the 1) To upgrade existing National Nutrition
Surveillance system to identify Surveillance system
strengths and weaknesses of existing 2) To improve coverage and quality of
system, to refine indicators and district Nutrition surveillance system
redesign the electronic nutrition 3) To implement DNAP, supporting more
surveillance system. sustainable interventions with high
2) District Nutrition Surveillance System- coverage for nutrition problems of
Pilot study on the surveillance was vulnerable populations
performed in Nuwara Eliya. 4) To strengthen implementation of multi-
3) District Nutrition Action Plan (DNAP) - sector action plan via improved multi -
Implementation of DNAP based on the sectoral coordination at district level
identified nutrition priorities of each 5) To conduct advocacy and awareness
district program during nutrition month to
4) Partnership in Multi-Sector Action Plan- promote nutrition
Health Ministry representation of the 6) To conduct preschool TOT programmes
Multi Sector Action Plan of the National in other districts and support preschool
Nutrition Secretariat. teacher training workshops in those
5) Nutrition Month Activity – Under the districts
Theme Shape your meal to Shape Your 7) To conduct pilot study on development
Body, National advocacy and awareness of MAM product.
program and regional level distribution 8) Improve Thriposha storage facilities in
of the programme to overcome selected district
malnutrition

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 Improving knowledge attitudes and life skills
12.2.5. Directorate of Youth, Elderly among youth to reduce youth health problems
and Disability (YED) and improve their wellbeing is the vision for the
programme areas of youth.
The Directorate of Youth, Elderly and Disabled
Persons is an apex body working on health of Upgrading of infrastructure facilities to establish
Youth, Elderly and Persons with disabilities in Sri elderly and disability friendly health care
Lanka. The goal of this unit is to improve services at health institutions, Advocacy
quality of health among youth, elderly and programmes to promote active healthy ageing
disabled persons through improvement of & prevention of disability including accessibility
health facilities, disability prevention and health facilities for the persons with disability and
promotion by coordinating, planning, promotion of life skills among youth were
implementing, monitoring and evaluating of implemented and activities are ongoing
activities related to programme areas successfully.

The rising pattern of non-communicable Activities are implemented according to the

diseases among elderly population will developed policies, guidelines and action plans
contribute to increase the proportion of elderly by the directorate related to its programme
living with disabilities. To overcome such areas & focusing results based frame work.
situations the vision of the unit is to produce
healthy, active and productive elderly
population by improving physical, mental and
social wellbeing of current elders and to
produce more active and healthy elders in the
future.

Main objective of the disability programme

area, of the directorate is to improve health
services for the disabled persons by improving
quality health care on disability & rehabilitation
improving multi-stakeholder network on
disability health care and rehabilitation based
on National Action Plan.

Non Communicable Disease Elderly males (%) Elderly Females (%)

Heart disease 52.8 52.1
High Blood pressure 55.3 58.2
Wheezing/ Asthma 29.8 29.1
Diabetes 43.8 48.6

Source: Demographic Health Survey - 2016 Sri Lanka

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164 Annual Health Bulletin 2016

 Priority key messages

• Elderly population is increasing in the country. Non communicable diseases are

more prevalent among elders. Promotion of Active Healthy ageing concept
focusing more towards control of modifiable risk factors to prevent NCDs is
implemented through life course approach.
• Active healthy elders are an asset to the society and they are a resource group to
the youth.
• Promotion of accessibility facilities and promotion of availability, affordability &
correct usage of recommended assistive devices enhance productivity of persons
with disabilities. Disability rehabilitation is complex. Therefore multi-disciplinary
team care and right based holistic approaches are to be considered for disability
rehabilitation.

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13. Medical Services
o Postgraduate training of the
medical professionals (PG Trainees)
Medical Services are organized under two o Arrangement for Internship training
Deputy Director Generals. of medical graduates passed out
from Sri Lankan and Foreign
Universities
13.1. Deputy Director General o Management of issues in relation to
(Medical Services) I Relief House Officers and Specialists
o Management of all human
Managing specialized human resources is a
resources related issues of Teaching
main function of the unit. Accordingly,
Hospitals and Specialized
management of Specialist Medical Officers,
Institutions
Postgraduate trainees, Intern Medical Officers
** These services will be provided on a
and Medical Administrators is an important
web-based platform for easy access
function of the unit. Furthermore, development
of tertiary level medical facilities in major • The Directorate of Healthcare Quality and
hospitals and other institutions including Safety (HQ&S) has established a standard
establishment of necessary infrastructure island wide programme to improve the
facilities, provision of medical equipment and quality of care, introducing a national set of
provision of administrative support are other twenty indicators. All hospitals are required
major functions of the division. to measure the indicators, and also conduct
a patient satisfaction survey at least
The unit consist of four directorates. annually. Another milestone achieved is
that the surgical checklists were introduced
1) Tertiary Care Services (TCS) to be filled for each surgery conducted in
2) Healthcare Quality and Safety (HQ&S) hospitals.
3) Registered Medical Officers (RMO)
4) Nursing - Medical Services (Nursing-MS) • The Directorate of Registered Medical
Officers
Following are some of the main duties o Supervision of in service training of
performed by the Deputy Director General Registered Medical Officers
(Medical Services) I and its directorates:
• All directorates also function towards
• Tertiary Care Services- achieving their visions and missions.

o Overseas Training, recruitment and

deployment of all Medical
Specialists in the government
health services
o Recruitment and deployment of
medical administrators

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 Priorities under DDG (MS) I for 2017/18 Actions taken in 2016 in relation to the key
Results Area
1) Establishment of online National
Deceased Donor organ allocation A) Adverse event/incident reporting system
System
Adverse event/ incident reporting guidelines
2) Capacity building of Medical
and formats under the circular No: 01-38/2016
Administrators (Scaling up medical
was introduced to facilitate the improvement or
administrative abilities for innovative
development of reporting systems that produce
management)
information which can be used to improve
3) Establishment of Web based
service quality and patient safety.
Management Information System for
Tertiary Care Services
Reporting can lead to learning and improved
4) Establishment of Online tool for
safety through,
assessment of Healthcare Quality and
Safety
5) Establishment of National ICU bed • Generation of alerts regarding
allocation System significant new hazards.
• Dissemination of lessons learnt

13.1.1. Directorate of Healthcare Analysis of many reports can reveal

Quality and Safety unrecognized trends and hazards requiring
attention, insights into underlying system
Key Results Areas failures and generate recommendations for
• Launching of Guidelines and formats of ‘best practices’ for all to follow.
Adverse Event/ Incident Reporting
Introductory programme on adverse
system to all healthcare institutions
event/incident reporting system was conducted
above base hospitals type B.
for line ministry institutions and provincial
• Development of Clinical indicators in all
ministry institutions (Base hospitals type B and
four major specialties (05 for each) and
above).
Microbiology (03) - Total 23 indicators.
• Establishment of National Council on
Accreditation Standards of Sri Lanka B) National guidelines on clinical indicators for
with collaboration of Australian Council all four major specialties and Microbiology
for Accreditation Standards (ACHS).
Development of accreditation National Guidelines on Clinical Indicators were
standards which suits to Sri Lanka is in finalized with the participation of relevant
progress. professional colleges and multi-disciplinary
• Capacity building programmes (05 day) team of stake holders.
for healthcare staff on 5S-CQI-TQM
Indicators for performance and outcome
implementation in Sri Lanka to develop
measurement allow the quality of care and
of master trainers were conducted.
services to be measured. Accordingly, Clinical

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 167

indicators in all four major specialties and 3) Percentage of Surgical facilities using
microbiology has been introduced to monitor the ‘Surgical Safety Checklist’
the quality of care of healthcare institutions in 4) Rate of Surgical Site Sepsis
Sri Lanka. 5) Average hospital-stay after an index
operation (ex: Appendicitis, inguinal
Five clinical indicators were introduced under hernia, amputation for diabetic
the specialty of Medicine gangrene)
1) Percentage of patients given a
fibrinolytic in <30 minutes of arrival in Five clinical indicators were introduced under
ST Elevation Myocardial Infarction the specialty of Paediatrics
(STEMI) or undergoing primary 1) Hypothermia on admission to Neonatal
Percutaneous Coronary Intervention Unit when transferring from one
(PCI) in <90 minutes of arrival to institution to another (outside born
hospital. baby) or from the maternity unit to the
2) Percentage of patients with diabetes neonatal unit in the same hospital (in
who are attending to Medical clinics, born baby)
having Fasting Blood Sugar (FBS) 2) Re-admission to the ward with
measured at least once in two months wheezing who had bronchiolitis under
or HbA1C measured at least once in 6 one year of age
months and controlled to target FBS < 3) Readmission rate within 14
126mg/dl and HbA1C < 7. days following discharge from a
3) Percentage of patients with Blood Paediatric ward
Pressure (BP) controlled to target 4) Hypoglycemia on Admission to the
<140/90mmHg in the patients with Neonatal Unit when transferring from
cardiovascular risks. one institution to another (Outside
4) Percentage of errors in administration born baby) or from the maternity unit
of prescribed medication to the right to the neonatal unit in the same
patient at any stage of medication hospital (In born baby).
process (i.e., prescribing, transcribing, 5) Case fatality rate in Dengue
dispensing, administration and Hemorrhagic Fever
monitoring)
5) Percentage of patients with a physician Five clinical indicators were introduced under
diagnosis of asthma who receive out- the specialty of Obstetrics & Gynaecology
patient/ETU/PCU nebulization. 1) Labour Induction Rate
2) Episiotomy rate
Five clinical indicators were introduced under 3) Caesarian section rate
the specialty of Surgery 4) Proper use of Partogram
1) Rate of Postponement of Elective 5) Average waiting time for routine major
Surgery Gynaecological surgery
2) Waiting time duration in indexed Three clinical indicators were introduced under
operations. Divided into cancer and the specialty of Microbiology
non-cancer

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168 Annual Health Bulletin 2016

 1. Staphylococcus aureus Bacteraemia
Rate per 10,000 patient days Recommendations
2. MRSA Bacteraemia Rate per 10,000
patient days 1. Strengthen the data collection method and
3. Hospital onset MRSA Bacteraemia reporting system of adverse events/
incidents to the Directorate through
Rate per 10,000 patient days
quarterly performance review meetings.

C) Establishment of Accreditation system in Sri 2. Launching and establishment of national

Lanka guidelines on clinical indicators in all four
major specialties and Microbiology to all
Independent council on accreditation of the line ministry institutions and provincial
healthcare organizations in Sri Lanka is ministry institutions (Base hospitals type B
established with the collaboration of Australian and above) to gather data in quarterly
Council for Healthcare Standards (ACHS). performance review meetings.

D) Conducted 04 Training of Master Trainers 3. Establishment of Accreditation System in Sri

programmes covering line ministry and all the Lanka includes;
provinces and trained 143 master trainers on
5S-CQI-TQM. • Development of Sri Lankan
Healthcare Accreditation Standards
(59 criteria under 12 main areas)
based on Australian Healthcare
Accreditation Standards.
• Surveyor induction on Sri Lankan
Healthcare Standards
• Piloting and gap analysis in 06
hospitals
• Island wide implementation of Sri
Lankan Accreditation Standards.

4. Expand the master trainers programme on

5S-CQI-TQM implementation towards
Regional Directorates of Health Services
level in order to improve the quality and
safety in provincial ministry institutions.

5. Commence training programmes on patient

safety and clinical audit in order to convert
healthcare organization into high reliable
organizations (HROs).

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 169

13.2. Deputy Director General 13 .2.1.Directorate of medical Services/
(Medical Services) II Medical Services Branch
Human Resource management of Grade
Medical Officers and development of medical Scope of work
services of the government hospitals constitute
• Recruitment and human resource
the main functions of the unit which includes all
management of post intern medical
the human resource management functions of
officers
Grade Medical Officers in government health
• Organizing and coordination of the
service other than production, disciplinary
training programmes for grade medical
actions and termination.
officers
Other responsibilities include management of • Appointing the diploma holders, MSc
Prison Medical Services, organization of holders and other post graduates
Hospital Directors Meeting, coordinating of following the release from the PGIM
mobile health services, facilitating progress • Facilitating the administrative affairs of
review meetings, Provincial Directors’ meetings the medical officers who are seconded
and the implementation of Parliamentary Select to the security force
Committee decisions. Additionally, the unit • Attending to all the necessary steps
assists in monitoring and coordination of with regard of the annual transfers of
private health sector. the medical officers, and implementing
the special transfer scheme for the
The DDG Medical Services II directly North and East provinces
implements following projects: • Attending to grievances and special
appeals of medical officers, and
• Accident and Emergency Development arrangements of temporary
project of government hospitals attachments, for the medical officers in
• Project to establish and develop Sports view of their personal problems
Medicine units in hospitals • Selection and appointment of medical
officers to the special post vacancies
Additionally, implementing of Human Resource requested from certain
Management Information System (HRMIS) for hospitals/special units as per the
Grade Medical Officers and costing programme service needs
for curative care institutions are other projects. • Attending to concerns regarding the
improvements/developments of the
The unit is organized under five directorates.
accident and Emergency care services
1) Medical Services
• Management of the electronic Human
2) Primary Care Development
Resource Management Information
3) Private Health Sector Development
System (HRMIS) for medical Officers
4) Medical Service Administration
• Facilitating the functions of hospital
5) Prison Medical Service
based Sports Medical Units, Health

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170 Annual Health Bulletin 2016

 Information Management Unit, and 3) Sports Medical Units were established for
Reproductive Health Service Unit all the General Hospital, and medical
• Providing annual funds for officers in sports medicine covering all
development activities of various health provinces were trained. Since 2014,
related institutions around 920 medical officers were trained
• Development of prison health care to assess medical fitness and issue
medical fitness assessment certificate.
Progress and Achievements in Year 2016 These medical officers are spread
throughout the country covering all the
1) 1506 Medical officers who have provinces.
completed their internship, were 4) Transfer orders of 437 medical officers of
appointed to healthcare institutions in all North & East and 469 special appeal
provinces. This has led to re-opening of transfer orders have been considered
closed institutions and opening of new during 2016
5) Attachment of Medical officers following
units in existing healthcare institutions
reverting back to Ministry of Health
(Figure 13.1). following completion of PGIM attachment
2) Annual transfer orders have been (Table 13-3).
implemented on 1st of January as per the 6) Establishment of well-equipped Accident
Public Service Commission guidelines and Emergency Care Units in the line
(Table 13-1). ministry hospitals. (Table 13-3)

1400
1198
1150
1200
1030
1000
Number of MOO

800

600

400 324 308

267
200

0
2014 2015 2016
Year
Batch 1 Batch 2

Figure 13.1 : Post Intern Appointments 2014 to 2016

Source: Directorate of Medical Services

Annual Health Bulletin - 2016 171

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 171

Table 13-1 : Implementation of Annual transfers
Year 2014 2015 2016
No. of Medical officers Transferred 3311 2924 2930
Source: Directorate of Medical Services

Table 13-2 : Attachment of Medical Officers after Post Graduate training

Year 2015 2016
No. of Medical Officers 133 179
Source: Directorate of Medical Services

Table 13-3 : Establishment of A&E units.

Completing in 2016 Commencing in 2016
04 Units 09 Units
1.TH Jaffna 1.TH Kandy 6. PGH Badulla
2.DGH Kalutara 2.BH Gampola 7. BH Mullaeriyawa East
3.DGH Polonnaruwa 3.DGH Chilaw 8. DGH Ampara
4.BH Kalmunai North 4.TH Kegalle 9. BH Gampola
5.DGH Trincolamlee

Source: Directorate of Medical Services

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172 Annual Health Bulletin 2016

 Upgrading of 14 A&E units in Line Ministry institutions;

1. BH Kanthale 8. BH Akkeripathuthu
2. PGH Kurunagala 9.TH Batticoloa
3. TH Karapitiya 10. AMH Kalmunai
4. Sirimavo Bandaranayake 11. PGH Rathnapura
specialized children Hospital 12. DGH Hambanthota
5. CSTH Kalubowila 13.DGH Monaragala
6. CNTH Ragama 14.DGH Nuwara Eliya
7. Lady Ridgway Hospital for
Children
Source: Directorate of Medical Services

Capacity Building under A&E project

Total of 40 Medical Officer attached to A&E

units are trained in SONOGRAPHY conducted by
foreign trainers. 114 Medical Administrators
and Medical Officers were given foreign training
opportunities.

Implementation of the Human Resource

Information Management System (HRIMS) for
the medical officers for transfers, appointments
and grade promotions

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 173

13.2.2. Directorate of Primary Care Improve the quality of service delivery
• Renovation of infra -structure of health
Services
care in selected institutions
• Training sessions on basic clinical care
Key Activities of Primary Care Services – 2016
and management competencies for
primary care staff.
1. Strengthening of Primary Care Services
2. WHO Biennium Funded Programme
Improve community involvement in decision
3. Post Intern Programme
making
4. Medical Board Process
• Improve community participation
through strengthening of hospital
1. Strengthening of Primary Care Activities -
development committees
2016
Objectives
To optimize, comprehensive, affordable, and Strengthening of management capacity and
quality health care with easy access, to the rural technical skills
population • Establish a district level focal point (MO
Primary Care services) to coordinate
activities.
Strategies

Increase the Utilization of Primary Care

Hospitals 2. WHO Biennium (2016 -2017)
• Establish well equipped ETUs in
selected Primary Care institutions a. Observational study tour to visit best
according to their grade. practices in primary health care
• Re arrange and renovation of clinics settings in regional countries
with specialized care services for the
patients who seek treatment from • Primary Care policy study
primary care institutions. • Family cantered care system
• Provide wide range of laboratory (population basis, doctor allocation,
investigation facilities in primary care unit composition, institutional
hospitals, sharing resources within responsibility, services, transport,
clusters. communication, database, treatment
• Improve the patients comfort in policy and referral)
selected primary care institutions. • Community services
Seating, maintain patients privacy • Guidelines
during consultation, number display • Inter relationship with non-health
systems etc. services
• Back referral of patients in • Shared care cluster system
convalescence after specialized care at
secondary and tertiary care centers.

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174 Annual Health Bulletin 2016

 b. Monitoring & Evaluation of primary 13.2.3. Medical Administration Branch
care activities and identify service gaps
• Regional level evaluation and identify Medical Administration branch under DDG (MS)
service gaps II divided in to EC1 and EC 2 branch, following
• Preparation of proposals are the main areas of work:

Scope of work:
c. Capacity building of Primary Care
curative Staff
• Documentation related to
• Positive attitudes for better health Appointments and Re-Instatements
care with compassion • Issuing formal appointment letters
• Administrative support for health • Confirmations in service
care managers in primary care • Grade promotions of the Medical
institutions Officers and Consultants (Grade II,
Grade I, Specialists Grade)
• Processing Leave (To handle Local No-
3. Post Intern Programme – 2016
Pay Leave, Foreign No-Pay Leave,
Objectives Foreign Leave, Short-term Leave,
I. To improve the quality of care at the
Special Medical Leave, Extended
primary level by capacity building of the
Maternity Leave, Earned Leave,
post intern medical officers appointed
Accident Leave, Adoption Leave and
to the primary care curative institutions
Surrogated Pregnancy Leave)
II. To introduce clinical protocols and
• Process medical board decisions
personal and health records for
• Processing disciplinary inquiries
personalized and continuing care at the
• Issuing Vehicle Permits
primary level
• Managing language proficiency details
III. To make an attitudinal change on
(English, Sinhala/Tamil) and language
essential primary care among newly
allowance payments arrangements
appointed medical officers to the
• Releasing and re-attaching doctors to
primary level
Permanent and Temporary stations
• Processing resignations and retirements
4. Medical Board Process – 2016 of the doctors
Objectives • Serving Vacation of Posts for Medical
I. Appointing the government and private Officers
sector medical boards • Delivering Summon Sheets for the
II. Approving the medical examination doctors
board reports • Office work on legal actions taken
III. Management of Data Base for the against doctors
medical board applications and reports • Processing bonds (bond charging and
clearing)
• Examination results clarification

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 175

13.2.4. Prison Medical Services 3. Establishment of Information system,
integrating OPD services, LAB services and
Prison Medical Service is under the purview of prison health record system.
Deputy Director General Medical Service II, The 4. Capacity Building for Health staff at prison
Director Medical Services currently in acting health services.
capacity for the Director Prison Medical • Foreign training of two medical officers
Services. The Ministry of Health deals only with in Norway accustoming health
health care components and the administrative international health standards.
part is being handled by the Department of
Prisons.
Other areas of responsibilities;
Health-ICRC-Prison Department Project:
1. Monthly progress meetings are
A special Project launched in Mahara and being conducted with partnership of
Walikada Prisons. It’s a tri party agreement with Ministry of Health, Department of
Ministry of Health, International Red cross and Prisons and Ministry of social &
Department of Prisons. The project details welfare.
enlisted below;
2. Administrative support;
1. Expansion of OPD services in Prison health
services including provision of infrastructure • Appointment of MOO to all Prison
and essential equipment. Hospitals in the country.
• Dental chair and X ray facility reinstalled • Allocation of Dispensers and
at Walikada prisons. Radiographers.
2. Establishment of standard screening package
for newly admitting prison inmates. 3. Supply of Necessary medical supply
including drugs through MSD.

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176 Annual Health Bulletin 2016

 13.2.5. National Intensive Care skills, research and IT. During the year 2016 in
Surveillance (NICS) collaboration with the Deputy Director General
(Education, Training & Research), it has
conducted training sessions for more than 500
National Intensive Care Surveillance is a critical
health care personals.
care registry networking 76 adult Intensive Care
The benefits from NICS includes; having an ICU
Units (ICUs), 10 paediatric ICUs and 17 neonatal
Bed availability system (24/7), enables planning
ICUs in government hospitals of Sri Lanka. It is a
ICU services based on needs, capacity and
collaboration of national and international
resources; helps coordinate ICU resource
organizations led by the Ministry of Health and
management during any national/regional
maintains a critical care registry and operates a
emergency or disaster, improve quality of
24/7 ICU bed availability service for adult,
patient care, improve cost effectiveness of
children and now neonates. The main
critical care, capacity building of critical care
objectives are:
personnel, promotes local and international
1. To setup a national critical care clinical
audits/research.
registry in Sri Lanka
2. To design a critical care bed availability
NICS collaborates with many organizations and
/ information system
individuals to conduct research. During 2016 it
3. To provide feedback/reporting to the
had actioned nearly 10 research projects
participating ICUs to improve quality of
NICS also supervise research students of
care
postgraduate programmes and provide
4. To contribute to the development of a
placement for interns from University of
network of multidisciplinary health care
Colombo.
professionals working to improve
Intensive Care Medicine (ICM) in Sri
NICS is presently under the administration of
Lanka
Director, Medical Services of Deputy Director
General (Medical Services) II. Further details of
NICS system is involved in gathering, cleaning,
NICS and its activities are available at
analysing and disseminating information from
www.reports.nicslk.com, www.nicslk.com and
ICUs regarding patients, staffing, beds and
www.nics-training.com and can be contacted at
other available resources. In addition, NICS
[email protected] or 94(0)112679038
captures information to enable benchmarking
of ICUs relative to how ill ICU patients are
The detailed characteristic of each ICU is
(severity scoring) using standard severity
described in Annexeure 1, including details of
scoring algorithms such as Acute Physiological
paediatric ICU patients. The information
And Chronic Health Evaluation (APACHE) IV. The
presented is mostly from the data submitted by
system also makes it possible to assess 30-day
ICUs through the NICS app. In 2016.
post ICU outcomes and quality of life of
critically ill patients.

NICS is also involved in training of doctors,

nurses and physiotherapists in critical care

Annual Health Bulletin - 2016 177

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 177

Characteristics of adult ICUs

The age distribution of patients admitted to

adult ICUs in 2016 is illustrated in Figure 13.2
The mean beds to patient ratio for each ICU for
year 2016 is demonstrated in Figure 13.4. The
Beds to patients ratio is derived by dividing the
occupied beds by total number of beds in each
day.

1600
1400
1200
Number of patients

1000
800
600
400
200
0
<10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80>
Age

Figure 13.2: Age distribution of patients admitted to adult ICUs in 2016

Source: NICS

180%
160%
140%
120%
Percentage

100%
80%
60%
40%
20%
0%
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76
ICU ID

Figure13.3: Patients per nurse ratio in adult ICUs in for 2016

Source: NICS

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178 Annual Health Bulletin 2016

 The mean patients per nurse ratio for each
adult ICU for year 2016 is shown in Figure 13.3
while Figure 13.5 shows the mean number of
organ failures in admissions to adult ICUs for
2016 by ICU survival status

100%
90%
80%
70%
Percentage

60%
50%
40%
30%
20%
10%
0%
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76
ICU ID

Figure 13.4: Mean beds to patients ratio of adult ICUs for year 2016
Source: NICS

4.5
4
3.5
3
2.5
Mean

Alive
2
1.5 Dead
1
0.5
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76
ICU ID

Figure 13.5: Mean number of organ failures among admissions to adult ICUs for 2016
by ICU outcome
Source: NICS

Annual Health Bulletin - 2016 179

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 179

Characteristics of Paediatric ICUs

The age distribution of patients admitted to

Paediatric ICUs in 2016 is illustrated in Figure
13.6

180
160
140
Number of patients

120
100
80
60
40
20
0
<1 1-3 3-5 5-7 7-9 9-11 11>
Age category

Figure 13.6: Age distribution of patients admitted to Paediatric ICUs in 2016

Source: NICS

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180 Annual Health Bulletin 2016

 14.Education Training and Research - Deputy
Director General Education Training & Research
(DDG-ET&R)
The ET&R unit is the focal point in policy
14.1. Medical Research Institute
formulation, provision of technical guidance
related to training and coordinating basic
Services
training programmes for all staff categories
except basic degree programmes for Medical Medical Research Institute provides multiple
Officers and Dental Surgeons. The unit is also services to the health care sector of the
responsible for capacity building of the health country. Functions as the Regional reference
workforce through post basic and in-service laboratory for Poliomyelitis while being the
training programmes. In addition, the unit National reference laboratory for Japanese
develops policies and capacity in research Encephalitis, Measles, Rubella, Rotavirus,
related to health and provide financial Influenza, Leptospirosis, Toxoplasmosis, Food
allowances to the relevant officers for carrying and Water Microbiology, Immunological
out work place based research. Investigations, Special Parasitological
Investigations and Platelet aggregation studies.
The unit also coordinates with Ceylon Medical Additionally, the MRI is also the National
College Council, University Grants Commission control laboratory for the National Authority for
and other relevant academic and professional Vaccines and biologicals. MRI also carries out
institutions and organizations in Sri Lanka with the pre-registration evaluation of
the objective of strengthening the human pharmaceuticals and reagents.
resource capacity of the health sector.
Furthermore, MRI conducts research in many
The unit is organized under three directorates. medical areas namely; bacteriology,
immunology, virology, mycology, parasitology,
1. Directorate of Education histopathology, hematology, biochemistry,
2. Directorate of Training nutrition, pharmacology, natural products, and
3. Directorate of Research animal sciences.

Medical Research Institute (MRI) and National General Achievements / Special Events in 2016
Institute of Health Sciences (NIHS) are under at MRI-
direct administrative and technical supervision
of the DDG (ET&R). • Limitation of Sample load being sent to
MRI by limiting samples for HbA1C &
Lipid Profiles from NHSL and Base
Hospital Panadura

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 181

 • Establishment of a Laboratory Test • Pilot project of Laboratory Information
Report issuing station which reduced Management System (LIMS) initiated at
delays in report issuing Virology department
• Establishment of sending reports back • Over 150 new Laboratory Tests initiated
to original laboratory - Lab to Lab in 2016
service

700,000
606,220

600,000

447,793
500,000

400,000
308,068 307,853
289,033
300,000

200,000

100,000

0
2012 2013 2014 2015 2016

Figure 14.1: The total Number of Laboratory tests done at MRI over the last 5 years

Source: Medical Research Institute

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182 Annual Health Bulletin 2016

 90

80

70

60

50

40

30

20

10

0
2012 2013 2014 2015 2016

Figure 14.2: Total number of Medical Research done at MRI over the last 5 years
Source: Medical Research Institute

Bacteriology Department: Department of Nutrition:

Significant Achievements in Clinical Department of Nutrition has a major

Bacteriology – 2016 contribution to nutrition related research
activities in the country. During the year 2016,
1. Opening of the newly established the department had several achievements in
molecular biology unit at the both the aspects, field and the laboratory;
Department of Bacteriology
2. Introducing automation in clinical • Field staff of the department
bacteriology by automated Bacterial successfully completed four national
Identification and Antibiotic surveys in collaboration with the
Susceptibility system UNICEF and WFP;
3. Newly introduced tests:
• Leptospira detection by real-time PCR National nutrition, and micronutrient survey
• Introducing automation – more than among pregnant and lactating mothers
14 new antibiotics for antibiotic (N=7443) National Iodine survey and baseline
susceptibility by MIC and more than nutrition survey among 6-12-year-old school
400 bacterial identification children (N=7400).
• Antibiotic resistant mechanisms by
molecular detection • Data dissemination seminars for the
surveys were conducted.
• In relation to these surveys, laboratory
analysis on Hb, Serum Ferritin, CRP,
Vitamin A and iodine content in urine,
salt, and water was carried out.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 183

 • The laboratory participated in external country were successfully trained by
quality assurance programme of CDC, organizing a one-day workshop at the
Atlanta for urine iodine and Iodine MRI on 10th of June 2016.
Global Network India for salt Iodine
analysis and received accreditation. 3. Commemoration of World Rabies Day
• In addition to this, more laboratory on 28th September 2016 in
analysis on, sugar content in collaboration with Public Health
carbonated beverages, salt content in Veterinary Services and Ministry of
fast foods, sugar content in diary milk Health to raise awareness about rabies
and food colorants in selected food prevention and to highlight progress in
items and beverages in Jaffna and defeating this horrifying disease with
Colombo districts were carried out. The rabies walk followed by media
analysis revealed results with significant conference
importance which could be used for
public awareness and for policy making. 4. A seminar organized by Department of
• Capacity building of laboratory staff on Animal Production & Health together
micronutrient analysis of serum and with SLAAS on “Situation of human
food analysis was carried out by foreign rabies in Sri Lanka with issues in
experts under UNICEF funding. diagnosis” to commemorate the World
Rabies Day 2016 at ICEAP at
Gannoruwa

5. Two research projects done in the

Department of Vaccine Quality Control and
department were accepted to be
Rabies: presented as oral presentations of Sri
Lanka College of Microbiologists
In addition to the routine rabies diagnostic, annual scientific sessions and one
reference and quality control services, vaccine paper received the 2nd price for oral
quality control activities, teaching, training and presentation
research, the Department of Rabies and Vaccine
QC had the following achievements of note for
6. Several awareness programmes on
the year 2016,
Rabies Post Exposure Therapy were
held for medical officers working in the
1. Department joined the Health
island wide rabies post exposure clinics
Management Information System
to promote their knowledge on
(HMIS) of the Ministry of Health to rational management
submit rabies diagnostic results of both
human and animals to the relevant
stakeholders - Public Health Veterinary Department of Histopathology:
Services (PHVS), Medical Officer of
Health, Regional Epidemiologist, Rabies Department of Histopathology showed the
PHII in real time to facilitate following achievements in 2016:
implementation of immediate rabies
control activities • Continuation of External quality control
program for Medical Laboratory
2. Over 160 medical officers who are Technologists and continuation of
managing rabies Post Exposure External quality control program for
Treatment (PET) covering the entire Consultant Histopathologists.

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184 Annual Health Bulletin 2016

 Food Chemistry Laboratory, NIHS
• In addition, conducted several
workshops: Workshop for External NIHS food chemistry laboratory has
Quality Assurance for Medical continued routine work as testing of food
Laboratory Technologists and and water for the regulatory compliance for
Workshop for External Quality the year 2016. Imported food samples and
Assurance for Consultants. water samples from the bottling water
plants were also tested for their quality
• Started special staining methods. parameters. This is one of the income
generating activity from the laboratory. The
annual income generated is Rs. 6,691,900.
14.2. National Institute of Health 00.
Sciences (NIHS)
Two advanced equipment namely HPLC and
The NIHS is the leading health sector training GC/MS were supplied to the laboratory
institute in the country which coordinates during this period and installation of these
public health manpower development activities equipment and training are underway. The
under the Ministry of Health. Apart from this laboratory renovation work was carried out
primary objective, it also conducts health during this period. The laboratory also
service research and provides guidance to participated in the Medicare Exhibition in
Ministry of Health on its policy on health March 2016 at Bandaranaike Memorial
manpower development. International Conference Hall (BMICH) to
educate general public on local food
Training Activities: quality.

The training faculty has conducted nine basic Of the 6515 food samples analyzed for
training programs, twenty three in-service quality, under the food regulations, 20
training programmes, three Post Basic training percent of them were of unsatisfactory
programme & five Post Graduate training quality. Of the imported salt samples 4
programmes in the year 2016. It has also percent were not complying with the
conducted seven examinations for the Ministry existing regulation due to excess and
of Health. deficiency of iodine content. Among the
imported frozen fish samples 2 percent had
NIHS has also revised following training unacceptable levels of formaldehyde
curricula to improve the trainer/examiner ranging from 25 to 66 mg/kg.
capacity which will help the training activities in
the future:

• PHM Part II curriculum

• MOH curriculum
• MLT curriculum,
• SPHM curriculum
• Tutor Training (Educational Science)
Diploma.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 185

15. Management, Development and Planning

15.1. Deputy Director General – 1. Strengthening the institutional mechanism

to develop Job Descriptions;
Planning
Circular no: HPS/ OD/ J/ 01/ 2016 issued to
Management Development and Planning Unit delegate job description development to
of the Ministry of Health is headed by the individual units to facilitate adoption of the
Deputy Director General Planning (DDG standard format.
Planning). Activities related to planning and
development are mainly coordinated and 2. Open Government Partnership (OGP)
formulated by the unit. Development of long process: Making Governments open,
term, medium and annual plans for the accountable and responsive to citizens
government health care delivery system is a
core function of the unit. It is also responsible Sri Lanka is a signatory of the Joint Declaration
for planning, finance allocation, monitoring and on Open Government for the implementation
evaluation of health projects conducted by line of the 2030 Agenda for Sustainable
ministry hospitals and programmes. Moreover, Development, signed during the OGP Global
it is responsible for maintenance of health Summit held in Mexico in 2015. This process led
databases, organization development and by the Ministry of Foreign Affairs (MFA)
performance monitoring and organizing recognized health as one thematic area for
international conferences. In addition, policy action during a National consultation with civil
development activities and reforms are also society organizations. Directorate of OD unit
undertaken by the unit. being focal point for the OGP, prioritized 3 main
The unit has following directorates and units activity areas to be implemented over a period
functioning under Deputy Director General of 2 years.
Planning.
• Enhance the knowledge among public
1) Directorate of Planning about the drug pricing process
2) Directorate of International Health • Strengthen the process to prevent and
3) Directorate of Organizational reduce the risk of getting Chronic
Development Kidney Disease of Unknown origin
4) Directorate of Health Information • Strengthen the Ministry of Health
5) Directorate of Finance planning processes to monitor health system
performance through better public
15.2. Directorate of Organizational understanding
Development
3. 'Shared Care Cluster model ' - Reforming the
Primary Health Care (PHC) services
“Improving organizational effectiveness of the
“Current need: reorient primary curative care to
Ministry of Health is linked to service delivery,
provide more patient centered care through a
performance improvement, human resources
continuity of care model to address the present
for health and governance”
health challenges”
A model identified based on "A Family doctor
for All” concept.

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186 Annual Health Bulletin 2016

 Key features of the reform; clustering of institutions by identifying a
minimum level of specialized facilities
• Demarcating the geographical area for each cluster and a rational
(catchment area) to health institutions distribution of other specialized
to provide primary care services with facilities.
the aim of improving accountability to
services provided by the curative care Next Steps
institutions as in preventive health
services • The OD unit will engage in a
• Improving the referral and back referral stakeholder discussion to present the
system through introduction of PHR changes as a Rational Healthcare
• Strengthening the competencies of PHC Delivery Policy for Sri Lanka. The
medical officers proposal enables the identification of a
road map for hospital development for
the country probably for next two
A consultative process involving all medical decades. In addition, it will also provide
faculties to improve understanding on the need the baseline for the specialized cadre
to strengthen undergraduate curriculum norm developments.
towards making medical graduates more
competent to serve in primary care settings was 5. Organization Structure- A reform towards
carried out. Several other advocacy programs improved health services
have been conducted and Honorable Minister
of Health, declared the primary care reform It has been identified that the Organization
during the 2016 budget debate. A clustering of Structure of the Ministry of Health needs to be
Northern Province carried out during a updated and agreed upon to support the
consultative process involving the staff of the governance mechanisms within the Ministry of
area. Health. The Directorate was able to develop a
Next Steps; data base on all the possible job functions of
the individual units and the draft organization
• Partnering with Asian Development structures of the individual units.
Bank to undertake clustering of health
institutions in 9 districts.
Next Steps;
• Advocacy among senior health officials
to institutionalize the reform process.
• To organize a high level stakeholder
meeting to further analyses the
4. Rational healthcare delivery policy- A Policy functions related to individual units.
for equitable and efficient service delivery for
the next two decades
6. Results Framework Development –
Accountable Health Service Delivery
Demand driven developments are considered
as per the prevailing policy on hospitals re-
The OD unit initiated a capacity building
categorization. However, it has been identified
program among public health programs on
that service delivery needs to be strengthened
results framework development. The aim is to
to provide services in an equitable and efficient
streamline the annual action plan development
manner.
process which will be then aligned to agreed
• A policy has been drafted after
health system results.
examining the distribution of
specialized facilities together with

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 187

 • Few units namely, Non Communicable 15.3. Directorate of Health
Diseases, Mental health, Environmental
Health, Cancer Control Program has
Information
started development of such results
frameworks. Directorate of Health Information of the
Ministry of Health is the national focal point for
Next Steps; health information system management. The
mission of this unit is to ensure availability and
• Improve the capacity of the programs accessibility of valid, accurate and timely health
to develop results framework information and continuous improvement of its
• Advocate programs to develop the quality to foster evidence based decision
results frameworks making in health care provision.

7. Health Development Committee – Major achievements of the Health Information

Organization Governance unit during year 2016

OD unit acts as a secretariat for coordinating 1. National Heath Information Policy

major national level policy decision making Work related to formulation of the Health
meetings. These are the National Health Information Policy and the Health
Development Committee and the Health
Information Strategic Plan continued for
Development Committee (HDC) meetings. OD
2014-2015. The Health Information Policy
unit organized bi-monthly HDC meetings during
the year 2016. and the Health Information Strategic Plan
was finalized by incorporating suggestions
8. Migration Health- Advocacy for migrant by key stakeholders and public.
health 2. Publishing National e-Health guideline and
standards completed
The OD Unit is the focal point to implement the 3. Publishing of annually updated telephone
National Migration Health Policy in Sri Lanka. directory
During 2016, the OD unit intensified its Health information unit published an
activities on advocacy to ensure migration
Annual Health Telephone Directory for
health is included as an agenda item for
Ministry of Health, Nutrition and Indigenous
discussion in local, regional and global health
forums. Sri Lanka and Italy co-hosted a side Medicine. Telephone Directory was
event on migration health at the United Nations published in all three languages complying
General Assembly in 2016. Migration health with the language policy.
was included as an agenda item during the 69th 4. Improve 16 computer maintenance units
WHO Regional Committee meeting in Colombo. Identifying the need of e-health initiatives
to be implemented in all healthcare
institutions, it was decided to establish
computer maintenance units at all Teaching
Hospitals. During the year, 16 health
institution staff were provided training in
hardware, electronic and network training

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188 Annual Health Bulletin 2016

 and all necessary equipment were provided 15.4. Finance planning Unit
for sixteen computer maintenance units.
5. Human resources data base Major functions
The information unit is maintaining the
human resources database and biannual 1. Allocate funds to the line ministry
human resource situation document is institutions for conducting capital activities
published. This document can be used in 2. Monitor the physical and financial progress
planning recruitment and placement of of the capital activities according to the
technical cadres. In addition, it is planned to action plan
develop an improved version of the 3. Conduct progress review meetings for
software with the assistance from ICTA. preparation of quarterly progress report.
7. Improving the networking of hospitals 4. Preparation of performance and progress
In order to facilitate implementation of e- reports
health initiatives, it was decided to 5. Conduct and coordinate workshops/
implement network of all line ministry training programmes to update the
hospitals. As a beginning, Networking of TH knowledge on health financial management
Kandy, NHSL, Cancer Hospital under WHO funds
Maharagama, North & South Colombo 6. Assists to develop and continue costing
Teaching Hospital were commenced. mechanism for the health sector
7. Preparation of audit reports

Major achievements of the Finance Planning

unit during year 2016

1. Funds allocation for each line ministry

institutions
2. 56% of the capital budget was utilized
3. Four progress review meetings were
completed
4. Prepared the performance and progress
report for 2015-2016
5. Three workshops were conducted on
finance management

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 189

16.Services for Prevention and Control of Non-
Communicable Diseases

16.1. Non- Communicable Disease NCD policy consisting of 9 strategies was

Unit developed in 2010 in view of reducing the NCD
burden. NCD voluntary targets needed to be
achieved by 2025 are as follows.
Non- Communicable Disease Unit is the focal
point in the Ministry of Health, Nutrition and
1. A 25% relative reduction in premature
Indigenous Medicine for prevention and control
of both chronic and acute NCDs in the country. mortality from cardiovascular disease,
cancer, diabetes, or chronic respiratory
NCD policy and targets diseases
2. A 10% relative reduction in the use of alcohol
Non Communicable disease prevention 3. A 10% relative reduction in prevalence of
programme mainly focus on prevention of insufficient physical activity
major 4 NCDs; i.e. cardiovacscular diseases
4. A 30% relative reduction in mean population
(Coronary heart diseases and cerebrovascular
disease), Cancer, Chronic respiratory diseases intake of salt/sodium
and Diabetes Mellitus. Unhealthy diet, physical 5. A 30% relative reduction in prevalence of
inactivity, smoking and consuming alcohol have current tobacco use in persons aged over 15
been identified as 4 main behavioural risk years
factors for NCDs. 6. A 25% relative reduction in prevalence of
raised blood pressure and or contain the
In view of reducing the burden due to NCDs,
prevalence of raised blood pressure
nine global and one regional target has been
introduced by WHO to be achieved by 2025 by 7. Halt the rise in obesity and diabetes
implementing cost effective interventions. 8. A 50% of eligible people receive drug
therapy and counselling (including glycaemic
The mortality target included among the 10 control) to prevent heart attacks and strokes
targets mainly focus on reducing the pre 9. An 80% availability of affordable basic
mature deaths (30- 70 years) due to major
technologies and essential medicines
chronic NCDs such as such as cardiovascular
diseases, cancer, diabetes and chronic including generics, required to treat major
respiratory diseases. Disease burden due to 4 noncommunicable diseases in both public
main NCDs in Sri Lanka is described below. and private facilities

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190 Annual Health Bulletin 2016

 A costed National Multisectoral Action Plan for Screening for non-communicable diseases and
the Prevention and Control of Non- risk factors
Communicable Diseases (2016-2020) was
developed and prioritized. This action plan has
Ministry of Health has taken an initiative to
been formulated based on the following 4 establish Healthy Life Style Centres throughout
strategic areas. the island to screen normal people. The target
group to screen at Healthy Life Style centers is
1. Advocacy, partnership and leadership people who are between 40 – 65 years. Main
2. Health promotion and risk reduction objective of screening is to identify behavioral
3. Strengthening health system for early and intermediate risk factors and to intervene
early to prevent occurrence of NCDs
detection and management of NCDs and
their risk factors
4. Surveillance, monitoring, evaluation and
research

 885 HLCs have been established to screen healthy adults between 40- 65 years
 More than 70% of clients screened are females
 Lack of adequate staff at HLC have been recognized as a main challenge

Table 16-1 : The number and services of Healthy Lifestyle Centres in Sri Lanka, 2011–2016

2011 2012 2013 2014 2015 2016

Total number of HLCs 126 420 672 760 814 826

% of MOH areas in a — — 56.0 69.5 77.8 79.6

district with two or (187/334) (235/338) (263/338) (269/338)
more HLCsa
Cumulative % of the 2.5 3.8 12.7 19.9 23.1 25.5
target population
(aged 40–65 years)
screenedb
Ratio of men: women — — 2.6:7.3 2.9:7.1 2.8:7.2 2.9:7.1
screeneda
HLC: Healthy Lifestyle Centre; MOH: Medical Officer of Health.
a Data not available for 2011 and 2012.
b Target population is nearly 25% of the country population.

Source: Directorate of NCD

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 191

16.2. Directorate of Mental health World Health Organization (WHO) including the
International Agency for Research on Cancer
Directorate of Mental Health is the national (IARC) and the World Bank through the Health
focal point of the Ministry of Health responsible Sector Development Project for improving
for policy development, strategic planning, facilities for cancer care and capacity building.
strengthening of mental health services through The in-service training programmes are annually
improved infrastructure, human resources and
arranged by the NCCP for skills development of
monitoring and evaluation of national mental
health programme. In implementing this role, a the healthcare staff in prevention and control of
close collaboration is established with cancers. The programmes conducted in 2016
professional bodies, provincial health are,
authorities, other relevant ministries and
departments, NGOs, civil societies and 1.Palliative care workshops for health care
consumer groups.
workers engaged in cancer care.

16.3. National Cancer Control 2.Programmes for health care staff attached to
Programme (NCCP) Healthy Lifestyle Centres for strengthening
oral cancer control activities carried out
National Cancer Control Programme (NCCP) through the clinics.
which was established in 1980 is the national
focal point for prevention and control of cancers 3.Training workshops for healthcare staff
in the country. It is responsible for advocacy for attached to Health Education Units on
policy formulation, development of strategies prevention and control of cancers.
and implementation of the activities for cancer
4.Training programmes on palliative care for
prevention and control at national level,
DCOs and DSSOs.
monitoring and evaluation of programme
activities including surveillance of cancers at all 5.Training programmes for Medical Officers and
levels and facilitating research related to cancer. Nursing Officers attached to Colposcopy
NCCP activities are conducted mainly using the units.
government funds and are also supported by the

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192 Annual Health Bulletin 2016

 17. Laboratory Services
17.1. Deputy Director General 3. National Blood Transfusion Services (NBTS)
Laboratory Services
National Blood Transfusion Service is a
Under the Purview of The Deputy Director specialized laboratory. It is the only free-
General – Laboratory Services, the Directorate of standing blood collection facility in the country
laboratory Services is responsible for and was established in 1950s. NBTS is a
formulation and enactment of essential and decentralized unit which comes under Ministry
relevant legislations and provision of financial, of Health, Sri Lanka. NBTS is the sole supplier of
technical and managerial guidance for blood and blood products to all state hospitals
maintenance of state owned laboratories in and some of the private hospitals which are
compliance with nationally and internationally registered under Ministry of Health for supply
accepted standards. of blood and blood products. Having its
headquarters at National Blood Centre (NBC),
Laboratory services mainly consist of; NBTS has 96 blood banks island wide. The
categorization of blood banks is as follows,
1. Laboratories in curative care institutions
1. National Blood Centre - the
Laboratories in curative care institutions provide headquarters
essential services to support medical 2. Cluster Centres
management of patients via rapid and reliable 3. Peripheral Blood Banks
analysis of clinical specimens. These laboratories
comprise of Chemical Pathology, Haematology,
Microbiology and Histopathology departments /
sections.

2. Laboratories in preventive care institutions

Laboratories in preventive care institutions

provide essential services including disease and
outbreak detection, emergency response,
environmental monitoring and disease
surveillance. These laboratories mainly comprise
of food laboratories and laboratories attached to
special campaigns.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 193

17.2. National laboratory system

The National laboratory system consists of a All tertiary care institutions and 93% of
tiered, country-wide hospital laboratory system secondary care intuitions have functioning
which includes laboratories in Primary care laboratories. Only 5.4% of primary care
institutions at the grass root level, Secondary intuitions have laboratories.
care institutions, Tertiary care institutions and
the Medical Research Institute (the national
reference laboratory) at the apex.

MRI

Labortaries in
tertiary care National Hospital of Sri Lanka, Teaching
instituions Hospitals, Provincial General Hospitals &
District General Hospitals

Labortaries in secondary Base Hospital A, Base Hospital B

care instituions

Labortaries in primary Care

instituions Divisional Hospital A,
Divisional Hospital B,
Divisional Hospital C, Primary
Medical Care Unit

Key message 1:
There is a dearth of laboratories in primary care institutions

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194 Annual Health Bulletin 2016

 120
100
100 93
% of Laboratories
80

60

40

20
5.4
0
Tertiary care institutions Secondary care institutions Primary care institutions
Institution type

Figure 17.1 :Distribution of Laboratories in Primary, Secondary and Tertiary Care Institutions
Source: Deputy Director General (Laboratory Services) division

Recommendation

 Strengthen and Establish laboratories in all There are laboratories in 83% of health care
primary care institutions institutions under the Line Ministry whilst only
17% of health care institutions under the
 Expansion of the cluster laboratory system
purview of the Provincial Ministry have
functioning laboratories.

Key message 2 :
Only 17% of curative care institutions under the purview of the Provincial
Ministries have functioning laboratories, as 99% of primary care intuitions are
managed by the Provincial Ministries

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 195

 90 83.05
80

70

60
% of Laboratories

50

40

30

20 17.43

10
0
Line Ministry Hospital Provincial Hospitals
Axis Title

Figure 17.2 : Distribution of laboratories in health care institutions under the purview of the Line
Ministry and the Provincial Ministry
Source: Deputy Director General (Laboratory Services) division

Out of 26 districts in the country, Line Ministry health care institutions are situated in 21
districts. Other than prison hospitals where laboratories are not available, all other Line
Ministry hospitals have functioning laboratories.

120%
100% 100% 100% 100%
% of Hospitals with laboratories

100%

80%

60% 50%

40%

20%
0% 0% 0% 0%
0%
TH PGH DGH BH-A BH-B DH-A DH-B DH-C PMCU
% of Laboratories available in Line Ministries
Type of Hospital

Figure 17.3 : Type of Line Ministry Institution according to availability of Laboratory Facilities
Source: Deputy Director General (Laboratory Services) division

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196 Annual Health Bulletin 2016

 120
100% 100%
% Hospitals with laboratories 100 91%

80
67%

60
43%
40

20
4%
0
0

Type of Hospital

Figure 17.4 : Type of Provincial Ministry Institution according to availability of Laboratory

Facilities
Source: Deputy Director General (Laboratory Services) division

Recommendations Laboratory financing

 Establish and strengthen Provincial Purchasing of laboratory equipment for Line

reference laboratories in all provinces. Ministry laboratories
 Strengthen the Provincial expansion
programme Total allocations for laboratory equipment for
Line Ministry laboratories have increased from
300 million in 2012 to 690 million in 2016.
While 100% of these allocations were released,
the actual expenditure remains less than 400
million throughout the last five years.

Key message 3 :
Increase allocation for purchasing laboratory equipment, but financial progress is
stagnant due to inadequate cash flow

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 197

 LKR (Millions)

2016

2015
Time (Years)

Total Allocation
2014 Total amount released
Actual expenditure

2013

2012

0 100 200 300 400 500 600 700 800

Figure 17.5 : Lab financing for purchasing of laboratory equipment for line ministry laboratories
Source: Deputy Director General (Laboratory Services) division

Key message 4:
Underutilization of service agreement funds by the health care institutions

Maintenance of laboratory equipment of Line agreement for maintenance of equipment from

Ministry laboratories the company after which the funds for
maintenance is released through the DDG-LS.
The actual expenditure for maintenance
Following the purchase of laboratory activities after 5 years of purchasing equipment
equipment, there is a five year service is approximately 30% of the initial allocation.

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198 Annual Health Bulletin 2016

 Lab financing for maintenance of laboratory equipment for Line Ministry laboratories

2012

2013
Year

2014 Actual expenditure

Total amount released

2015 Allocation

2016

0 2 4 6 8 10 12 14 16
LKR in Millions

Figure 17.6 : Lab financing for maintenance of equipment

Source: Deputy Director General (Laboratory Services) division

Recommendation 6) Poor remuneration of staff.

Make the Heads of institutions aware of the Achievements in 2016

allocation for maintenance activities beyond 5
years of purchasing.
1) Strengthening of mobile laboratory
services.
Challenges
a. Mobile laboratory services were
established with the aim to
1) Poor collaboration and coordination
improve accessibility and
between the national reference
laboratory (MRI) and other laboratories availability of necessary
at the Ministry level, as MRI is not laboratory investigations to
under the purview of DDG-LS. those living in far remote and
2) No strong collaboration between the difficult areas. In the year 2016,
curative sector laboratories and mobile laboratory services were
preventive sector laboratories at the
offered to 111 centres all over
Ministry level.
the country and 47,773 tests
3) Balancing the capacity of new
technology with current needs. were done through the service.
4) Preventive maintenance and repair of
laboratory equipment. 2) Strengthening of the Provincial
5) Rapid staff turn-over and shortage of laboratory expansion programme.
qualified/specialized staff.

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 199

 a. The Provincial level hospitals million LKR was released to the
laboratories are not directly PDHS of the 9 provinces to
supported by the directorate. procure laboratory equipment,
However, to improve the overall 30 million per province.
quality of the services the
Provincial laboratory expansion 3) Initiation of the Laboratory inspection
programme was instated in programme.
2014, to provide funds to
procure technologically advance 4) Implementation of the decision to
laboratory equipment aiming to perform all laboratory investigations in
expand Haematology, the hospitals ensuring full utilization of
Biochemistry, Pathology and available resources.
Microbiology services in
Provincial General Hospitals and 5) Heads of all health care institutions were
both type A and type B Base made aware of the allocation for
Hospitals in the country. maintenance activities beyond 5 years of
purchasing.
b. In the year 2016 direct
purchases by laboratory sector 6) Awareness programmes were
included 145 million LKR to the conducted on biosafety and biosecurity
Provincial hospitals and 270 for laboratory staff.

Priority actions for 2017

1) Formulation of the National Laboratory Policy

2) Formulation of a National Laboratory Regulatory Act
3) Establish a National system for Accreditation of Health Laboratory
4) Geo mapping of island wide state laboratories
5) Develop a Laboratory Management Information System
6) Develop the National laboratory strategic plan
7) Update the Manual on Laboratory Services

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200 Annual Health Bulletin 2016

 17.3. National Blood Transfusion 7) Introduction of National Blood
Service (NBTS) Transfusion Services Information
System (NBTSIS) to all blood banks,
Directorate of NBTS assure supply of blood and island wide.
blood products from voluntary non- 8) Conducting Teaching & Training
remunerated blood donors to cater the programs by NBTS
demands of all government hospitals and a. Continuous Medical Education
majority of private sector hospitals through and on the job training to all
disseminated services in cluster blood banks staff categories of NBTS
island wide.
b. Training of Undergraduates,
Medical students, Nursing
Main functions of the institution
Officers, Students of Allied
1) Adequate and continuous supply of Health Sciences and Security
blood and blood products from regular Service personnel.
voluntary non-remunerated blood c. Post Graduate Training in
donors. Transfusion Medicine,
2) Regular voluntary non-remunerated Hematology and Oncology.
blood donor recruitment, retention & d. Training for foreign delegates,
donor care. WHO fellowship holders and
3) New blood bank development to Base other international
Hospitals (Kiribathgoda and organizations.
Kattankudy)
4) Supply of new laboratory equipment to
regional blood banks.
5) Introduction of new technologies to
NBTS.
a. Immuno-Hematology Reference
Lab
b. HLA Molecular Testing
c. Nucleic Acid Testing
d. Pathogen Inactivation of
Platelets (PI)
e. Frozen Red Cell (FRC)
f. Stem Cell Facility – Processing
and storage of stem cells for
stem cell Transplantation
programme at CIM.
g. Cord Blood Bank (under
Processing)
6) Conducting Hospital Transfusion
Committees (HTC).

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 201

 7%

93%

Mobile Collection In house Collection

Figure 17.7 : Distribution of total blood collection by mode of collection

Source: National Blood Transfusion Service

420,000

410,000

400,000

390,000

380,000

370,000

360,000

350,000

340,000

330,000

320,000
2012 2013 2014 2015 2016

Figure 17.8 : Yearly improvement of Voluntary blood collection

Source: National Blood Transfusion Service

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202 Annual Health Bulletin 2016

 90000
80000
70000
60000
50000
40000
30000
20000
10000
0

Total Mobile Collection Total In-House Collection

Figure 17.9 : Total blood collection cluster wise

Source: National Blood Transfusion Service

90000
80000
70000
60000
50000
40000
30000
20000
10000
0

2015 2016

Figure 17.10 : Comparison of cluster blood collection with previous year

Source: National Blood Transfusion Service

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Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 203

 0.35%

0.30%

HIV (SCR.+VE)
0.25%
HIV (Conf.+ve)
0.20% Hepatitis B (rpt.+ve)
Hepatitis C (rpt.+ve)
0.15%
VDRL+ve

0.10% TPPA +ve

MP+ve
0.05%

0.00%
2012 2013 2014 2015 2016

Figure 17.11 : Prevalence of Transfusion Transmitted Infection and comparison with previous
years
Source: National Blood Transfusion Service

Statistics of HLA Laboratory

Table 17-1 : Comparison of HLA Statistics

Typing and cross matches 2014 2015 2016

Class 1 2293 2288 2015

Class 11 2297 2214 1777
Cross match 1365 1471 2490
B27 352 194 319
PRA7 (Class I , Class II ) 179 295 484
Transplantation
Kidney (Patients ,Donor) 2455 2094 1589
Bone Marrow (Patients, Donors) 192 108 167
AP donor 11 32 171
Cadaveric Donors 7 15 11
Source: National Blood Transfusion Service

7 PRA - Panel reactive antibodies

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204 Annual Health Bulletin 2016

 The project of Nucleic Acid Testing (NAT) Review Report of Nucleic Acid Testing (NAT)
facility at National Blood Centre facility at National Blood Centre (NBC) – up to
31st December 2016
Introduction:
Testing summary:
Nucleic Acid Testing (NAT) was introduced to
the National Blood Centre (NBC) by the State of  NAT testing were done for the samples
Art Technology Project funded by the collected in-house or from mobile
Government of the Netherlands. campaigns conducted by the NBC.
 Following table summarizes the testing
done up to 31st December 2016.

Table17-2 : Nucleic Acid Tests done up to 31st December 2016

Total tests performed Tested samples
49,726 42,675
Source: National Blood Transfusion Service

Stem Cell Transplantation

1. On the 24th of October 2016, the Stem

Cell Transplantation was initiated.
2. There were 4 procedures, which was
done for 2 patients diagnosed with
Multiple Myeloma. All these 4
procedures were done at the Regional
Blood Centre, Apeksha Hospital,
Maharagama.
3. Processing of harvested Stem Cell
product was done at NBC, and the
Teaching & Training was done by
Australian Delegates by the St. Vincet’s
Hospital, Sydney.
4. Initial 2 procedures were done under
the supervision by the Foreign
Delegates.
5. The 2nd patient’s transplantation was
done by the local team.

Outcome: - Both the Stem Cell

Transplantations were done successfully
in December 2016.

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18. Dental Services
1 Curative care services – provided
18.1. Deputy Director General – through the clinics located in Divisional
Hospitals, Base Hospitals, District
Dental Services General Hospitals and Teaching
Hospitals.

The oral health care delivery system of the 2 Preventive care services – provided
Ministry of Health of Sri Lanka is managed by through School Dental Clinics (SDC),
the Deputy Director General – Dental Services. Adolescent Dental Clinics (ADC) and
Community Dental Clinics (CDC).
The services include both curative services and
preventive services. Oral health care for school children is provided
by School Dental Therapists (SDT) working in
1 Curative Care Services – provided School Dental Clinics (SDC) and dental surgeons
through the clinics located in Peripheral working in the Adolescent Dental Clinics (ADC)
Units, District Hospitals, Base Hospitals, with a discernible Preventive component.
District General Hospitals and Teaching
Hospitals. Specialized care is provided School Dental Clinics (SDC) are located in school
through National Dental Institute – premises providing oral health care to children
Colombo, Dental Hospital (Teaching) between 3-13 years. During the year 2016,
Peradeniya and Institute of Oral Health there were 488 SDC manned by 391 SDTs. Sixty
Maharagama. two ADCs which are located in school premises
were manned by Dental Surgeons catering to
2 Preventive Care Services – provided the children above 13 years of age and special
through School Dental Clinics (SDC), groups. Community Dental Clinics (CDC) are
Adolescent Dental Clinics (ADC) and located in highly populated metropolitan areas
Community Dental Clinics (CDC). and dental surgeons working in these clinics
focusing on preventive care to specialized
18.2 Dental care services groups like pregnant mothers and children
below 3 years of age.
Oral Health Services are provided to the public
During 2016, 101 new Dental Surgeons and 30
by both Government & private sector. However,
new School Dental Therapists were recruited
nearly 60-65% of services are provided by the
and at present there are 1416 Dental Surgeons
government sector in both urban & rural areas.
working in the public sector.
Moreover, majority of the dental surgeons who
work in the government sector are involved in
part time private practice. Nearly 2% of the oral Specialized services
health services provided through Universities,
tri forces, police and non-governmental The five main specialties in the oral health care
organization to their employees and families. services in Sri Lanka are Oral & Maxillo Facial
(OMF) Surgery, Orthodontics, Community/
Oral health services in public sector provided by Public Health Dentistry, Restorative Dentistry
the government services are mainly consist of and Oral Pathology. By the end of 2016, there
two components. were 68 Dental Consultants belonging to these
specialized fields under the Ministry of Health.

Annual Health Bulletin - 2016 206

206 Annual Health Bulletin 2016

 OMF surgeons were attached to the Teaching Mobile Dental Unit has conducted more than
Hospitals, District General Hospitals and Base 200 mobile dental clinics and has provided
Hospitals. Restorative and Orthodontic dental care to more than 20,000 Individuals of
consultants were attached to Teaching different age groups. Moreover, several other
Hospitals, Institute of Oral Health, Maharagama districts are having their own mobile dental
and District General Hospitals. Consultants in units to cater to the general public in remote
Community Dentistry were attached to National areas.
Dental Hospital (Teaching) Sri Lanka, Institute of
Oral Health- Maharagama, Family Health Special Community Oral Health Care
Bureau, Cancer Control Programme, Health Programmes
Education Bureau and Offices of Provincial
Directors of Health Services. Consultants in Oral There are five main ongoing special community
Pathology are attached to Teaching Hospital oral health programmes conducting successfully
Karapitiya & National Dental Hospital (Teaching) Island wide.
Sri Lanka. The National Dental Hospital
(Teaching) Sri Lanka, Dental Hospital (Teaching) 1. Oral health care services to pregnant
- Peradeniya and the Institute of Oral Health, mothers.
Maharagama are the premier institutions of 2. Early childhood caries prevention
providing multi-disciplinary tertiary oral health Programme/Fluoride Varnish
care services in Sri Lanka. programme.
3. Save Molar programme for School
Table 18-1: Distribution of dental specialists Children.
by specialty 4. Oral Potentially Malignant disorder
(OPMD) and Oral Cancer Prevention
Specialty Number and early detection programme.
5. Dental Fluorosis prevention & control
Oral & Maxillo Facial Surgery 29 programme.

Oral health care programme for pregnant

Orthodontics 23
mothers is geared to provide comprehensive
oral health care for them in order to improve
Community Dentistry 07
the oral health by reducing the complications of
dental decay during pregnancy and prevent
Restorative Dentistry 07 worsening of the existing oral disease. This will
result in reducing the risk of transmission of
Oral Pathology 02 caries causative bacteria to the new born and
thereby reducing the possibilities of adverse
Total 68 pregnancy outcomes.

Source: Deputy Director General Dental Services Division Identifying Oral diseases at early stages enables
curing them with simple interventions. Primary
Mobile Dental Services health care providers are advised to examine
the children’s teeth at the age of 12 &18 month
The Mobile Dental Unit at the National Dental & requested to refer them for dental advice and
Hospital (Teaching) Colombo and the Ministry treatment if they are detected any
of Health deploys to any destination of the abnormalities during the screening. Ministry of
country on request. During the year 2016 Health decided to introduce Fluoride varnish in
to ADC, CDC and to the dental surgeons

Annual Health Bulletin - 2016 207

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 207

attached to the MOH offices in Sri Lanka in programme. Mainly the School Dental
order to prevent and control the developing Programme and oral health Programme for
dental caries among young children. pregnant mothers. Details and the
achievements pertaining to these services are
Ministry of Health started the Save Molar expedited under Family Health Bureau.
programme in the year 2013 to strengthen the
primary oral health care services in Sri Lanka. Health Promotion Bureau
The school children are screened and the high-
risk children were identified to seal the molar Health Promotion Bureau (HPB) is the center of
teeth with a sealant material which will protect excellence for Health Promotion in the country.
the occlusal surfaces for carious attack. Oral Health Promotion Unit of the HPB has
Ministry of Health with the collaboration of launched the National Oral Health Promotion
National Cancer Control Programme has Program (NOHPP) covering the following key
commenced early detection and prevention of areas.
OPMD and Oral Cancer to strengthen the
primary oral health care in Sri Lanka. In this 1) Awareness and capacity building of
programme high risk groups for OPMD are health staff on Oral Health Promotion
identified by applying the risk factor model. This 2) Awareness of general public on novel
strategy used for screening for OPMD and knowledge and current Oral Health
referring these persons who score more than 12 activities
in the risk factor model, to a dental surgeon at 3) Development of technical guidelines on
the nearest hospital. Oral Health Promotion
Dental Fluorosis is a defect of tooth enamel 4) Development of IEC material on Oral
caused by excessive intake of Fluoride during Health
tooth developing stage. This brings about 5) Conducting research activities relevant
discolouration and pitting of the enamel of the to the field of Oral Health Promotion
teeth. 6) Monitoring and evaluation of Oral
Children as well as adolescents with Dental Health Promotional activities at
Fluorosis suffer significant embarrassment and national level
anxiety over the appearance of teeth.
Ministry of health started dental fluorosis
prevention and control programme in 2016 in
Dental Fluorosis endemic areas which involves

1. Screening for Dental Fluorosis

2. Treatment of identified cases
3. Mapping of high fluoride water sources

Coordinating bodies of the oral health

programs

Family Health Bureau

Family Health Bureau is Responsible for

provision of essential oral healthcare services
through existing maternal and child healthcare

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208 Annual Health Bulletin 2016

 National Cancer Control Programme
To fulfil the requirements derived by those
National cancer control programme is the focal responsibilities following main functions have
point for prevention and control of all types of been identified.
cancers in the country. Prevention and control
of oral cancer and Oral Potentially Malignant 1) Maintaining a data base of dental
Disorders is under the preview of the National research conducted in Sri Lanka (or
Cancer Control Programme. Targets for oral relevant to Sri Lanka.)
cancer to be achieved by the year 2020 are 2) Analyse the research published annually
being set as and make recommendations to the
DDG (DS) on the significant research
 To reduce the rate of increase of the findings.
crude oral cancer incidence rate by 25% 3) Conducting national level research
by the year 2020 from the existing level pertaining to oral health (including
of 0.73 during 2005 and 2009. National Oral Health Survey and other
research which are important for
 To reduce oral cancer detected at national level planning.)
stages III and IV by 12% by the year 4) Encourage research in field of dentistry
2020 from the baseline level of 72% in by providing necessary information,
2007 technical support for the researchers
and assist in exploring research
potentials.
Research and Surveillance Division 5) Liaise with other organizations in
promoting oral health research.
Research and surveillance division of dental 6) Maintain timely and accurate
services which is headed by a Consultant in information pertaining to the dental
Community Dentistry, is located at the Institute service.
of Oral Health, Maharagama. 7) Carry out and coordinate collaborative
research.
This division is

1) Responsible for promoting research Training Division

pertaining to dentistry and maintain
The training division of the dental service
acceptable quantity, quality, and
established in 2011 and is located at the
standards in dental research done Institute of Oral Health Maharagama and
within the country. headed by a consultant in Community
2) Responsible for conducting national Dentistry. The unit provides training for the
level research pertaining to oral health following categories of staff.
in various sub-specialties in Dentistry
1) Entry level recruitment/ Orientation
such as Restorative dentistry,
training
orthodontics, community dentistry, etc
2) Newly appointed dental surgeons and
3) Responsible for developing and
other oral healthcare personnel
maintaining a quality and accurate
assigned to the oral health service of Sri
surveillance system for oral health in Sri
Lanka are given orientation training.
Lanka

Annual Health Bulletin - 2016 209

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 209

 3) In-service technical competency
development training
4) Develop and conduct training based on
the needs with the collaboration of the
other relevant organizations.
5) Refresher training and soft skill
development
6) This type of training programmes are
designed to prepare employees to
perform the activities required to
oversee productivity and quality of
care.
7) Training programmes on oral health for
the stakeholders of other sectors
related to oral health care provision.

Activities carried out in the year 2016

Four one-day hands on workshops on surgical

orthodontic techniques for all the dental
laboratory technicians
Hands on Workshops on Infection control for
dental healthcare staff in Gampaha District
Hands on Workshop on clinical preventive
dentistry procedures for all dental surgeons at
ADC and CDC

Main Stake Holders Involved in Oral

Healthcare

• Ministry of Education
• Departments of Oral Health in Sri Lanka
Police, Sri Lanka Army, Sri Lanka Navy and
Sri Lanka Air Force
• National Authority on Tobacco and Alcohol
• Faculty of Dental Sciences, University of
Peradeniya

Annual Health Bulletin - 2016 210

210 Annual Health Bulletin 2016

 Human resource

Dental Surgeons and specialists

Table 18-2 : Number of dental surgeons and dental specialists in place

31st December 2015

31st December 2016

filled Percentage of
appointments as at
Vacancies as at 31st
Number in place as
at 31st December

vacancies During
Total Cadre as at

December 2015

the year 2016

2015
Grade 1516 1416 100 100 100%
Dental
Surgeons
Dental 99 63 36 5 13%
Specialists
Source: Deputy Director General Dental Services Division

Auxiliary services

Table 18-3 : No. of auxiliary services personnel in place

31st December 2015

31st December 2016

filled Percentage of
appointments as at
Vacancies as at 31st
Number in place as
at 31st December

vacancies During
Total Cadre as at

December 2015

the year 2016

2015

School Dental 524 361 163 30 18%

Therapists

Dental 60 37 23 0 0%
Technicians
Source: Deputy Director General Dental Services Division

Annual Health Bulletin - 2016 211

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 211

19. Medical Supplies
19.1 Medical Supplies Division Achievements /Special events in 2016

1) Medical Supplies Management

The Medical Supplies Division (MSD) of Ministry
of Health is the central organization responsible Information System (MSMIS) has been
to supply all Pharmaceuticals, Surgical items, established and it has become fully
Laboratory items, Radioactive Items and Printed functioning from the year 2015.
forms for the Government sector healthcare Verification and estimation through
institutions island-wide. In addition, MSD is the MSMIS started in 2016.
sole supplier of dangerous drugs (narcotics) to 2) Conducted monitoring and coordinating
all hospitals in the country including the private
programmes for 22 districts to improve
sector. In this context, the main functions of
MSD are estimating, indenting, procuring, medical supplies management process
storing, monitoring, distributing and accounting from the year 2015 and up to 2016.
of medical supplies. The national requirements 3) Weekly supply position review
of medical items are procured mainly through meetings have been held regularly with
the State Pharmaceutical Corporation (SPC) the participation of the representatives
which is the procurement agency for MSD. In
of all stakeholders including NMRA
addition, MSD has its own purchasing unit for
emergency local purchase of selected items and State Pharmaceutical Corporation and
procurement of locally manufactured Ministry of Health, to minimize out of
pharmaceutical from the private sector. stock situation in the year 2016.
4) Awareness and updating workshops
Medical supplies are stored until they are being done for relevant staff in all institutions.
distributed among government healthcare 5) A plan of action is being implemented
institutions in a network of stores comprising of
to dispose quality failed medical
a central medical stores in Colombo (MSD) and
26 Regional stores at the district level (RMSD). supplies accumulated in institutions at
The central medical stores consist of 18 Bulk Kalutara, Matara, Galle, Hambantota,
warehouses at the main building, 3 bulk Colombo, Gampaha, Kandy, Kegalle,
warehouses at Angoda, 5 bulk warehouses at Batticoloa, Trincomalee, Jaffna,
Wellawatha, one warehouse at Digana and one Polonnaruwa, Kurunegala, Badulla, and
warehouse at Welisara. Rathnapura districts have been
completed and it is to be extended to
These Medical items are distributed directly to
line ministry institutions by the MSD and to other districts in 2017.
institutions under the provincial administration 6) Construction works on the roof top of
through Regional Medical Supplies Division MSD main building has been almost
(RMSD) based on their annual estimates and on completed.
their requests. In addition, donations received 7) Development and modification of the
from donor agencies such as WHO/UNICEF etc,
cold store facilities with digital
are cleared by the wharf branch of MSD and
stored and distributed. temperature control and monitoring
system has been completed, which will
ensure continuous 24 hour surveillance

Annual Health Bulletin - 2016 212

212 Annual Health Bulletin 2016

 and monitoring of cold chain to visit and observe new development
maintenance of drugs and vaccines in a of Medical Supplies Management in a
more reliable & safe manner. Regional Country as well as a diploma
8) Workshops have been organized in the programme locally at SLIDA.
institutions, in all districts to introduce 15) Conducted workshop for Divisional
Drug and Therapeutic Committees Pharmacist, Officers in Charge of
(DTC). With this effort now there are 80 RMSD, and Other staff attached to
institutions with functioning regular RMSD.
DTC meetings which are sending their 16) In-Service training for Public
reports regularly. Management Assistants/Health
9) Tender is awarded to construct a new Management Assistants and
pre-fabricated 40,000 square feet store Development Officers has been
facility for MSD at the Welisara Hospital initiated.
premises. 17) Effective direct communication and
10) Work is completed on Air conditioning coordination system has been
the main pharmaceutical stores established with appointing
complex of MSD. coordinators for each and every district
11) Action plan has been implemented to and provinces out of Stock Control
improve infrastructure facilities at MSD Officers and Assistant Directors and
sub stores and other relevant also through mobile communication
institutions. network.
12) Human resources capacity building plan 18) Facility and performance data base for
has been initiated with local and foreign stores has been designed and will be
in service trainings implemented soon.
13) Expansion of MSMIS to Peripheral 19) Teleconferencing and distance learning
institutions has been initiated. facilities have been developed at MSD
14) Foreign fellowship programme has and will be implemented soon with
been completed for Stock Control assistance of institutions.
Officers & Medical Supplies Assistants

Annual Health Bulletin - 2016 213

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 213

Last 5 year Performance Trend.

30,000

25,000

20,000
LKR Millions

15,000
Drug- Estimate
10,000 Surgical- Estimate
5,000 Lab- Estimate

0
2010 2011 2012 2013 2014 2015 2016
(Mn) (Mn) (Mn) (Mn) (Mn) (Mn) (Mn)
Year

Figure 19.1 : Medical Supplies Estimated

Source: Medical Supplies Division

40,000

35,000

30,000

25,000
LKR Millions

20,000 Lab- Issues

Surgical-Issues
15,000
Drug - Issues
10,000

5,000

0
2010 2011 2012 2013 2014 2015 2016
(Mn) (Mn) (Mn) (Mn) (Mn) (Mn) (Mn)
Year

Figure 19.2 : Medical Supplies Issued

Source: Medical Supplies Division

Annual Health Bulletin - 2016 214

214 Annual Health Bulletin 2016

 Special Development Activities Planned for the Capacity Building Programmes
year 2017
1) Distance Learning Programme for Para
Improve storages capacity and Facilities medical staff.
2) Training programmers for drivers and
1) Completion of pre-fabricated 40,000
minor staff.
square feet store facility for MSD at the
3) Visit to observe supply chain
Welisara Hospital premises in 2017 and
management & management of
planning for 2nd phase of store complex
organization in a regional country for
as a replacement of Wellawaththa
Medical Supplies Assistants (MSA) and
warehouse.
Stock Control Officers.
2) Destruction of quality failed items in
4) In service programmes for Public
rest of the districts where the
Management Assistants/ Health
destruction have not been completed.
Management Assistants and
3) Strengthening the Medical Supplies
Developments.
Chain by expanding MSMIS system up
to the hospitals maintaining under the
RDHS.
4) Construction of receiving bay at old
store warehouse premises at Welisara.
5) Construction of Day Care centre at MSD
premises
6) Expansion of infrastructure for office
area and refurbishment of existing
office area at MSD.
7) Establishment of hoist at central MSD &
establishment of New Ramp
8) Establishment of Distance learning &
Tele conferencing centre at MSD.
9) Facility and performance database for
monitoring of stores.

Annual Health Bulletin - 2016 215

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 215

20. Biomedical Engineering, Logistics and
Administrative Services

20.1 Deputy Director General Biomedical Engineer – 14 nos

Foreman – 42 nos
Biomedical Engineering
Technician – 43 nos
The Division of Biomedical Services of the
Ministry of Health is functioning under Deputy Major Achievements in 2016
Director General Biomedical Engineering. The Strengthening BES
unit is entrusted with procuring, installing,
commissioning and maintaining medical BES able to extend regional Biomedical
equipment in Line Ministry Hospitals. This Engineering Units in Anuradhapura, Badulla,
division also provides to the Provincial Health Kandy, Jaffna and Batticaloa with newly
authorities based on their requirements and recruited Biomedical Engineers.
needs.Activities of the unit are also performed
through decentralized units established in many Training Programs for BES staff and End users
provinces and hospital-based units. Number of training programs arranged for the
Technical staff of the Division as well as end
20.2 Biomedical Engineering Services users with the help of local and foreign experts.

Training for Engineering undergraduates

Biomedical Engineering Services (BES) is
responsible for; The Biomedical Engineering Services has been
providing facilities for industrial training to
Engineering undergraduate and technical
1) Procurement of Medical Equipment
trainees from University of Peradeniya, Sir John
2) Repairs & Maintenance of Medical
Kothalawala Defence University, Vocational
equipment training institutes and Armed forces.
3) Training of end users and technical staff (See Annexure II for Major Procurements in 2016)
4) Provision of Local/ Foreign technical
expertise in medical equipment

The headquarters of the Biomedical Engineering

Services Division is located in Colombo has
workshop facilities, warehouse facilities for
equipment and spare parts storage and
administrative functions. Biomedical
Engineering Services has also started
development of web based software for
medical equipment Inventory Management
System.At present following staff is attending
on management of medical equipment.

Annual Health Bulletin - 2016 216

216 Annual Health Bulletin 2016

 21. Indigenous Medicine Sector
Ministerial Priorities Institutions under the Ministry of Indigenous
Medicine
1) Strengthening the legal frame work for 1) Department of Ayurveda
the indigenous medical system. • National Institute of Traditional
2) Strengthening and improving the Medicine
Ayurvedic researches. • Bandaranaike Memorial Ayurvedic
3) Using Information Technology for Research Institute
Ayurvedic medical system. • Ayurvedic Medical Council
4) Development of Human resources for • Teaching Hospitals
updating and improvement of Ayurveda • Research Hospitals
health conservation. • Herbal Gardens
5) Improving the production of Ayurvedic 2) Sri Lanka Ayurvedic Drugs Corporation
medicine and cultivation of herbal 3) Homeopathic medical Council
plants and setting up new herbal 4) Community Health Promotion service
gardens. 5) Homeopathic hospital
6) Maintaining the Ayurveda in
accordance with the commercialization. In addition to the provision of Indigenous
7) Increase the use of Homeopathy medical care services through the island wide
medical system. network of Ayurvedic hospitals and
dispensaries, the creative research activities are
carried out by the Ayurvedic research institute.
The seven medicinal plants gardens (of the total
area of 303 acres) are established to promote
island wide Ayurvedic drugs manufacture.

Table 21-1 : Government Ayurvedic and Homeopathic Medical Institutions in Sri Lanka- 2016
Type of Institution No of Location
Institutions
Ayurvedic Teaching hospitals 05 Borella,Yakkala, Kaithady, Trincomalee,
Manchanthuduwa
Ayurvedic Research hospitals 03 Nawinna, Hambanthota, Ampara
Ayurvedic hospitals under 95 Throughout the country
Provincial councils
Ayurvedic Central Dispensaries 230 Throughout the country
under Provincial councils
Free Ayurvedic Dispensaries 374 Throughout the country
Medicinal plants gardens 07 Girathurukotte,Pallekelle,Halthumulla,
Pinnathuva,Pattipola,Kanneliya,Nawinna
Homeopathic hospital 01 Walisara
Homeopathic clinics 07 Palamunai,Parakaduwa,Kurunagala,
Tholangamuwa,Matale,Dehiwala,Moneragala
Source: Statistics division, Indigenous Medicine sector

Annual Health Bulletin - 2016 217

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 217

The service provision of Indigenous Medical the purview/guidance of the Indigenous
preventive and curative care is carried out by Medicine sector of The Ministry of Health,
the island wide network of 707 Ayurvedic Nutrition and Indigenous Medicine.
hospitals and dispensaries which come under

Table 21-2 : Resources in the Ayurvedic Hospitals and Dispensaries - 2016

Type of hospital/ No. of No of Medical Pharmacists Nurses Attendants
dispensary Institution beds officers
s
Ayurvedic Teaching 05 493 141 16 64 95
hospitals
Ayurvedic Research 03 231 126 03 31 19
hospitals
Ayurvedic hospitals 95 3423 619 28 136 363
under Provincial
councils
Ayurvedic Central 230 - 282 - - 29
Dispensaries under
Provincial councils
Free Ayurvedic 374 - 226 - - -
Dispensaries
Homeopathic hospital 01 20 03 - - 02
Total 708 4167 1397 47 231 508
Source: Statistics division, Indigenous Medicine sector

In Ayurvedic hospitals and dispensaries the

Indigenous medical out-patient (OPD) care is
carried out on daily basis and in addition to
that, in hospitals the in-patient (ward patient)
care also provided.

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218 Annual Health Bulletin 2016

 Table 21-3 : Daily Attendance of Patients at Out-patient and In-patient Departments in Hospitals
and Dispensaries - 2016

Type of hospital/ No of Total no of Total no of Total no Average Average no

dispensary days patients patients of no of of patients
hospital (OPD) patients patients per day
open * (IPD) per day (IPD)
(OPD)

Ayurvedic 306 350,472 346,242 4,230 1,132 14

Teaching hospitals

Ayurvedic 292 98,618 96,618 2,000 331 07

Research hospitals
Ayurvedic 302 2,334,387 2,298,026 36,361 7,609 121
hospitals under
Provincial councils
Ayurvedic Central 272 1,369,827 1,369,827 - 5,036 -
Dispensaries
under Provincial
councils

Homeopathic 244 28,933 28,821 112 118 -

hospital

Homeopathic 244 77,474 77,474 - 318 -

clinics

Total 1,660 4,259,711 4,217,008 42,703 14,544 142

Source: Statistics division, Indigenous Medicine sector
*Sundays and public holidays excluded

The necessary medicines are mainly

manufactured locally to cater the demand while
some additional medicines are imported.
Around 100 types of medicines are imported
with duty free concession.

Annual Health Bulletin - 2016 219

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 219

Table 21-4 : The Value of the Medicines Imported under Tax Concession

Year Amount (kg) Value of the imported medicines (Rs)

2013 1,495,721.5 583,476,174.00

2014 2,075,280.2 829,630,447.50

2015 2,220,408.4 891,811,144.50

2016 2,580,473.3 890,085,922.50

Source: Statistics division, Indigenous Medicine sector

Annual Health Bulletin - 2016 220

220 Annual Health Bulletin 2016

 22. Financial Services

Financial services under the ministry is Line ministry funding is also used to procure
performed under the responsibility of Chief drugs and consumables used in the service
Accountant under whom two Deputy Director delivery for all health institutions coming under
Generals are serving. line ministry as well as provincial health system.
Provincial administration funds are used to
operate health facilities under the provincial
22.1 Health Sector Finances administration. These institutions mainly
provide primary and secondary level medical
Overview care for the community. service delivery
component of the preventive health services is
Government of Sri Lanka provides funding for also financed through the provincial system.
the health system mainly from two avenues. In the ground level, provision of health services
First through Line Ministry of Health which simultaneous use provincial and central funds.
obtains funds from the treasury and secondly Furthermore, absence of a referral system or
through the provincial health systems which patient registration system makes tracing of
obtains funds from the Finance Commission fund flow difficult.
(FC). Additional to the main health system
Ayurveda Health Department, armed forces and
Line Ministry Expenditure
police run separate medical service delivery
systems using government funds which are not
Line Ministry expenditure (capital and
discussed in this report.
recurrent) for 2016 was LKR 134.78 billion
Funding provided for line ministry is used to
which is an increase of about LKR 4.6 billion
meet the capital and recurrent expenditure of
from the previous year. (refer figure 22.1 and
hospitals under the line ministry, vertical
Annexure 1)
programmes and campaigns, training facilities
Line ministry expenditure has shown a steady
and other health institutions under the purview
increase over the last five years. Only exception
of line ministry.
being capital expenditure for the current year is
less than that of 2015.

Annual Health Bulletin - 2016 221

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 221

 134.78
2016 111.75
23.03
130.24
2015 100.75
29.49
112.12
2014 90.49
21.63
92.99
2013 75.56
17.44
71.51
2012 57.86
13.65

0.00 20.00 40.00 60.00 80.00 100.00 120.00 140.00 160.00

Total Expenditure Recurrent Expenditure Capital Expenditure

Figure 22.1 : Line Ministry expenditure from 2012 to 2016 (in LKR billions)

Line Ministry Capital Expenditure

Line Ministry capital expenditure is used for

development activities as well as for
operational activities. The ministry had spent
LKR 23.027 billion as capital expenditure for the
year. Spending on development activities
accounted for LKR 17.46 billion while
operational activities utilized LKR 5.56 billion
during the year. (refer
(referfigure
figure 14.2)
22.2)
Even though a steady increase is observed
during the last five years, 2016 expenditure
represents a drop of LKR 6.46 billion (21.9%)
from last year expenditure of LKR 29.49 billion.

Annual Health Bulletin - 2016 222

222 Annual Health Bulletin 2016

 2016 23.03

2015 29.49

2014 21.63

2013 17.44

2012 13.65

0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00

Figure 22.2 : Line Ministry Capital expenditure from 2012 to 2016 (in LKR billions)

Annual Health Bulletin - 2016 223

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 223

Line Ministry Recurrent Expenditure Salaries and wages also continue to increase
steadily as observed in last five years. Increased
Recurrent expenditure of the Line Ministry has recruitment and salary increase granted to
shown a steady increase over the past five years public employees spread across next five years
and in 2016, LKR 111.75 billion was spent. (refer starting from 2016 would significantly escalate
figure 22.3)
figure 14.3) salaries and wages component of recurrent
expenditure over the next few years.
The main contributor was the Medicinal Drugs
purchased for the entire country accounting for
LKR 38.03 billion. Drug cost have steadily
increased over the past five years with only a
small dip in 2015. Upcoming policy changes and
increasing demand factors are expected to
further escalate drug cost in upcoming years.

19.30
2016 38.03
111.75

16.30
2015 31.70
100.75

15.28
2014 34.81
90.49

14.62
2013 27.27
75.56

14.30
2012 16.80
57.86

- 20.00 40.00 60.00 80.00 100.00 120.00

Salaries and Wages Drugs Recurrent Expenditure

Figure 22.3 : Line Ministry Recurrent Expenditure from 2012 to 2016 (in LKR billions)

Annual Health Bulletin - 2016 224

224 Annual Health Bulletin 2016

 Provincial expenditure on health

Provincial councils have different fund sources For the current year provinces had spent LKR
to meet their health expenditure. Main source 58.74 billion for health and out of which LKR
of funds is through the finance commission. 50.92 billion was recurrent expenditure
Capital expenditure of the provinces was accounting to about 86.7% of the expenditure.
boosted by the Second Health Sector Capital expenditure was LKR 7.82 billion for the
Development Project (SHSDP) and few other same period accounting to about 13.3%.
sources.

58.74
Total

50.92
Recurrent

7.82
Capital

- 10.00 20.00 30.00 40.00 50.00 60.00 70.00

2016 2015 2014

Figure 22.4 : Provincial Expenditure on Health (in LKR billion)

Annual Health Bulletin - 2016 225

Ministry of Health, Nutrition and Indigenous Medicine - Sri Lanka 225

Capital Expenditure of Provinces Provincial capital expenditure over last three
years show that Uva, Southern and North
Provincial Health Systems have many sources Central had spent consistently low investments.
for capital expenditure. For the current year, all It is also important to note that the concerned
provinces have spent LKR 7.8 billion. A steady provinces have very few line ministry
increase is reflected over the last three years. institutions thus capital infusion is low to the
population of the province.

932.51
Western

354.11
Uva

496.32
Southern

1,120.49
Sabaragamuwa

1,006.70
Northern

1,330.66
North Western

348.37
North Central

750.47
Eastern

1,484.00
Central

0 200 400 600 800 1000 1200 1400 1600

2016 2015 2014

Figure 22.5 : Capital Expenditure by the provinces from 2014 to 2016 [in LKR million]

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226 Annual Health Bulletin 2016

 Recurrent Expenditure of Provinces Provincial level disaggregation of the
expenditure shows that Western Province is the
Recurrent expenditure for the current year province with largest spending accounting to
made on health institutions by the provinces LKR 10.61 billion equivalent of 20.8% of the
was LKR 50.92 billion. Similar to other total recurrent expenditure of the provinces.
expenditure, recurrent expenditure of North Central Province had the minimum
provinces also had increased steadily over the Recurrent Expenditure of LKR 3.24 billion
past five years. It is important to note that drug equivalent of 6.4% of total recurrent
cost is not reflected in the provincial expenditure of the provinces.
expenditure.

5.17
Sabaragamuwa

4.32
Uva

3.24
North Central

5.98
North Western

4.33
Eastern

4.85
Nothern

6.13
Southern

6.30
Central

10.61
Western

- 2.00 4.00 6.00 8.00 10.00 12.00

2016 2015 2014 2013 2012

Figure 22.6 : Recurrent Expenditure by the provinces from 2012 to 2016 [in LKR billion]

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23. Human Resources for Health

and locating the right number of doctors with

23.1. Human Resource Unit the appropriate specialties for the right place at
the right time. In 2016 the HR unit conducted a
establishment study to project the clinical specialists’ cadre for
2016-2025 lead by the unit head Dr. Dileep De
The Human Resource Unit (HRU) was Silva.
established in 2016 with cabinet approval with
the main aim of properly coordinating the Outlined below are main outputs and
human resource activities of the Ministry of recommendations derived from the study. The
Health. The Ministry looks over more than figure1 23.1: shows the overall projection for
115000 healthcare workers employed in various the selected clinical categories. At end of
parts of the country needing careful planning December 2015 there were 1860 clinician
and coordination of related activities. Hence the consultants/medical specialists, working in the
decision to establish the HRU could be Ministry hospitals/institutions and provincial
considered a vital step in HR management. The hospitals. The average age of a clinician medical
Unit is headed by a specialist and to be consultant was 46.8 years. This gives a country
strengthened with staff and other resources in ratio of 1 medical specialist to 11,183
coming years. population with severe maldistribution
between districts.
One of the key initial steps undertaken by the
HRU is detailed in the next section. The study shows that the country will have
4067 consultants (clinician medical specialists
excluding consultants in Community Medicine
23.1.1. Clinical specialist cadre and Administration) by 2025 giving a country
ratio of 1 medical specialist to 5,114
projection population and with a much improved
distribution compared to 2015.
Sri Lanka provides free medical education at
Undergraduate and postgraduate levels and
estimated to spend nearly Rs10 million to
produce a medical specialist at the tax payers’
expense. Furthermore, due to the very long
duration of specialist training, the training
outcomes and other decisions taken regarding
the training will takes long time to materialize.
Hence it is important to optimize the Health
human resource utilization in general and that
of Medical specialists in particular in the Sri
Lankan context, given the amount of resources
injected for it.

Therefore, the HR unit commenced the task of

planning health human resources by identifying

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 2016 2025

121%

134%

97%
112%
118%

Medical group Surgical group Paediatric group Dental group Other clinical group
Medical group Surgical group Paediatric group Dental group Other clinical group
2016 436 343 205 57 819
2025 1021 677 434 124 1811

Figure 23.1 : Clinical specialists cadre projection for 2016-25

Source: Human Resource Unit, Ministry of Health, Nutrition & Indigenous Medicine

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Medical group of consultants selected for different specialities on completion
of MD(Part II) examination. Even if reduced to
The number of trainees enrolled for pre MD 68, the number of specialists in Medicine
programme should be reduced to 68 per Specialties will grow by 134 % during 2016 to
year while ensuring that the correct number is 2025 period.

Figure 23.2 : Current training and proposed training rates for medical specialists
CTR- Current training rate PTR-Proposed training rate

Source: Human Resource Unit, Ministry of Health, Nutrition & Indigenous Medicine

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 Surgical group of consultants selected for different specialities on completion
of MD (Part II) examination. If increased up to
The number of trainees enrolled for pre MD 71, the number of specialists in surgical
programmes should be increased to 71 per year specialities will grow by 97 % during 2016 to
while ensuring that the correct number is 2025 period.

Figure 23.3 : Current training and proposed training rates for surgical specialists
CTR- Current training rate PTR-Proposed training rate

Source: Human Resource Unit, Ministry of Health, Nutrition & Indigenous Medicine

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Paediatric clinical group of consultants selected for different Sub-specialities on
completion of MD (Part II) examination. Even if
The number of trainees enrolled for pre MD reduced to 39, the number of specialists in
programme should be reduced to 39 per year Paediatric specialities will grow by 112% during
while ensuring that the correct number is 2016 to 2025 period.

Figure 23.4 : Current training and proposed training rates for paediatrics specialists
CTR- Current training rate PTR-Proposed training rate

Source: Human Resource Unit, Ministry of Health, Nutrition & Indigenous Medicine

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 Other clinical groups of consultants Histopathology and Virology specialities should
increase their intake while all other specialities
The number of trainees to be trained should be to reduce the number of intake by 2025.
increased or decreased as per the projections.
i.e. Obstetrics & Gyanecology, Mycology,
Ophthalmology, Forensic medicine,

Figure 23.5 : Current training and proposed training rates for other specialists
CTR- Current training rate PTR-Proposed training rate

Source: Human Resource Unit, Ministry of Health, Nutrition & Indigenous Medicine

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Dental specialists

The number of dental specialists should be

reduced for all the three sub-specialities i.e.
restorative dentistry -3, Orthodontics – 3 and
OMF – 4 respectively. Even with this reduction,
there will be 118% increase from 206
2016toto2025.
2025.

Figure 23.6 : Current training and proposed training rates for dental specialists
CTR- Current training rate PTR-Proposed training rate

Source: Human Resource Unit, Ministry of Health, Nutrition & Indigenous Medicine

The number of clinical specialist will increase by Intake to these two specialties has to be
119% between 2016 and 2025. However special increased by a substantial rate, with immediate
attention is needed in the specialties of Neuro- effect.
Surgery and Cardiothoracic Surgery. Also it is important to do a comprehensive
cadre planning for other categories of
specialists in coming years.

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  MD and Board Certification in Geriatric
23.2 Training for health workforce Medicine
 MD and Board Certification in Sports and
Education, Training and Research Unit of the Exercise Medicine
Ministry of Health which functions under purview of  MD and Board Certification in Clinical
Deputy Director General (ET&R) and has three
Nutrition
directorates i.e. Directorate of Training, Nursing
(Education) and Research. The ET&R unit is the focal  Board certification as a Specialist in Old Age
point in policy formulation, providing technical Psychiatry
guidance related to training and also coordinating  Board certification in Addictions Psychiatry
basic training programmes for all staff categories
except for basic degree programmes for Medical Following Curricula/Prospectuses of existing
Officers and Dental Surgeons. Furthermore, the Unit programmes were revised during 2016:
is responsible for capacity building of the health
workforce through post basic and in-service training  Master in Medical Toxicology and
programmes. The unit also coordinates with Postgraduate Diploma in Medical Toxicology
international training institutions to conduct training
 MD and Board Certification in Medical
programmes for the benefit of health workforce.
Parasitology
 Postgraduate Certificate in Medical
Education
23.2.1 Postgraduate Institute of Medicine  MD and Board Certification in
The PGIM was established by the PGIM ordinance Otorhinolaryngology
No.01 in 1980 and was affiliated to the University of  MD and Board Certification in
Colombo. This institute is providing instructions Histopathology
training and research in range of specialties and sub  Postgraduate Diploma in Sports Medicine
specialties in Medicine. The PGIM is training both
 MD and Board Certification in Orthopaedic
medical and dental graduates for the award of the
Surgery
degrees of Doctor of Medicine, Master of Science,
PG Diplomas and certificates. The PGIM works in  MD and Board Certification in Obstetrics &
close collaboration with the Ministry of Higher Gynaecology
Education, Ministry of Health, Faculties of Medicine  Board Certification in Neuroradiology
of Universities and Professional Colleges.  Board Certification in Interventional
Radiology
The PGIM has been contributing immensely during
the past thirty years towards the development of  MD and Board Certification in Chemical
specialist doctors needed by the country. Pathology
 MD in Forensic Medicine & Board
1) 1 PGIM conducted 136 examinations including Certification in Forensic Medicine with
selection/Certificates/PG Diploma/ MSc/ MD special interest in Clinical Forensic
examinations in addition to the in-course Medicine, Forensic Toxicology, Forensic
assessments. Paediatric and Perinatal Pathology, Forensic
2) Action was taken to prepare the prospectus for Histopathology, Forensic Anthropology
the following new training programmes in order  MD and Board Certification in Orthodontics
to implement during the year 2017.  Graduate output during the year 2016

3) PG
PG Certificate
Certificate - 75

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4) PG Diplomas - 282
5) MSc - 97
6) MD - 342 - 342
7) Board Certification- 194

 New entrants for year 2016

 PG Certificate - 12
 In-service - 54
 PG Diplomas - 389
 MSc - 129
 MD - 613

 Workshops for trainers/ Examiners - 08

 Workshops for trainees - 02

 Research/Theses/ Dissertations done by PG

trainees in year 2016 - 496

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Annexure I
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Table 37. Utilization of Medical Institutions by Regional Director of Health Services
Division, 2016
Provincial General
TeachingHospitals District General Hospitals Base Hospitals Type A Base Hospitals Type B
Hospitals

Bed Turn Over Rate

Bed Turn Over Rate

Bed Turn Over Rate

Bed Turn Over Rate

Bed Turn Over Rate

Bed Occuancy Rate

Bed Occuancy Rate

Bed Occuancy Rate

Bed Occuancy Rate

Bed Occuancy Rate

Aerage Duration of

Aerage Duration of

Aerage Duration of

Aerage Duration of

Aerage Duration of
RDHS Division

Stay

Stay

Stay

Stay

Stay
Colombo 3.32 71.56 78.04 2.09 79.04 137.15 2.63 66.99 92.31
Gampaha 3.16 85.27 97.88 1.90 70.39 134.31 2.03 71.53 127.63 1.78 61.11 124.72
Kalutara 2.29 70.34 111.69 1.89 76.94 148.19 1.75 45.50 94.71
Kandy 3.10 75.64 88.46 2.30 60.98 96.15 2.17 70.62 118.44
Matale 2.28 63.08 100.72 1.82 102.25 203.58
Nuwara Eliya 2.49 89.90 130.86 2.11 100.53 172.94 1.79 74.45 151.39
Galle 3.23 80.96 90.76 2.06 63.50 111.74 1.94 47.32 88.81
Matara 2.26 67.82 109.20 2.23 57.05 93.05
Hambantota 2.47 69.09 101.46 2.24 99.51 161.07 1.79 46.73 94.73
Jaffna 2.78 80.76 105.59 2.52 50.99 73.53 2.22 32.23 52.79
Kilinochchi 2.06 92.73 163.52 1.49 35.79 87.25
Mullaitivu 1.93 41.56 78.06 1.51 26.62 64.37
Mannar 1.18 21.71 67.00
Vavuniya 2.31 64.51 101.52 2.40 35.27 53.54
Batticaloa 3.88 84.67 78.73 1.47 36.85 91.26 1.41 34.43 88.87
Ampara 2.41 61.74 92.99 1.82 57.41 114.46
Trincomalee 1.55 58.85 137.96 1.64 40.13 88.80 1.63 66.55 148.27
Kalmunai 2.32 60.48 94.74 2.42 56.10 83.89
Kurunegala 2.92 82.28 102.20 2.02 52.34 94.39 2.45 73.93 109.21
Puttalam 2.30 60.69 95.43 2.14 88.53 150.54 2.11 77.28 133.31
Anuradhapura 2.85 59.62 75.76 1.94 74.94 140.08
Polonnaruwa 2.43 75.36 112.79 1.89 60.03 115.74
Badulla 3.60 71.82 72.10 2.22 72.41 118.60 1.89 76.43 147.02
Monaragala 2.20 84.98 140.17 2.24 60.64 98.34
Ratnapura 2.71 73.43 98.29 2.24 87.17 141.08 2.06 72.71 127.92
Kegalle 2.34 65.51 101.59 2.38 81.55 124.61
Grand Total 3.19 74.50 84.51 3.03 76.44 91.30 2.22 68.34 111.61 2.06 68.98 121.43 2.09 64.09 111.46
Continued…
Source : Medical Statistics Unit

Table 37. Utilization of Medical Institutions by Regional Director of Health Services

Division, 2016
Hospitals with Indoor
Divisional Hospitals Type A Divisional Hospitals Type B Divisional Hospitals Type C Other Hospitals
Facility
Bed Turn Over Rate

Bed Turn Over Rate

Bed Turn Over Rate

Bed Turn Over Rate

Bed Turn Over Rate

Bed Occuancy Rate

Bed Occuancy Rate

Bed Occuancy Rate

Bed Occuancy Rate

Bed Occuancy Rate

Aerage Duration of

Aerage Duration of

Aerage Duration of

Aerage Duration of

Aerage Duration of
RDHS Division
Stay

Stay

Stay

Stay

Stay

Colombo 1.43 32.66 82.75 1.38 38.57 101.53 1.36 53.51 143.11 8.48 78.29 32.94 3.61 72.60 72.79
Gampaha 2.30 46.97 74.06 1.19 53.26 162.55 1.33 63.66 174.06 8.83 65.65 26.68 2.64 69.97 96.18
Kalutara 1.60 32.92 75.09 1.34 32.05 86.85 1.64 39.77 88.18 1.91 60.47 115.21
Kandy 1.72 32.72 69.14 1.59 34.09 78.32 7.14 43.29 21.68 2.63 61.50 84.97
Matale 1.42 28.08 72.20 1.97 36.76 67.95 2.00 59.21 107.61
Nuwara Eliya 1.73 18.68 39.26 1.76 31.62 65.23 1.40 30.24 78.40 2.00 51.95 94.20
Galle 1.67 26.11 57.04 1.79 35.78 72.59 1.42 34.41 88.03 3.33 60.18 63.67 2.61 65.27 90.55
Matara 1.89 38.10 73.29 1.59 34.05 78.04 1.27 27.49 78.83 2.08 54.82 95.77
Hambantota 1.44 31.82 80.64 1.25 25.87 75.57 1.97 53.52 98.72
Jaffna 1.39 23.68 62.19 1.79 15.20 30.98 2.52 55.51 79.88
Kilinochchi 1.82 20.51 41.00 1.48 30.45 75.08 1.92 60.66 114.53
Mullaitivu 1.48 29.84 73.20 1.32 32.22 88.55 1.10 19.60 64.59 1.67 33.87 73.84
Mannar 1.13 5.72 18.40 1.17 5.01 15.63 1.17 11.77 36.64
Vavuniya 1.00 16.98 61.97 1.02 22.44 80.60 2.20 56.22 92.68
Batticaloa 1.23 20.63 61.24 1.54 25.88 61.18 1.54 25.88 61.18 2.62 55.54 76.85
Ampara 1.36 20.66 55.40 1.41 24.92 64.20 2.09 52.62 91.37
Trincomalee 1.56 29.85 69.55 1.62 46.17 104.01
Kalmunai 2.12 33.61 57.52 1.84 32.61 64.43 2.26 51.07 82.03
Kurunegala 1.38 28.79 75.85 1.50 26.93 65.23 1.43 27.76 70.88 2.24 55.21 89.46
Puttalam 1.87 31.45 61.18 1.36 18.12 48.40 1.36 18.12 48.40 2.08 56.67 99.17
Anuradhapura 1.82 42.09 84.08 1.72 35.60 75.52 1.70 32.91 70.61 6.27 30.61 17.65 2.28 51.17 81.37
Polonnaruwa 1.15 24.10 76.08 1.37 31.95 84.81 1.80 47.01 94.89 2.11 61.14 105.13
Badulla 1.52 36.59 87.57 1.55 25.58 60.12 1.52 34.51 82.65 2.49 58.20 84.60
Monaragala 1.67 32.48 70.69 1.46 27.33 67.93 1.15 50.22 159.01 1.89 56.85 109.14
Ratnapura 1.67 32.32 70.59 1.36 24.63 65.96 1.33 27.46 75.47 2.18 59.22 98.74
Kegalle 1.57 39.21 90.79 1.38 40.40 107.00 1.56 40.46 94.10 47.37 126.33 8.53 2.21 64.18 105.34
Sri Lanka 1.66 33.62 73.80 1.55 29.69 69.80 1.53 32.39 77.00 8.57 73.89 30.79 2.48 60.48 88.54
Source : Medical Statistics Unit

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Annexure II
 Table 01: Distribution of Notified Cases of Selected Notifiable Diseases by RDHS Division-2016

Food poisoning

Human Rabies

Viral Hepatitis
Enchephalitis

Typhus Fever
Leptospirosis
Enteric Fever
Dysentery
Dengue
RDHS Division

Colombo 16767 183 13 68 70 0 292 10 49

Gampaha 7173 164 18 32 98 0 338 20 54
Kalutara 3502 131 10 36 41 5 440 11 33
Kandy 4063 162 18 24 40 0 118 103 50
Matale 1148 65 1 19 5 1 92 20 26
Nuwara-Eliya 421 115 3 60 36 0 70 97 39
Galle 3086 148 8 9 13 0 377 121 10
Hambantota 900 95 2 7 61 0 106 67 106
Matara 1384 117 17 8 41 0 209 61 41
Jaffna 2468 413 13 91 128 2 24 689 10
Kilinochchi 86 56 2 36 76 0 17 26 2
Mannar 232 48 4 24 12 0 11 43 0
Vavuniya 268 18 5 103 46 0 19 12 7
Mullativu 182 31 6 20 41 1 29 6 2
Batticaloa 612 345 5 55 103 1 56 6 14
Ampara 260 52 3 1 21 0 26 0 12
Trincomalee 503 59 2 13 29 1 41 28 46
Kuruneagala 2556 347 13 5 22 4 173 51 36
Puttalam 1046 110 6 8 3 3 53 62 3
Anuradhapura 731 146 4 12 61 1 278 30 41
Polonnaruwa 479 53 4 12 15 0 91 4 5
Badulla 1185 167 15 14 32 1 135 118 131
Monaragala 475 142 1 5 11 1 175 128 151
Rathnapura 3130 374 36 32 25 0 638 43 219
Kegalle 1513 89 22 34 65 0 188 43 34
Kalmunai 980 122 7 5 65 0 22 0 7

Sri Lanka 55150 3752 238 733 1160 21 4018 1799 1128

Source: H399 Notified; Epidemiology unit

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 Table 02: Age distribution of clinically confirmed selected notifiable diseases -2016

Human Rabies

Viral Hepatitis
Leptospirosis
Enteric Fever
Encephalitis

Chickenpox

Meningitis
Whooping
Dysentery

*Measles

*Rubella
Tetanus

Mumps
Dengue
Cough
AGE

Under
437 9 3 0 2 17 0 2 25 355 17 75 19 430
1
1-4 1010 21 64 0 7 2 0 17 6 3095 2 271 31 197
5-14 729 40 139 4 82 1 0 108 9 11055 1 657 51 198
15-24 156 17 79 3 386 22 0 235 1 13801 22 1034 54 41
25-49 203 27 126 6 1326 32 2 410 0 20375 32 1850 117 88
50-59 77 8 45 3 488 1 0 39 1 4567 1 226 13 13
60
and 106 41 41 5 347 0 0 22 0 1901 0 130 1 26
above
Total 2718 163 497 21 2638 75 2 833 42 55150 75 4243 286 993
Source: H 411a Clinically confirmed cases; Epidemiology unit
*Lab confirmed cases

Table 03: Distribution of notified cases of selected notifiable diseases by Month, 2016 Viral Hepatitis
Human rabies

Leptospirosis
Enteric Fever
Encephalitis

Meningitis
Chikenpox
Whooping
Dysentery

* Measles

*Dengue

*Rubella
Tetanus

Months

Mumps
cough

January 303 36 104 1 638 73 142 13 669 73 482 38 131

February 192 16 61 6 294 38 1 88 5 443 38 481 43 115
March 180 18 63 0 386 57 1 120 4 269 57 479 31 120
April 267 12 42 2 379 39 1 77 5 283 39 472 44 114
May 298 15 39 0 281 14 2 76 5 242 14 400 36 104
June 421 27 69 434 21 1 61 0 473 21 362 29 94
July 496 30 96 1 320 23 1 77 7 107 23 404 31 125
August 265 22 73 2 200 16 1 97 10 487 16 441 28 103
September 379 14 58 5 303 11 0 142 7 362 11 473 26 130
October 264 13 41 2 236 14 1 100 5 218 14 406 35 98
November 284 14 29 5 243 19 1 82 6 225 19 363 31 124
December 403 21 58 3 304 16 1 66 3 767 16 429 35 230
Total 551
375 238 733 27 401 341 11 112 70 341 519 407 148
Source: H399 Notified; Epidemiology unit
* All notified cases were not confirmed measles or rubella

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 Table 04: Cases Incidence, Deaths and Case Fatality Rate (CFR) of Dengue Fever(DF)/Dengue
Haemorrhagic Fever(DHF), Leptospirosis and Encephalitis 1996-2016

Annual282
Health Bulletin - 2016

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283

283
* Incidence Rate (per 100,000 population)
CFR: Case Fatality Rate/ ND= No data
Population for year 2016=21,203,000 (Source= Registrar General’s Department, Sri Lanka) Source: Notified cases
from H399; Epidemiology unit
 Table 05:Cases and Deaths of Dengue Fever/Dengue Haemorrhagic Fever and Leptospirosis by Age
Group, 2016
*Dengue Leptospirosis
Cases
Deaths Cases Deaths
Age Group

No % No % No % No %

Under 1 355 0.64% 2 2% 2 0.07 -

1-4
3095 5.61% 1 1% 7 0.26 -
5 - 14 11055 20.05% 10 10% 82 3.1 -
15 - 24 13801 25.02% 13 13% 386 14.6 4 6.5%
25 - 49 20375 36.95% 42 43% 1326 50.2 28 45.2%
50 - 59 4567 8.28% 18 19% 488 18.5 14 22.5%
60 and above 1901 3.45% 11 11% 347 13.1 16 25.8%
Total 100.0 62 100%
55150 100.00% 97 100% 2638
Source: H399; Epidemiology Unit
Population for year 2016=21,203,000 (Source= Registrar General’s Department, Sri Lanka)

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Table 6: Incidence of Extended Programme of Immunization (EPI) Target Diseases, 1955-2016
1955 - 2015Diptheria Tetanus Whooping
Measles Poliomyelitis Tetanus Tuberculosis
Year Neonatarum Cough
Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate Cases Rate
1955 1179 13.5 3499 40.1 155 1.8 873 10 ND - ND - 1941 22.2
1960 1042 10.5 3060 30.9 303 3.1 1435 14.5 ND - 10519 106.3 1786 18
1965 1232 11.0 2037 18.2 494 4.4 1812 16.2 ND - 6927 62 2109 18.9
1970 986 7.9 4086 32.6 405 3.2 1441 11.5 847 230.2 5762 46 1651 13.2
1975 310 1.3 5000 37.0 396 2.9 1186 8.8 812 216 7324 54.3 1341 9.9
1980 37 0.3 5032 34.1 262 1.8 892 6.0 351 83.9 6212 42.2 542 3.7
1985 10 0.1 9398 59.3 40 0.3 405 2.6 76 19.5 5889 37.2 536 3.4
1986 3.0 0.01 6235 38.7 34 0.2 453 2.8 49 13.6 6596 40.9 161 1.0
1987 0 0 3508 21.4 149 0.9 258 1.6 37 10.3 6411 39.2 31 0.2
1988 0 0 2650 16.0 25 0.2 273 1.6 39 12.8 6092 36.7 25 0.2
1989 0 0 780 4.6 16 0.1 295 1.8 19 5.3 6429 38.2 61 0.4
1990 0 0 4004 27.6 9.0 0.1 183 1.1 5 4.7 6666 39.2 271 1.9
1991 1 0.005 1896 12.8 1.0 0.005 188 1.3 10 4.7 6174 35.7 25 0.2
1992 0 0 701 4.0 12 0.1 231 1.3 14 2.6 6802 39.0 6 0.03
1993 1 0.005 558 3.2 15 0.1 196 1.1 11 3.7 6885 39.0 18 0.1
1994 0 0 390 2.2 0 0 156 1.1 11 2.0 6121 34.3 34 0.3
1995 0 0 465 2.6 0 0 167 1.0 2 3.0 5869 31.5 171 1.0
1996 1 0.005 158 0.9 0 0 97 0.7 6 4.8 5366 29.3 33 0.2
1997 0 0 66 0.4 0 0 23 0.5 4 3.5 6547 35.6 205 1.8
1998 0 0 23 0.1 0 0 24 0.1 4 4.5 6925 36.9 94 0.5
1999 0 0 2341 12.5 0 0 23 0.1 3 4.0 7157 37.6 61 0.3
2000 0 0 4096 21.2 0 0 38 0.2 1 0.3 8129 42.9 88 0.5
2001 0 0 309 1.7 0 0 75 0.4 3 0.9 8418 45 52 0.3
2002 0 0 139 0.7 0 0 34 0.2 2 0.6 8884 46.9 16 0.1
2003 0 0 65 0.4 0 0 30 0.2 2 0.6 9312 48.4 118 0.6
2004 0 0 35 0.4 0 0 32 0.2 1 0.6 8639 48.4 51 0.2
2005 0 0 24 0.4 0 0 25 0.1 1 0.6 9448 48.4 80 0.4
2006 0 0 21 0.1 0 0 38 0.2 2 0.01 10016 48.1 48 0.2
2007 0 0 37 1.2 0 0 16 0.1 0 0 9817 47.9 21 0.1
2008 0 0 2 0.01 0 0 22 0.1 1 0.005 8181 39.5 16 0.1
2009 0 0 129 0.1 0 0 26 0.1 0 0 10306 49.8 48 0.2
2010 0 0 49 0.2 0 0 15 0.1 0 0 10235 48.9 15 0.1
2011 0 0 129 0.6 0 0 26 0.1 0 0 9454 44.1 55 0.3
2012 0 0 51 0.3 0 0 8 0.03 0 0 8720 43 61 0.3
2013 0 0 2725 13.3 0 0 19 0.1 0 0 5488 26.8 67 0.3
2014 0 0 3100 15.0 0 0 14 0.1 0 0 6710 32.5 81 0.4
2015 0 0 2432 12.0 0 0 16 0.08 0 0 7402 35.3 107 0.5
2016 0 0 341 1.0 0 0 11 0.05 0 0 7486 35.3 70 0.3
Source: H399 Notified; Epidemiology Unit
Population for year 2016=21,203,000 (Source= Registrar General’s Department, Sri Lanka)

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Table 7: Immunization Coverage by (RDHS) area, 2016
Province RDHS BCG PVV3 OPV3 IPV1 MMR1 MMR2
PVV1
Western
Province Colombo 96 99 97 97 97 96 97
Gampaha 98 94 96 96 96 97 95
Kalutara 99 95 97 97 97 99 99
Central Kandy 96 102 96 96 96 104 106
Matale 102 99 97 97 98 98 99
Nuwara Eliya 99 92 94 94 94 105 103
Southern Galle 96 98 98 98 98 99 97
Hambantota 100 101 97 97 97 99 100
Matara 96 102 99 99 100 103 102
Nothern Jaffna 102 92 91 91 91 93 102
Kilinochchi 103 99 97 97 99 96 97
Mannar 103 97 98 98 98 101 104
Vavuniya 93 96 95 95 95 96 105
Mullaithivu 80 98 98 98 99 92 123
Eastern Batticaola 101 95 93 93 93 95 99
Ampara 100 92 91 91 91 92 91
Kalmunai 100 102 97 97 98 99 95
Trincomalee 95 96 96 96 95 97 91
Noth Western Kurunegala 101 99 98 98 99 99 102
Puttalam 94 95 96 96 95 97 99
North Central Anuradhapura 98 96 97 97 97 99 101
Polonnaruwa 104 100 95 95 94 101 98
Uva Badulla 98 104 103 103 102 105 103
Moneragala 89 102 105 105 105 107 105
Sabaragamuwa Ratnapura 96 97 97 97 97 98 98
Kegalle 98 96 96 96 96 98 99
*Estimated population considered is the population predictions for the year based on 2012 census data.
Note - Some districts reported more than 100% coverage for some vaccines. This is because in Sri Lanka
children can receive their due vaccine at any clinic conducted by National Immunization Programme, other than
from a clinic of their respective place of residency. Therefore, the numerator (no. of children vaccinated for a given
vaccine) can exceed the denominator (estimated no of children in the respective district).
PVV= Pentavalant Vaccine, MMR=Measles, Mumps, and Rubella Vaccine, OPV= Oral Polio Vaccine, IPV= Inactive
Polio Vaccine
Source: Epidemiology Unit

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 Table 8: Number of Selected Adverse Events by Vaccination in 2016
Total **
number
BCG OPV PVV* DPT MMR LJE DT TT aTd of AEFI
reporte
d
Total Number of AEFI Reported 32 77 5161 3655 921 405 305 82 95 10733

AEFI reporting rate/100,000 doses

administered 10.0 4.6 535.3 1106.6 131.3 121.6 87.7 15.3 29.8
o
No of High Fever (>39 C) cases reported 2 32 2048 1454 146 103 57 2 12 3856
Rate of reporting High Fever /100,000
doses administered 0.6 1.9 212.4 440.2 20.8 30.9 16.4 0.4 3.8
No of Allergic reactions reported 5 16 485 508 519 204 97 34 20 1888
Rate of Reporting allergic reactions
/100,000 doses administered 1.6 1.0 50.3 153.8 74.0 61.2 27.9 6.3 6.3
No of Severe local reactions reported 1 170 193 28 8 12 4 4 420
Rate of severe local reactions /100,000
doses administered 0.1 17.6 58.4 4.0 2.4 3.5 0.7 1.3
No of Seizure (Febrile/Afebrile) reported
3 108 227 16 20 3 372
Rate of seizures /100,000 doses
administered 0.2 11.2 68.7 2.3 6.0 0.9
No of Nodules reported 5 9 1249 456 20 5 25 3 8 1780
Rate of nodules /100,000 doses
administered 1.6 0.5 129.6 138.1 2.9 1.5 7.2 0.6 2.5

No of Injection site abscess reported 10 3 388 75 9 1 9 1 1 497

Rate of injection site abscess/100,000
doses administered 3.1 0.2 40.2 22.7 1.3 0.3 2.6 0.2 0.3
No of Hypotonic Hypotensive Episodes
reported 6 1 7
Rate of Hypotonic Hypotensive episodes
/100,000 doses administered 06 0.3

*PVV- Pentavalent vaccine **Total given only for nine vaccines listed in the table

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 Table 9: Sentinel Site Surveillance of Influenza like Illness (ILI) and Severe Acute Respiratory Illness
(SARI), 2016

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 Table 10: Reported Cases and Case Fatality Ratios (CFR)
Source: NDCU
Year Dengue Cases Reported Dengue Deaths Case Fatality Rate
2010 34,105 246 0.72
2011 28,473 186 0.65
2012 44,461 181 0.41
2013 32,063 89 0.27
2014 47,502 97 0.20
2015 29,777 60 0.20
2016 54,945 98 0.18

Table 11: High Dependency Units of Health Institutions provided with equipment in 2016
Type of Hospital No. of HDUs facilitated in 2016
Teaching Hospitals (with NHSL) 08
Provincial General Hospitals 03
District General Hospitals 12
‘A’ Grade Base Hospitals 14
‘B’ Grade Base Hospitals 17
Total 54
Source: NDCU

Table 12: Distribution of High dependency unit equipment: Hospital type wise
Multipara Monitors

Micro haematocrit

Weighing Scales -

Weighing Scales -

Weighing Scales -
Infusion Pumps

Blood Pressure
Type of Hospital
Centrifuges

Paediatrics

apparatus
HDU Beds

Infant
Adult

Teaching Hospitals (with

NHSL) 35 40 49 13 32 11 8 15
Provincial General 5 10 10 4 12 - - -
Hospitals
District General Hospitals 29 29 29 16 28 2 - 9
‘A’ Grade Base Hospitals 54 31 31 22 36 2 - 18
‘B’ Grade Base Hospitals 25 21 27 30 31 5 1 17
Total 148 131 146 85 139 20 9 59
Source: NDCU

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Table 13: Distribution of High dependency unit equipment: Province wise

Weighing Scales -Adult

Multipara Monitors

Microhaematocrit

Weighing Scales -

Weighing Scales -
Infusion Pumps

Blood Pressure
Centrifuges

Paediatrics

apparatus
HDU Beds

Infant
Province

Western 68 53 56 23 54 4 4 17
Southern 23 14 14 9 18 6 17
Central 10 20 28 11 12 6 4 11
Northern 8 5 5 1 6 1 - 10
Eastern 2 9 9 9 12 1 - -
North Western 14 12 14 11 13 1 1 -
North Central - 2 2 3 4 - - 4
Uva 8 8 10 14 4 - - -
Sabaragamuwa 15 8 8 4 16 1 - -
Total 148 131 146 85 139 20 9 59
Source: NDCU

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 Table 14: Summary of emergency Dengue control programs in 2014

Legal Actions
to be taken
with larvae
premises

premises
visited

Notice
No. of

No. of

%
Program Dates

Phase I 07th-09th Jan 72,454 1,234 1.70 3,163 573

Phase II 28th-30th Jan 59,515 746 1.25 2,120 303

Phase III 11th-13th Feb 68,922 911 1.32 2,958 477

Phase IV 11th-12th March 45,511 719 1.58 1,755 259

Phase V 04th May 12,932 222 1.72 495 147

Phase VI 02nd-04th June 12,994 227 1.75 520 97

Phase VII 16th-18th June 12,170 178 1.46 362 125

Phase VIII 30th June & 1-2nd July 55,420 875 1.58 2,565 429

Phase IX 13th-15th July 65,095 1,160 1.78 2,883 613

Phase X 29th-30th July & 1st Aug 69,994 1,403 2.00 3,238 859

Phase XI 11th-13th Aug 72,173 661 0.92 2,389 338

Phase XII 26th,27th & 29th Aug 65,088 634 0.97 2,385 283

Phase XIII 27th & 28th Oct 29,515 489 1.66 1,337 273

Phase XIV 10th & 11th Nov 11,495 492 4.28 843 292

Phase XV 02nd & 03rd Dec 34,510 818 2.37 1,360 323

Phase XVI 07th -09th Dec 60,497 639 1.06 1,889 402

Phase XVII 27-28 Dec 49,189 722 1.47 1,934 403

Sub Total WP Special Programs 797,474 12,130 1.52 32,196 6,196

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 –

premises with

Legal Actions
to be taken
premises
visited

Notice
larvae
No. of

No. of
Program Dates

%
Phase I Galle,Matara,
Hambantota,
Kandy,Jaffna,Vavuniya,
Mannar, Batticaloa,
Kalmuane,Puttlum,
Kegalle 99,611 2,997 3.01 3,642 621
Phase III Jaffna,Vavuniya,Batticaloa,
Kalmuane,Puttlum,
Kurunegala,Kegalle 36,366 830 2.28 1,653 187
Phase IV Kurunegala, Matara ,
Kalmunai 5,771 89 1.54 306 15
Phase VII
Kandy,Galle,Puttlam,
Rathnapura, Kurunegala 27,662 1,225 4.43 1,354 247
Phase VIII
Kandy,Matale 11,364 338 2.97 408 177
Phase IX
Kandy,Matale,Galle,
Matara , Kurunegala 31,536 1,276 4.05 1,408 879
Phase XVI Galle,Rathnapura,Badulla,
Kalmunai 17,231 501 2.91 993 214

Phase XVII Galle, Kalmunai 7,062 140 1.98 1,037 87

Sub Total Other Provinces 236,603 7,396 3.13 10,801 2,427
NMCW1 -
2016 29th March to 4th April 631,416 11,621 1.84 25,627 2,104
NMCW2 -
2016 27 Sept. to 03rd Oct 632,510 9,140 1.45 28,968 2,213

Total 2,298,003 40,287 1.75 97,592 12,940

National mosquito control week

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 Table 15: Distribution of TB cases by district

Source: NPTCCD

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 Table 16: Distribution of treatment outcome of all forms of TB by districts in 2015

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Source: NPTCCD

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 Table 17: Functioning miturupiyasa centres
1) Army Hospital- Narahenpita 24) Kegalle- Teching Hospital
2) Ashraff Memorial Hospital- Kalmunai 25) Kethumathie Maternity Hospital
3) Avissawella- Base Hospital 26) Kilinochchi- Base Hospital
4) Akkareipattu- Base Hospital 27) Kiribathgoda- Base Hospital
5) Badulla- Provincial General Hospital 28) Mahamodara- Teaching Hospital
6) Balangoda- Base Hospital 29) Marawila- Base Hospital
7) Bandarawela- Divisional Hospital 30) Matara- General Hospital
8) Batticaloa- Teaching hospital 31) Meerigama- Base Hospital
9) Castle Street Hospital for Women 32) Nawalapiiya- District General Hospital
10) De. Soysa Hospital for Women 33) Nuwara Eliya- General Hospital
11) Dickoya- District General Hospital 34) Peradeniya- Teaching Hospital
12) Diyathalawa- Base Hospital 35) Pimbura- Base Hospital
13) Elpitiya- Base Hospital 36) Ragama- Teaching Hospital
14) Embilipitiya- Base Hospital 37) Rathnapura- Provincial General Hospital
15) Family Health Bureau 38) Rikillagaskada- Base Hospital
16) Base Hospital- Gampola 39) Thalangama- Divisional Hospital
17) Hambanthota- General Hospital 40) Thambuththegama- Base Hospital
18) Horana- Base Hospital 41) Tissamaharama- Base Hospital
19) Jayawardanepura- General Hospital 42) Trincomalee- General Hospital
20) Kalmunai (North)- Base Hospital 43) Valachchenai- Base Hospital
21) Kalubowila- Teaching Hospital 44) Vavuniya- District General Hospital
22) Kaluthara- General Hospital 45) Welimada- Base Hospital
23) Kandy- Teaching Hospital

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Table 18: Details of number of people attended in 2016
Year Number of Total Total Total Total Total number
functioning number of number of number of number of of
Mithuru new subsequent consultation consultation consultations
Piyasa survivors consultation held with the held with the
centres seeking held with the family perpetrators
care over survivors members of
the year survivors
2011 06 447 230 232 101 1010
2012 08 870 355 432 249 1906
2013 16 1722 726 827 471 3746
2014 20 2949 1360 1309 717 6335
2015 31 4670 2683 2135 1261 10749
2016 45 7577 4131 3077 2243 17028

Table 19: Details of local trainings facilitated by DDG (MS)II division

2014 2015 2016

Repeat Proper Repeat Proper Repeat Proper
batch batch batch batch batch batch
Pre-intern
Training in A&E 355 1100 332 1215 320 1194
scenarios

AIIMS Training of Total of 40 Medical Officer attached to A&E units are trained in SONOGRAPHY
MO in A&E units conducted by foreign trainers.

Source: DDG (MS)II division

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Table 20: Details of foreign trainings facilitated by DDG (MS)II division

Foreign Training
Training Program Country Year (2016)
A&E Emergency Training of TONTOCK SENG Hospital 42
Medical Officers Singapore
Leadership, Development Management Institute of 32
Training of Medical Malaysia
Administrators
Bio Medical Informatics INDIA 20
Sports Medicine Malaysia Institute 20

Source: DDG (MS)II division

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Table 21: Major Procurements of Biomedical Engineering Division in 2016

Index Equipment Name Qty Awarded Cost (Rs.Mn)

1 Laparoscopy M/C 3 Rs.36 Mn

2 ICU Ventilator 10 Rs.30 Mn
6 Eye Microscope 8 Rs.85 Mn
7 ENT Microscope 4 Rs.40 Mn
9 Laparoscopy M/C 3 Rs.36 Mn
10 Eye Laser 5 Rs.44 Mn
11 Patient warmer 75 Rs.18 Mn
12 OT Table 28 Rs.74 Mn
13 OT Table (Orthopedic) 9 Rs.67 Mn
14 Ventilator (Trans) 24 Rs.25 Mn
15 Ventilator (ICU) 45 Rs.63 Mn
16 Intra-Aortic Balloon pump 3 Rs.38 Mn
17 Autoclave Table Top 145 Rs.42 Mn
18 Central Monitoring Sys (A'pura) 1 Rs.18 Mn
19 Central Monitoring Sys (Kara'pitiya) 1 Rs.18 Mn
20 C-PAP 33 Rs.27 Mn
21 Exercise ECG 6 Rs.14 Mn
22 Eye Operating Microscope 2 Rs.16 Mn
23 ENT Operating Microscope 2 Rs.20 Mn
24 Neuro Navigator 1 Rs.103 Mn
25 Operating Microscope (Neurosurgery) 1 Rs.33 Mn
26 Operating Microscope (Plastic Surgery) 1 Rs.42 Mn
27 USS (Radiology) 8 Rs.31 Mn
28 Ventilator (Transport) 17 Rs.17 Mn
29 X-ray (mobile) 20 Rs.49 Mn
30 X-ray (Fluoroscopy) 3 Rs.134 Mn
31 USS (portable) 15 Rs.21Mn
32 Multi monitor 150 Rs.17 Mn
33 Echocardiography 4 Rs.38 Mn
34 Skull Base Navigator 1 Rs.27 Mn
35 Echocardiography 1 Rs.21 Mn
36 Neurosurgical operating Microscope (Teach) 1 Rs.93 Mn
37 Lithotripter 1 Rs.62 Mn
38 Heart Lung M/C 1 Rs.35 Mn
Total Amount Rs.1,450 Mn

Source: Biomedical Engineering Division

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