Country Capacity and Accomplishments and Application of the Policy Options Framework(cont...)

Sri Lanka

Key Policy Options and Strategic Actions

Assess

* Develop a NCD surveillance system. A national ongoing NCD surveillance system is required for strategic planning. It should include behavioral risk factors, NCD morbidity, mortality, health

services utilization, and special population-based registries for cancer and injury.

Plan

* Finalize nation NCD policies. Sri Lanka has made good progress in developing key NCD policies, which are near adoption by government. A push to finalize these policies and to resource them, as well as to engage stakeholders in implementation, is needed.

Develop and Implement

* Create an intensified national NCD program. Currently, the responsibility for NCDs is divided

among at least three directorates. In order to get the best from this arrangement, an intensified

national NCD program with sufficient resources and authority to make it effective is needed to

develop, coordinate, and implement national prevention and control policies.

* Increase use of lower-level facilities to treat NCDs. Inefficiencies in health services delivery are occurring with the overuse of higher-level facilities. Lower facilities for NCD care need to be

utilized where appropriate. In addition, integration of preventive and curative services at the

primary care level to manage NCDs would improve efficiency. Currently, the capacity for

diagnosis and treatment within primary care is limited. Human resource development upgrading

facilities will be needed.

* Develop financing strategies to assure access and protect the poor. A substantial proportion of

health services is currently financed with private resources, mostly out of pocket—and this

proportion is increasing. Financing strategies for health services to assure access to diagnostics

and to simple, inexpensive, and effective medications is badly needed. In addition, these policies

need to be sensitive to the poor who may currently be forgoing basic treatment since they

cannot pay for it.

* Develop public–private partnerships. The public sector now provides a significant proportion of health services. However, the private sector remains poorly understood. Public–private

partnerships that link the two systems would allow for better coordination and efficiencies.

Evaluate

* Develop monitoring and evaluation capacity. Evaluation of the process and outcome of health

services is currently a critical issue and will only become more important as the burden of NCDs

and services use increase. Thus, health information systems need to be refined. In addition, as

national policies are implemented, evaluation will need to assess progress and to direct

resources to where they will have the largest impact. While some of the surveillance effort (see

Assess above) will assist with this task, more detailed evaluation will be required for some

aspects of policy evaluation.