Marga Storehouse of Knowledge

 Marga Storehouse of Knowledge ….. Commencing a series on articles from Marga Quarterly Journal published from 1972 – Abstracts of vintage literature are cited for requests of full articles

A unique facility for

  • Scholars
  • Students
  • Researchers
  • Academics
  • Writers and journalists
  • Feature writers


  • Historical data & information
  • Analytical writing on critical subjects
  • History of Current problems.
  • Critiques of policies, lessons to be learnt
  • Illustrations of successes and failures in project implementation

 Through this series of articles on the subject in past Marga Journals

  • Listen to the voices of past academics, researchers and practitioners through their writings
  • Use concise tables with historical data for trend analysis
  • Question why the similar conditions  persist
  • Consider past suggestions for remedies in policy today

Friday 18th   July 2014………..File these citations for future reference.

Subject: Health Challenges in Sri Lanka……Excerpts from recent writing

i.          “WHO- Country Cooperation Strategy—At A Glance

Health Situation

Sri Lanka is on track for achieving most of the MDG targets. However demographic and epidemiologic transitions now pose a new challenge which calls for the reform of the primary healthcare model of the country. Although significant achievements have been made in nearly eradicating/eliminating vaccine  preventable diseases, leprosy, malaria, Japanese encephalitis, congenital syphilis, neonatal tetanus, lymphatic filariasis, etc., diseases such as dengue and some of the neglected tropical diseases such as leptospirosis continue to be a threat.

Noncommunicable diseases are on the rise, particularly the burden of cardiovascular, cancers, diabetes and chronic respiratory diseases which account for about 70% of deaths in the country. Traumatic injuries continue to be the leading cause of hospitalization. The government has however made significant progress in curbing tobacco use by the ban of smoking in public spaces, increasing the tax levied on cigarettes and implementing othermeasures.”

ii.         Emerging Health Challenges in Sri Lanka: More Money for Health and More Health for the Money……………Samanthi Bandara Insights April 18, 2011

By Samanthi Bandara, Research Officer – IPS

Excerpts: Public sector services are totally free at the point of delivery for all citizens through the public health institutions distributed island-wide, while private sector services are mainly through ‘out-of-pocket expenditure’ (OOPE), private insurance and non- profit contribution.

The government health expenditure as a percentage of total government expenditure was 4.9% in 2007, which is a decrease of over half from the 7.2% recorded in 2006. It is increasingly evident that private sector financing has become more prominent over time.

Sri Lanka has enjoyed exceptional health outcomes, with strong maternal and child health and low prevalence of infectious diseases, at low cost, in the past two decades. However, as this article has shown, there are visible gaps/disparities in health outcomes with regard to NCDs and elderly care. Empirical data shows that the country needs sufficient investment in health, especially given the emerging burden due to NCDs and ageing population (i.e., elderly care needs). These needs have to be addressed soon to avoid the resultant socio-economic consequences, such as a withdrawal from the workforce early due to ill health in the case of NCDs, and the rising fiscal costs for pensions and long-term care in the case of the ageing population.

The Health Master Plan (2007-2016) for Sri Lanka estimated that the total health expenditure as percentage of GDP by 2015 would be 4.5 – 5% (medium) and 6.7% (high). This is based on various assumptions and projections but it appears that the emerging NCD burden and the ageing population were not adequately taken into account and if factored in more robustly, the requirement is likely to be much higher.”

  1. Title:  Section on Health in “An Experience in a Need Oriented Development

Author:            Ann. R. Mattis

IN:                   Vol. 5  No 3 -1978 Pages-13-14


Excerpt:” planning in the field of health must perforce be seen as a part of total planning for development. More equitable distribution of income will be one element of the process to halt malnutrition and infant diseases. This, combined with appropriate health education (for patients as well as health personnel), are part of the approach health planning”

  1. Title:    infra-structure for health in Participatory Development and  Dependence-The Case Of Sri LankaIN:                   Vol. 5 No 3 1978 pages  59-60Gives detailed description of the health infrastructure at the time with tables containing data put together from varied sources.      3.  Title:     Environmental Determinants of Health and Their Influence on Infant Mortality: The Case Of Sri Lanka IN:                  Vol. 6 No. 1 1980, Pages 67-80                        Contains tables with historical data put together in tables and graphs.Excerpt:Excerpt: Author:            Prof Priyani SoysaPages 1-38                        One of the most detailed analyses of the subject by a pioneer in child nutrition studies and research of that period with about 25 tables of statistics and derived indicators, graphs and charts.Excerpt:                         Author:            A. D. Nikapotha                        Excerpt:It is timely however, to look at other approaches to identification of factors relevant for healthy development. Recent research has adopted an ethological perspective to issues relating to child mental health and development, and has highlighted the essentially interactive nature of the process. Research on the impact of environmental interactions on problems such as malnutrition highlights the need for services to broaden perspectives  and not focus solely on preventive health for specific risks or provide services to reduce disadvantage of target groups….”     6.     Title:   Climate Change its Impact and Implications for Human Health in Sri Lanka IN:                  Vol. 14 no 3 1997 Pages 39-48                        Contains a wealth of historical data as well as projections up to 2070.     7.      Title:     Affordability and Accessibility of Health Care for NCDS in Sri Lanka: A Synopsis of a Sri Lanka Case StudyIN                    Special Issue  on Health- April 2006 pages 1-43                        It summarises findings from a detailed study in six locations on ten NCDs. The study focused on the household situation when persons with NCDs have to be cared for and also points out the strengths and weaknesses of the  response of the health care system.                        Excerpt:           Author:            Godfrey Gunatilleke                                                                      “Trends in Health Status, Health Care and Poverty”i.                    Equity in Health Statusiii.                Equity in the Capability for HealthExcerpts:“The study highlights the need for restructuring of the health system and the more equitable dispersion of the health infrastructure which has been heavily concentrated in the urban sector. The lines on which such restructuring could take place have been briefly discussed in the section on access to health care”9.              Title: Youth Risk Behaviour –Health hazard-Special issue  March 2008  Lanka and the Search for Security.(Co-Editor of the journal) Excerpts:“In December 2004, the Asian Tsunami reached Sri Lanka’s shores and killed more than 31000 coastal residents. The victims were mostly women and children. How does a nation rebound and recover from the cumulative impacts of both civil unrest and natural devastation? What are the hopes and aspirations of generations of young people as they search for both material and personal security? Is paradise lost or is there hope for the present let alone the next generation? These articles provide a snapshot of issues facing youth in Sri Lanka. included some articles on youth risk from other global sites. Youth in Sri Lanka are not alone, and like their counterparts in Chile or Rwanda or Canada, they face a number of lifestyle choices as well as health risk challenges”Articles: Selected titles:                        Author: Rosemary Kennedy.                         Authors:Prof.  Sarath Amerasingha, et al  Pages 151- 164                        “ Suicide and Sri Lankan youthPages 165-172“Youth Suicides In Sri Lanka’Pages 173-189                       
  2. Author: Dr Ranil Abeysingha
  3. Author: Himalee Waidyasekera
  4.                         Author: Dr Neil Thalagala
  5.                         “ Prevalence of Risk Factors of Risk Behaviours Among Late Adolescents (17-19) in Sri Lanka
  6.                         Pages 109- 134
  7.                         “Risky Behavior: a Gender- based Analysis of the Detriments to Health and Well Being  of Young men and Women in Post –Conflict Sri Lanka
  8. Pages 21-44
  9.                         “Literature Review of Tobacco Use by Youth in Asia: Identifying the Knowledge Gaps and Future Tobacco Control Research Needs for Youth in Post conflict and Post Disaster Sri Lanka:
  11. “This paper attempts to begin a dialogue on the determinants of health which affect youth health behaviors, with special focus on tobacco drug and alcohol use, particularly within conflict and post conflict situations”
  12. `Pages 5-20
  13. Author:            Dr Carol Amaratunga-former Chair, Women’s Health Council, Institution of Population Health and Faculty of Medicine, University of Ottawa,
  14. Title: Rebuilding Paradise Lost: A Reflection on Youth Risk Behaviors in Sri
  15. “The study has revealed disparities in the three components that have been selected for analyzing equity in health.. The analysis in the study indicates clearly that access to health care for these diseases (NCDs) is as yet highly skewed and that the system which had been relatively equitable for the pattern of disease relating to infancy is not adjusting adequately to the epidemiological transition that has taken place.”
  17. ii.                  Equity in Access to Health Care
  18.                         “Indicators of Equity in Health”:
  19. Subheads:
  20. Contains innovative indicators, past data, tables and graphs. Analysis around three main indicators to measure equity:
  21. IN                    Special Issue on Health –April 2006 pages 45-83
  22. 8.              Title:    Equity in Health: The Case of Sri Lanka
  23. “The study explores the extent and causes of inequities in access, quality and affordability of care for NCDs in Sri Lanka. The study uses the Affordability Ladder Approach to examine household costs for ten chronic diseases throughout the changing disease cycle, and their impact on household income, care sought, the response of the major care provider- the government health care system-the role of the private care services and disease outcomes and puts forward policy recommendations to enable successful management of the growing burden of NCDs in the country”
  24. Authors:          Myrtle Perera & Godfrey Gunatilleke       
  25. Author:            D.H. Satischandra
  26. “Preventive health measures to reduce risk factors identified such as low birth weight, have formed part of child health services for years in the country.
  27. IN:                   Vol. 11 Nos. 2&3 1990, pages  39-48
  28. 5.        Title:   Child Mental Health : Meeting Needs of the Young Child
  29.  “We need a mass effort to correct the spectrum of nutrition problems in our country. This must be a united and concerted thrust even in educating people to think nutritionally. The marketing system of all foods including milk foods must be clean, safe and closely monitored. Knowing that improved nutrition will increase the capacity to learn and work, we have to sensitise politicians that food nutrition is a contribution to national growth and development. Our gains along the line have been very modest. We have to harness political commitment and public concern to recognize those programmes that are most cost effective and affordable in leading to better nutrition”
  30. IN:                   Vol. 11, No. 2 & 3 1990, Needs Of the Pre-School Child,
  31. 4        Title:    Nutritional Status of the Pre-School Child
  32.  “In order to design an effective policy package it would be necessary to carry out an indepth epidemiological investigation of the effects of environmental determinants of morbidity for all age groups”
  33.  “One of the findings that has emerged from this study is that regional variation in the infant mortality rates in Sri Lanka are large from 26 per thousand live births in Jaffna to 91 per thousand live births in Nuwara Eliya, an estate district. These differences are associated with regional variations in environmental determinants more than with regional variations in public health expenditure”
  34. Author:            Mahesh Patel
  35.                         Author:            Godfrey Gunatilleke

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