In the second of two parts, international health students give an insight to the highs and lows of health around the world

Despite economic constraints, Sri Lanka has achieved impressive health indicators, comparable to those in developed countries, by placing high value on the right of each individual to health and education. Sri Lanka's traditional system of values has always been highly oriented to welfare, and the Buddhist ethos reinforces social egalitarianism and collective responsibility to help the poorest in society.1

Sri Lanka's political system has also supported the development of a welfare state, with universal franchise since 1931.2 Visionary social policies introduced in the 1940s included sizeable and universal food subsidies, free and universal health care, and free education. Such policies provided minimum levels of consumption for the entire population and helped to remove destitute poverty.3

Early interventions in health prioritised primary health care, focused on low cost and effective interventions, which were within the reach of the entire population. The Sri Lankan government paid particular attention to improving maternal and child health, which brought high returns; the leaps in life expectancy during the 1940s and '50s can largely be attributed to the reduction in infant, child, and maternal death.4 Improving infant and child health depends on educating women, which was encouraged in Sri Lanka and was thought to be the single most important reason behind this reduction in mortality.5

Today there is a mixed provision of health care by the public and private sectors; the public sector serves nearly 60% of the population.6 Interestingly, the public sector incorporates Ayurvedic medicine, as well as Western medicine. This gives people an opportunity to seek medical care from various sources and spreads the burden of care between different types of medical systems, including the private sector. Health care units are on average no further than 1.4 km from any home, which ensures good access to health care.6

Inevitably the conflict in the north and eastern parts of the country has hindered Sri Lanka's social development in the past two decades. The government has been distracted from administration and economic policy making, and social services have no longer been a primary concern.5 Estimates suggest economic losses from the war amounting to as much as 2% of the gross domestic product each year.7

In 1997, the government took measures to tackle existing problems in the health service and set up a presidential taskforce.6 Sri Lanka's achievements in social development serve as an example to other low income countries who strive to obtain good health that, with adequate political commitment and a focus on primary health care, this may be possible.