Dilrook Kannangara

Sri Lankan government spend on public health is not the same across the provinces. There is acute discrimination against some provinces. Healthcare cost is measured in per head (per capita) spend so it is a fair and comparable measure. When per head public healthcare cost is compared across the provinces, a terrifying and discriminatory practice comes to light. The following map is taken from an unrelated publication by the Institute of Health Policy. The original document can be downloaded from the following link.

https://www.ihp.lk/publications/docs/SLHAPB1E.pdf

Although it contains data from 2018 the trend has not changed as Sri Lanka follows incremental budgeting.

As the war ended in 2009 there is no earthly reason why some provinces should get more than the others in per capita healthcare spend. All districts must be allocated the same per capita healthcare cost by the government. Tax is collected from all and therefore it must be distributed uniformly.

But tragically, the northern province is allocated a whopping 10,095 rupees per person by the government in healthcare costs whereas the North Western Province was given only 6,494 rupees per capita! In other words, the government spent a person in the northern province over 55% of the cost the government spent on a person in the north western province in healthcare costs. This is unacceptable and discriminatory at the worst level.

Aren’t the lives of some as valuable as others!

Due to lower government spend on per capita public healthcare cost in some provinces those with means spend more on private healthcare. But it is only affordable to a very small percentage of the people.  

Almost all public health related fatal and other disabling incidents happened in provinces where the government spent very low amounts in per capita healthcare costs. This includes Kurunegala, Kalutara, Colombo, Gampaha, Ratnapura, Kegalle, Galle and Kandy. Although Central province receives 9,063 rupees a person in healthcare costs, this is misleading as the allocation is not uniformly distributed across the 3 districts of Matale, Kandy and Nuwara Eliya. Matale and Kandy get a smaller per capita healthcare allocation than Nuwara Eliya.

There is a very strong ethnic and racist aspect to it when one considers the first three highest provinces and the last three provinces.

This discriminatory practice must be ended forthwith.

The relative high in the North Central province was due to a dedicated attempt to counter CKD in the province since 2015 and is not indicative of a long term trend.

The per capita public healthcare cost for each province in 2018.

Northern Rs. 10,095

Central Rs. 9,063

Eastern Rs. 8,992

North Central Rs. 8,952

Uva Rs. 8,555

Western Rs. 7,888

Southern Rs. 7,819

Sabaragamuwa Rs. 6,584

North Western Rs. 6,494

SLHAPB1E.pdf (ihp.lk)