Envisioning a path to a more inclusive, affordable Lankan healthcare system

Elaborating on the ramifications of the many changes happening in the local healthcare sector, Sri Lanka Chamber of Pharmaceutical Industries (SLCPI) Chairman Shyam Sathasivam called for greater partnership between the public and private sector stakeholders in order to preserve and enhance the country’s existing facilities while developing specialized capabilities to shift the goal of healthcare outcomes from treatment to prevention. Following are excerpts:

How is Sri Lanka’s healthcare sector changing and what are some of the factors underlying these changes?

Like all other basic services, the healthcare sector tends to be directly connected to the GDP growth. Particularly when considered over the long term, the Sri Lankan economy has witnessed tremendous growth over the recent past. As the country continues to move steadily with a GDP growth rate of 4 percent, the expectations and aspirations of our citizens are also growing and changing. This trend certainly has important ramifications across all facets of daily life. 

Today there are more people living sedentary lifestyles that when combined with increased disposable income and greater leisure options, tends to impact negatively on the overall health and wellness, as evidenced by the tremendous rise in the non-communicable diseases (NCDs) over the recent past. 

Conversely however, we also see that with the rising prosperity, there is an increased willingness to invest in healthcare and greater interest in making healthier lifestyle choices. As a middle-income country, I think it’s safe to say that this will be a progressive trend and move forward; expect the tension between these two dynamics. 

Another important issue to consider is the growing demand for high-quality tertiary healthcare services that are affordable and available to all those who want access to such care. 

What do you believe are some of the low hanging fruit that that the government and private sector can look to over the short term?

There are no quick fixes in the healthcare sector and the benefits of any alterations to the healthcare policy tend to play over the medium to long term. Nevertheless, one of the best areas to aggressively target would be the development of our diagnostics capabilities. In the healthcare industry, this is often referred to as the ‘Rule of Halves’: of those who are diagnosed with a disease, only half receive treatment from a qualified healthcare professional and again just half of these people achieve their treatment targets. Unfortunately, the Rule of Halves does not end there: only half of this relatively small group actually achieves the desired outcome and lives a disease-free life. 

Essentially, there tends to be an exponential reduction in the number of people who receive treatment relative to those who require it and ultimately, this is a problem of awareness. If the public is more aware of what they can do to prevent the illness through early diagnosis, parallel to investments to enhance our diagnostic capabilities, I believe that we, as a nation, can start enjoying the benefits of these investments fairly quickly.
Early diagnosis can often pre-empt the need for treatment, which is significantly more complicated and expensive than the diagnosis. Therefore, these investments will be money well spent. 

What are some of the areas the public and private sectors can work together to deliver positive healthcare outcomes?

There are certainly a few areas with low hanging fruit, which can be powerfully leveraged through public-private-partnerships (PPP) and one of the most opportune areas in this regard would be in early detection. 

I believe that the PPP model will be central to driving successful healthcare outcomes and there are certainly a wide variety of examples of the PPP model in developed and developing economies that have generated remarkable improvements in the availability and delivery of healthcare products and services. 

While the Sri Lankan debate on healthcare has tended to focus solely on the issues of affordability, we feel that awareness building can serve a much more powerful role in producing better healthcare outcomes – this is an area, which the government is best equipped to engage with people and communities across the island. The private sector also needs to join in and find means of contributing to these awareness campaigns by following up in these areas and providing access to affordable healthcare products and services and in this manner.  

Economic policy tends to dictate investments and growth in the healthcare sector but what is the potential impact of a progressive health policy in economic performance?

There is a clear gap in terms of research into pharma-economic dynamics. Hence, one of the key recommendations by the SLCPI to the government has been for the commissioning of robust research into this field to ensure that the future policy decisions are evidence based and clearly reflective of realities on the ground. Such initiatives would naturally result in a much deeper, holistic analysis of the healthcare sector and provide insights into vitally important factors that go beyond simply analysing the cost of products and infrastructure alone. 

Minimal invasive surgery is another area that can have a significant impact on cost reduction and recovery time. Such facilities and services require investments that can seem costly and prohibitive when we only consider the rupee values of such treatments. 

However, when balanced against the duration of stay and cost of recovery, the patient and the state healthcare system can both benefit immensely. That is why it is absolutely vital to take a nuanced, well-considered, evidence-based approach when deciding macro policy. We need to ensure that we preserve what works and reform what does not.  

Ultimately, if we are successful in formulating a well-balanced healthcare system, the impacts of these reforms will be far-reaching and will most certainly be keenly felt when examined from the perspective of economic performance and productivity. 

What would be an ideal direction for the Sri Lankan healthcare sector to move in over the next decade?

Sri Lanka has already extended its basic and essential healthcare services to all corners of the island under our universal healthcare system. It’s clear that the government can - and should - play a leading role in primary healthcare services moving forward. However, when considering global examples, there is a clear trend towards greater investment by the private sector into tertiary care services and facilities. 

This speaks to a fundamental shift that occurs in any nation that transitions into a stable middle-income status. The Sri Lankan perceptions around healthcare are changing. In the past our people would perceive medical treatment as something paid for only when needed, today we see a more holistic long-term approach that is tied to quality of life. 

Today, more Sri Lankans look at their healthcare as a proactive investment in their future. This change in the mindset is no trivial matter.

Regardless of what resistance there may be to change, ultimately, our systems will have to be reformed in order to meet not only the needs but also the aspirations of all Sri Lankans.  One possible solution would be the creation of a voucher system through which the government can ensure those in need are given free treatment at private healthcare facilities, allowing citizens to get the best possible treatment, while saving the government the expense of actually constructing and operating a fully-fledged hospital. 

Instead, the public sector can look to invest in vital allied services like drug assurance laboratories or set up joint ventures along those lines in order to aggressively test all products coming into the country thereby ensuring that our citizens are guaranteed medication of a high-quality standard. I think the key point from this is that we need to update our ideas on the role of the public and private sectors in the healthcare sector so that we measure success in terms of simply the amount spent of brick and mortar infrastructure, given the vast untapped capacity in the private sector. 

Has there been any recent policy progress with regard to the establishment of such quality assurance labs?

The NMRA has clarified that a plan for the establishment of quality assurance laboratories is currently being developed. However, we would like to have some more clarity on the scheme and its scalability. This is a crucial area for ensuring that our citizens are provided with drugs of an appropriate quality standard, therefore, the stakeholder consultation can only help to ensuring a positive outcome. 

The best way forward will be for the establishment of PPPs, whereby the private sector is tasked with making investments in infrastructure and capacity under stringent oversight from an impartial and empowered public sector regulator. 

We are concerned that the government may not wish to make this transition from actually performing a task, to regulating its performance but ultimately I think there is a growing recognition that currently, the most important step is to set up a robust regulatory framework.

What are some of the key concerns for the SCLPI moving forward? 

For our part, the SLCPI will continue to engage with the Health Ministry, NMRA and all related regulatory authorities to help set policies that are efficacious for all stakeholders. We have been working with these stakeholders to review the existing data and we continue to ask for evidence for the positive benefits of price control to the sustainability of the overall healthcare system. 

Our goal moving forward is merely to ensure that we take a more systematic approach to policy and that we understand that there is no one silver bullet to fix all of the challenges we face. So we must be organised and systemic in our reforms.