Identifying the Knowledge, Capacity, and Policy Gaps in the Face of Sri Lanka’s Health Transitions and Journey Towards Universal Health Coverage : A Qualitative Analysis

Sri Lanka is well-recognized in terms of the progress made on several social indicators, including its health achievements. The country has made significant progress in health outcomes, including increased life expectancy, gains in maternal and child health outcomes, and elimination of major diseases like malaria and polio. Currently, four major, inter-linked health transitions in diseases, demography, domestic financing and donor assistance (the “4Ds” of global health transition) impact Sri Lanka’s health sector. This study examines knowledge, capacity and policy (KCP) gaps surrounding the 4Ds of health transitions in Sri Lanka. In particular, the study aims to understand: (1) the KCP gaps perceived by key country stakeholders in navigating these simultaneous health transitions; and (2) the actions that need to be taken to address these gaps to meet Sri Lanka’s present and future health needs. Based on information collected from 30 key stakeholders in health and related sectors, the study adopts a qualitative methodology – consisting of deductive framework and thematic analysis – to understand the KCP gaps across the four health transitions, and opportunities and potential solutions that can be used to address these gaps. Findings suggest that the gaps are inter-related, requiring intersectoral and integrated policy approaches to addressing them. While substantial progress has been made using a low-cost delivery model that has facilitated progress towards universal health coverage (UHC), lack of uniform knowledge regarding health transitions, capacity gaps in resource mobilization and technical capacity, and policy coordination issues are challenging strategic planning and financing to address the changing and emerging health needs of the country. Since health is a cross cutting issue, better collaborations with non-health sector officials as well as awareness building on the importance of recognizing health dimensions in all policies are important for attaining UHC. Concerted efforts are also needed to improve evidence generation and awareness about health transitions, capacity for informed planning and decision-making, and policy coordination across all levels of government and key stakeholders. Provision of an essential health service package for all Sri Lankans is an important first step in addressing the multiple gaps in the system and better handling of the health transitions