Sustaining Sri Lanka’s Preventive Health Achievements: Emerging System Challenges and Policy Directions - A Narrative Review

Abstract

Sri Lanka has achieved health outcomes that have historically compared favourably with countries at similar or higher levels of economic development, supported by a tax-funded health system, geographically defined preventive health services, strong maternal and child health programmes, and established communicable disease control mechanisms. However, sustaining these gains requires adaptation to a changing health-system environment. This narrative review examines evidence relevant to five interrelated challenges: the growing role of the private sector, health misinformation and socially networked beliefs, population mobility, decentralised governance, and fragmentation between services and information systems. A targeted literature search prioritised peer-reviewed publications indexed in major biomedical databases, with additional use of authoritative national and international health-system reports where needed for current indicators and institutional context. The reviewed evidence suggests that Sri Lanka’s historical strengths remain important, but emerging pressures related to mixed public–private care, economic shocks, health-worker migration, information disorder, and coordination gaps can weaken continuity, equity, surveillance, and accountability. Policy priorities include stronger public-health functions within curative institutions, interoperable person-level health information systems, workforce-retention measures, clearer governance arrangements across central, provincial and local authorities, and stronger national stewardship to reduce duplication and fragmentation. Sustaining Sri Lanka’s preventive-health achievements will depend less on preserving existing structures unchanged than on modernising their coordination, information architecture and accountability while retaining universal and community-oriented principles.