Sri Lanka in terms of health achievements has out-performed all other low-income and lower-middle income developing countries. Sri Lanka’s health statistics are more akin to those of some members of the OECD than to its neighbours. While the existing health system is evolving as a consequence of economic and social changes brought about by economic liberalization in the late 1970s, the same paradigm may not be the most effective to meet the new challenges of the 21st Century. Long-term trends that impact the system include growing private sector involvement in health care, public sector decentralization, an advanced health transition, and rising consumer expectations.

These trends will present major challenges for national policy makers, particularly in the areas of health system financing. Finding answers and ensuring that change, when it occurs, is beneficial will not be easy. Since few countries’ health performance surpasses Sri Lanka’s, borrowing solutions from elsewhere carries risks, unless it is done with a clear understanding of the strengths and weaknesses of Sri Lanka’s existing system.

A lesson from the past is that health policy change has been gradual, and often not by design. Sustained reform required broad consensus amongst policy makers and stakeholders, the most important being the electorate. Technical expertise has often not been significant in the design of Sri Lankan health policy. Recognizing this, a key priority is to engage in research which will strengthen the empirical basis for policy debate, as well as provide policy makers with the analysis they will need, when reform becomes inevitable.