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Public Health Situation Analysis Standard Operating Procedures
Humanitarian Action Technical Brief 2500 words
WORLD HEALTH ORGANIZATION
Table of Contents Public Health Situation Analysis- Short Form – SRI LANKA 2 1. Summary of Crisis 2 2. Map of Affected Country/Region 3 3. Health Status and Threats 4 Health and other determinants pre-crisis 4 Health and other determinants post-crises 4 Healthcare threats 4 4. Health System Status & Local health system disruptions 7 Pre-crisis 7 In-crisis 7 5. Humanitarian Health Response (3/4W matrix) 8 Health response coordination 8 Health response actors 8 6. Information gaps & information source 8 7. Key References 9 8. Contacts 9 Annex 1 WHO recommended surveillance case definitions 10 Annex 1: References and Citations 12 Annex 2: Crisis Typology Icons Legend 12 Annex 4: Scoring the magnitude of health threats /needs 15 Annex 5: Table 1 a and 1b: Expected evolution of crisis emergent health threats over time 17 Annex 6: Table 2 of the long form PHSA: Scoring the magnitude of disruption to key health system components 22 Annex 7: Table 2 of the long form PHSA: Expected evolution of disruptions to key health system components over time 23 Annex 8: Appropriate methods for the collection of primary data 27
Public Health Situation Analysis- Short Form – SRI LANKA
Last update: August 4, 2022
Initiated by: Country Office □ Regional Office □ HQ □
Type of emergency (see Annex 2 of this document)
Main health hazards
· Give a bullet point list of the main emerging health hazards (or hazards that are likely to become an issue) resulting from the crisis
For the UNDSS website (dss.un.org), enter UN
username and password. Fill out the following table:
risk , out of 10.
Download the excel sheet. Include risk class (e.g. Very High)
Rank: Include rank of country
1. Summary of Crisis
Sri Lanka is facing one of the most severe humanitarian crises in the country’s history. Since 2021, the country has not recovered from the COVID-19 pandemic and coupled with unsustainable debt and public corruption, a public health crisis has emerged that requires immediate international attention.
The following are the highlights of the public health crises that faces Sri Lanka
· The public health crises affect all of Sri Lanka since 95% of healthcare is provided by public health facilities.
· The capital city Colombo is the most affected by the crisis, since it is the area that has experienced the most casualties resulting from the protests that have been going on for the past one year
· The government lacks the foreign exchange to purchase medicine which has led to an acute shortage of medicine and medical supplies in the country
· The underlying causative factor is an ongoing economic crisis
· Fears of resurgence of a deadlier wave of COVID-19. Dengue fever and malaria cases could rise in the coming months
2. Map of Affected Country/Region
Population in need: 22 million
Population in need of humanitarian health assistance: 21.2 million
Deaths (estimates): N/A
Injuries (estimates): 20000
(The HNO/HRP is useful to find this information). Another good source is the “RW Crises” phone app.
3. Health Status and Threats
The most immediate threat facing Sri Lanka at the moment is a resurgence of COVID-19 and Dengue fever which might be caused by oncoming monsoon rains. Sri Lanka has managed to achieve significant health outcomes which are above its income levels, pre-crisis. The country managed to eliminate diseases such as malaria, filariasis, polio and neonatal tetanus.
Health and other determinants pre-crisis
Pre-crisis, the country struggled with a rising healthcare challenge of an ageing population and non-communicable diseases. According to statistics, 75% of deaths in the country were caused by non-communicable diseases.
A significant bulk of healthcare services in the country is provided by the public sector. Over 90% of inpatient care and over 50% of outpatient care is provided by public healthcare facilities. The private health care sector is functional but is inaccessible to the majority of the population due to high costs.
National budget expenditure in comparison to GDP has remained around 1.7% since 2013 and the household expenditure on healthcare is significant but catastrophic health expenditure is very low because a large percentage of healthcare services are provided by the government.
Health and other determinants post-crises
Sri Lanka imports more than 80% of the medical supplies that it needs. Because of the economic crisis the country is currently unable to import medicines which has led to a shortage in public hospitals. According to ACAPS, approximately 200 medical items were in acute shortage as of May 2022. About 50% of medical procedures have been delayed all around the country because of shortage of crucial supplies such as surgical instruments and anesthesia.
There is no official statistics on the population mortality from the public healthcare crisis that faces the country. COVID-19 is going to be the most significant healthcare threat if the economic crisis persists amidst rising cases of COVID-19 infections. Because of the shortage of medical supplies, vaccination rates, which were once up pre-crisis may come down, leading to a rise in cases of diseases such as post-natal tetanus, polio, measles and diphtheria.
Key Risks in the coming month*
Public Geographi Likelihood** Public health** Level of Rationale
Health cal Scope consequence risk***
measles some regions Low Moderate Low
Lack of vaccines
Malaria Some regions Low moderate Low
Oncoming monsoon rains and lack of support
COVID-19 Countrywide High Severe High
Lack of preparedness
Dengue Fever countrywide likely Moderate Moderate
Oncoming monsoon rains and lack of proper planning
Mental Health Colombo Low Low Low
Mental Health Colombo Low Moderate High
Not enough statistics is available
NCDs and cancer countrywide High Moderate High
Lack of medicine and medical supplies
Red: could result in high levels of excess mortality or morbidity in the upcoming month. Orange: could result in considerable levels of excess mortality or morbidity. Yellow: could make a minor contribution to excess mortality or morbidity Green: will probably not result in any excess mortality or morbidity/relatively normal satiation in the upcoming month.
Sri Lanka has performed really well over the past five decades in eradicating epidemic-prone diseases such as measles and polio. There has not been any recent breakout of epidemic diseases in the country in the past two decades. However, in the absence of strong medical services in the country due to the ongoing economic crisis, there might be a resurgence of epidemic-prone diseases in small pockets of the country. The likelihood remains very low, the risk and the public health consequence is also very low.
Endemic infectious diseases
The current economic crisis is likely to aggravate the endemic infectious diseases, particularly Dengue Fever and Malaria. The areas most at risk of malaria outbreak include Polonnaruwa, Ampara and Badulla, especially with the coming Monsoon rains which could provide the perfect breeding conditions for malaria-causing mosquito. The incidence rates for Dengue Fever are projected to be low since incidences of the disease have not been observed even during rainy seasons.
Sexual and reproductive health
There is a real risk of the gains in sexual and reproductive health being rolled back as a result of the lack of funding for such programs. Sri Lanka has in the past recorded low maternal deaths, and high births attended by skilled health personnel, high delivery of births at a health facility and high uptake of family planning methods. With the collapse of the public healthcare system, there is a really high risk of lack of family planning medicine which may affect the quality of life of families
Non-communicable diseases (NCDs)
Over 75% of deaths in the country in the past has been due to NCDs such as cancer. The elderly population is at the greatest risk of death from NCDs due to lack of medical care. 90% of the population that present with NCDs to healthcare facilities are treated at government hospitals. In the absence of public healthcare services due to lack of funds, there is a risk of an increase in the mortality due to NCDs.
4. Health System Status & Local health system disruptions
Main figures on disruption of key health system components
Damage to health facilities: lack of public funding on healthcare facilities could lead to a deterioration in the coming months
Health workforce: 90% of healthcare workers could go without pay for the foreseeable months leading to lack of enough workforce.
Drugs and other supplies: Widespread shortage of drugs and other medical supplies because of shortage of foreign exchange
The quality of primary healthcare in Sri Lanka is above its income group. The focus of the country since 2013 has been to reduce the deaths attributed to NCD and aging. There has been an increased trend of NCDs in the country, which are attributed to several factors such as unhealthy dieting, smoking, drug abuse and mental health. Pre-crisis, more than 600,000 Sri Lankans had access to healthier lifestyles and improved healthcare.
Pre-crisis, the country had made important healthcare strides in eliminating diseases such as malaria, polio and post-natal tetanus.
There are several programs aimed at strengthening primary healthcare in Sri Lanka, all which are presently at risk of collapsing in the crisis.
· The disruption in primary healthcare mainly affects vaccinations, inpatient and outpatient care and the management of chronic diseases.
· There are no official statistics of the effect of the crisis on PHC in Sri Lanka owing to how recent the crisis is.
· General risks to PHC include lack of medicine and medical supplies, lack of electricity supply in hospitals and lack of funding for crucial healthcare programs in the country.
· One in three parents in Sri Lanka states that they
have noticed a negative change of behavior in their
children in the last six months since January,
according to a Save the Children survey conducted
in June 2022.
5. Humanitarian Health Response (3/4W matrix)
Health response coordination
The data on the health response in insufficient. However, since the crisis began, the Sri Lanka Red Cross and other international agencies such as the World Health Organization have stepped in to provide crucial healthcare services to the citizens of Sri Lanka and to plug in the gaps in healthcare provision that has been left by the collapse of public healthcare systems.
No. of partners
As at present, there is no concrete data or information on the partners or organizations that are leading healthcare service delivery.
Health response actors
· Sri Lanka Red Cross
· Ministry of Health
· GAP organizations working to advance the SDGs’ healthcare and development objectives
· WHO providing guidelines and doing needs analysis to support the Healthy Cities initiative
· Fast response to medical emergencies
· Collaborations between public and commercial organisations to advance the healthcare SDG agenda
· Providing necessary healthcare services that are not provided by hospitals
· Making efforts to resume providing healthcare services over the next three months
(There is no sufficient information to construct the 3/4W matrix, and therefore a brief description of the partners and response actors is given)
Sri Lanka Red Cross
Emergency medical care for protesters who become injured
City of Colombo
Since June 2022
Ministry of Health
-Working with relief organizations to give PHC to citizens
-Working to restore healthcare services nationwide
Coordination of activities to meet SDG targets for healthcare and building out the infrastructure for healthcare
World Health Organization
-Provision of emergency medical supplies as a result of the paralysis of public services
-Coordination of the Healthy Cities initiative with the MOH and GAP agencies
Countrywide, City of Colombo
Since May 2022
6. Information gaps & information source
There is a general lack of information on the public health crisis that is facing Sri Lanka at the moment. The available information exists in forms of news reports and in websites of international organizations like the World Health Organization. The information that exists in secondary sources is not up to date because the economic crisis is a recent event.
There is little to no information and official figures on the prevalence of diseases and on the vaccination rates.
The following are recommended for collection of primary data in where sufficient secondary data cannot be found:
7. Key References
SRI LANKA Socioeconomic crisis. ACAPs
Rajapaksa L, De Silva P, Abeykoon A, Somatunga L, Sathasivam S, Perera S et al. Sri Lanka health system review. New Delhi: World Health Organization Regional Office for South-East Asia; 2021.
Vaidyanathan, Rajini. “Sri Lanka Healthcare on the verge of Collapse in Economic Crisis.” BBC News. Last modified April 17, 2022. https://www.bbc.com/news/world-asia-61111405.
WHO | World Health Organization. Accessed July 27, 2022. https://www.who.int/docs/default-source/health-workforce/health-labour-market-analysis-in-sri-lanka.pdf.
“The Devastating Health Consequences of Sri Lanka’s Economic Collapse.” The BMJ. Last modified June 29, 2022. https://doi.org/10.1136/bmj.o1543.
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