Ravindra Rannan-Eliya

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• MBBChir, MA, DPH
• Executive Director at Institute for Health Policy

Introduction: This study's objective was to produce robust, comparable estimates of the prevalence of diabetes and pre-diabetes in the Sri Lankan adult population, where previous studies suggest the highest prevalence in South Asia. Research design and methods: We used data on 6661 adults from the nationally representative 2018/2019 first wave o...

■ The Sri Lanka Health and Ageing Study (SLHAS) is a nationally representative cohort study of the Sri Lankan population, established to provide a multidimensional platform to understand and track health and ageing. ■ The SLHAS aims to undertake periodic surveys every 3–5 years. Wave 1 recruited and interviewed in person 6668 participants of all ad...

Background: There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other...

Background Sri Lanka has suffered four decades of violent conflict, a tsunami, terrorist attacks and an economic crisis, with unknown mental health consequences. People living with mental health difficulties may experience individual, interpersonal, social or structural barriers to help-seeking. These may include stigma, lack of knowledge, denial,...

Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria...

Background Sri Lanka’s health policies prioritize improving hypertension control. The care cascade framework, a valuable tool that has informed hypertension control strategy in many countries, has not been assessed previously in Sri Lanka. This study addresses this gap using data from a nationally representative, longitudinal cohort study, providin...

Background Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods We used da...

Objectives: Addressing the challenge of cost-effective asthma diagnosis amidst diverse symptom patterns among patients, this study aims to develop a machine learning-based asthma prediction tool for self-detection of asthma. Methods: Data from 6,665 participants in the Sri Lanka Health and Ageing Study (2018-2019) are used for this research. Thirte...

Background Low awareness of chronic conditions raises the risk of poorer health outcomes and may result in healthcare utilization and spending in response to symptoms of undiagnosed conditions. Little evidence exists, particularly from lower-middle-income countries, on the health and healthcare use of undiagnosed people with an indication of a cond...

This study examines how Sri Lanka, a lower-middle income country, managed its COVID-19 response and maintained health services. It draws on an extensive document review, key informant interviews and a national survey of public experience and opinion to assess what Sri Lanka did, its effectiveness and why. Owing to a strong health system and luck, S...

Background While screening for cardiovascular disease (CVD) risk can help low-resource health systems deliver low-cost, effective prevention, evidence is needed to adapt international screening guidelines for maximal impact in local settings. We aimed to establish how the cost-effectiveness of CVD risk screening in Sri Lanka varies with who is scre...

Background: Although indications suggest that Sri Lanka is facing serious mental health challenges within its diverse populations, the extent of the problem is poorly quantified and even tools required to explore its nature are unavailable. The present study tests the psychometric equivalence of the PHQ-9, a widely used measure of depression, acros...

Background: While hypertension, diabetes, hypercholesterolemia and high-risk of cardiovascular disease can be easily diagnosed and treated with cost-effective medicines, a large proportion of people remain undiagnosed. We assessed the potential effectiveness, cost, and distributional impact of opportunistically screening for these chronic conditio...

Background: South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention...

Background: Sri Lanka lacks robust estimates of hypertension (HTN) prevalence owing to few national studies, hindering optimization of control strategies. Evidence on how the revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) HTN definition affects prevalence in low- and middle-income countries (LMICs) is also limited...

The faltering of progress towards malaria elimination follows a plateauing in international financing since 2010. Despite calls for increased international financing, this will be hard to achieve. Both developed country donors and developing countries with malaria face severe fiscal constraints in expanding malaria funding in the next few years. Si...

Abstract Background People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for the prevention of T2D in South Asians that are cost-effective, generalisable and scalable across settings. Hypothesis Compared to usual care, the risk of T2D can be reduced amongst South Asians with central ob...

Introduction South Asians are at high risk of type 2 diabetes (T2D). We assessed whether intensive family-based lifestyle intervention leads to significant weight loss, improved glycaemia and blood pressure in adults at elevated risk for T2D. Methods This cluster randomised controlled trial (iHealth-T2D) was conducted at 120 locations across India...

Experts agree that reverse transcription-polymerase chain reaction (PCR) testing is critical in controlling coronavirus disease 2019 (COVID-19), but decision-makers disagree on how much testing is optimal. Controlling for interventions and ecological factors, we used linear regression to quantify testing's impact on COVID-19's average reproduction...

Background South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high-costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for prevention of T2...

Background People from South Asia are at increased risk of type 2 diabetes (T2D). There is an urgent need to develop approaches for prevention of T2D in South Asians, that are cost-effective, generalisable and scalable across settings. Hypothesis Compared to usual care, risk of T2D can be reduced amongst South Asians with central obesity or raised...

Background: Malaysia's public healthcare sector provides a greater volume of medicines at lower overall cost compared to the private sector, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH) has concerns about the continuous increase in the public sector medicines budget, and achieving...

Background Malaysia’s public healthcare sector provides a greater volume of medicines at lower overall cost, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH), as the main healthcare provider, has concerns about the continuous increase in the public sector medicines budget, and achievin...

In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors t...

Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperatio...

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies. This paper presents a descriptive analysis on health f...

Universal health coverage (UHC) - the availability of quality affordable health services for all when needed without financial impoverishment - can be a vehicle for improving equity health outcomes and financial wellbeing. It can also contribute to economic development. In its Global Health 2035 report the Lancet Commission on Investing in Health (...

The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security--its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities,...

Objective: To compare the quality of inpatient clinical care in public and private hospitals in Sri Lanka. Methods: A retrospective, cross-sectional comparison was done of inpatient quality, in a sample of 11 public and 10 private hospitals in three of 25 districts. Data were collected for 55 quality indicators from medical records of 2523 publi...

This publication presents estimates of health expenditure in Sri Lanka from 1990-2012. It is the third published release in the current Sri Lanka Health Accounts (SLHA) series, updating the previous publication released in 2011. The report presents expenditure estimates by source of funding, function and provider, as well as on a per-person basis...

Objective: To compare the quality of clinical care and patient satisfaction in public and private outpatient primary care services in Sri Lanka. Methods: A prospective, cross-sectional comparison was done by direct observation of patient encounters and exit interviews of outpatients in 10 public hospital general outpatient clinics and 66 private...

Child undernutrition is a major risk factor for child mortality and adult ill-health. Despite substantial progress in most health indicators, undernutrition remains high in Sri Lanka, with recent trends being unclear, owing to methodological differences in national surveys. This study uses data from the 1987, 1993, 2000 and 2006-07 Demographic and...

This study analyses the DHS 1993, 2000 and 2006-07 and NFSS 2009 survey data to investigate trends, inequalities and determinants of low birth weight (LBW) in Sri Lanka. We re-evaluated recent trends in LBW incidence, adjusting for changes in the coverage of DHS surveys to ensure comparability, and used multivariate logistic regression to investiga...

This paper reports on a project to improve the comparability and availability of private health expenditure under the joint health accounts questionnaire (JHAQ) data collection. The JHAQ is a framework for joint data collection in the area of health expenditure data developed by OECD, Eurostat, and WHO. In particular, the study questions were: How...

To elicit the public’s views on health system issues, we conducted an opinion poll survey in Bangladesh, Mongolia, Nepal, and Sri Lanka. We focused on health inequalities. The results show high levels of dissatisfaction with government health services in all four of the countries. Access to government health services was an important concern. A siz...

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Healt...

Out-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that are catastrophic, in the sense of severely disrupting household...

Alongside the first phase of SHA pilot implementations in the OECD, several non-OECD Asian economies piloted the SHA to produce standardised estimates of their national health spending. They range from some of the poorest economies in the world (Bangladesh, Nepal, Mongolia) to some of the richest (Hong Kong SAR, Taiwan). These results provide the f...

Background: In the past five years, the Equitap collaboration profiled equity in health systems financing and delivery in 17 Asian economies, ranging from Bangladesh to Hong Kong. Although higher income economies generally do better than poorer economies, significant differences exist in countries at similar income levels, and significant similarit...

The article compares the incidence of public healthcare across 11 Asian countries and provinces, testing the dominance of healthcare concentration curves against an equal distribution and Lorenz curves and across countries. The analysis reveals that the distribution of public healthcare is prorich in most developing countries. That distribution is...

Conventional estimates of poverty do not take account of out-of-pocket payments to finance health care. We aimed to reassess measures of poverty in 11 low-to-middle income countries in Asia by calculating total household resources both with and without out-of-pocket payments for health care. We obtained data on payments for health care from nationa...

To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. Total domes...

We represent ten groups of citizens and researchers from low- and middle-income countries who were recipients of International Health Research Awards (IHRA) presented at the Bangkok Conference on International Health Research for Development, 2000. The IHRA, funded by the Rockefeller Foundation and administered by the World Health Organization, rec...

National health accounts combined with data from a nationally representative household survey of health care utilization and expenditures are used to compile a description of the distribution of all health expenditures across a national population. This approach extends the earlier tradition of benefit-incidence studies by using NHA data to constra...

Abstract This first year PHR Applied Research Review has been developed as part of the process to select activities for the Applied Research component,of the PHR Project. The document,reviews current policy issues in all the core health sector reform areas, which are the concern of the project and relevant to achieving USAID strategic objectives. I...