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Worsening economic crisis in Sri Lanka: impacts on health
... The resilience of the Sri Lankan healthcare system was evident over the past several years as the country's economy underwent a massive downturn [8]. Sri Lanka experienced an economic and political implosion in 2022 following years of structural inefficiencies and macroeconomic mismanagement, combined with a very recent history of exogenous shocks (i.e., COVID-19, 2019 Easter attacks, global oil price hikes) that further exacerbated an already vulnerable economy [8]. ...
... The resilience of the Sri Lankan healthcare system was evident over the past several years as the country's economy underwent a massive downturn [8]. Sri Lanka experienced an economic and political implosion in 2022 following years of structural inefficiencies and macroeconomic mismanagement, combined with a very recent history of exogenous shocks (i.e., COVID-19, 2019 Easter attacks, global oil price hikes) that further exacerbated an already vulnerable economy [8]. Consequently, the acute shortages in essential items like fuel, food, and medicines profoundly impacted public health and healthcare [8,9]. ...
... Sri Lanka experienced an economic and political implosion in 2022 following years of structural inefficiencies and macroeconomic mismanagement, combined with a very recent history of exogenous shocks (i.e., COVID-19, 2019 Easter attacks, global oil price hikes) that further exacerbated an already vulnerable economy [8]. Consequently, the acute shortages in essential items like fuel, food, and medicines profoundly impacted public health and healthcare [8,9]. For instance, the threat of malnutrition loomed over young children due to crisis-induced food insecurity. ...
... This pandemic has both direct and indirect implications on the demographic Patterns in many countries including Sri Lanka (Sri Lanka Epidemiology Unit, 2023). For instance, many COVID-19 deaths have implications on mortality directly, while the COVID-19related economic recession observed in present Sri Lanka is expected to enlarge non-communicable diseases and deaths (NCDs) indirectly (Sri Lanka Epidemiology Unit, 2023;Matthias & Jayasinghe, 2022). At the same time, long-term lockdown experienced in the country and the death of a loved one in a family would have postponed the planned marriages considerably. ...
... Apart from the deadly virus, the economic performance of the country has suffered due to the lockdown and travel restrictions (Central Bank of Sri Lanka, 2022). Today, Sri Lanka is facing a challenging situation with the current economic crisis and high inflation which critically affected the country before the recovery from the ill effects of the COVID-19 pandemic (Matthias & Jayasinghe, 2022). Political uncertainty developed from the early part of 2022, which continues even today, and various socio-economic problems, the public faces become worse (Matthias & Jayasinghe, 2022). ...
... Today, Sri Lanka is facing a challenging situation with the current economic crisis and high inflation which critically affected the country before the recovery from the ill effects of the COVID-19 pandemic (Matthias & Jayasinghe, 2022). Political uncertainty developed from the early part of 2022, which continues even today, and various socio-economic problems, the public faces become worse (Matthias & Jayasinghe, 2022). Against this backdrop, the main objective of this paper is to investigate the impact of the COVID-19 pandemic and subsequent economic recession on the four demographic components, namely mortality, fertility, migration and marriage in Sri Lanka and possible implications. ...
The objective of this paper is to investigate the impact of the COVID-19 pandemic and subsequent economic recession on the three demographic components, namely mortality, fertility and migration in Sri Lanka and possible implications. A secondary data analysis of mortality, fertility, migration, and marriage data from the Registrar General’s Department of Sri Lanka and the Ministry of Health was conducted. Although excess mortality (COVID-19 deaths) in 2022 was substantially lower, it was elevated in 2021. In comparison to non-COVID-19 years, the number of deaths has increased substantially during the post-COVID-19 era – 146 thousand deaths in 2019 increased to 194 thousand in 2023 (30.1%). This marked increase could be attributed to the economic recession and related serious constraints faced by the health system in Sri Lanka. Further, a marked decrease in marriages (14.2%) was observed in 2020 due to COVID-19 which recovered to pre-COVID-19 level in 2021. However, instead of experiencing the “babyboom” phenomenon (as observed in some previous pandemics) in the aftermath of the COVID-19 pandemic, the observed data for Sri Lanka indicates a significant downward trend in fertility. Unexpectedly, 319 thousand births were reported in 2019 in Sri Lanka dropping to 257 thousand by 2023, which is a decline of over 62 thousand births (19%). This situation is further complicated by the highest reported outbound migration ever reported in Sri Lanka in 2022, displaying a 250% year-to-year increase. The changes in these demographic components would impact the macroeconomics.
... 10 While the growing numbers and geographical distribution stretch India's public health system, 11 the economic crisis in Sri Lanka affects the healthcare seeking behaviour. 12 Coupled with the diversity of sociodemographic and cultural factors, these result in a lack of nationally representative credible data on the burden, determining factors and management modalities for endometriosis and adenomyosis. With minimal exceptions, all Asian countries present a similar situation, warranting an urgent requirement to prioritise endometriosis and adenomyosis research activities specific to each country's needs. ...
... Both countries face significant challenges in healthcare infrastructure and resource allocation, with India's vast population and Sri Lanka's ongoing economic crisis further complicating the situation. 11,12,46,47 Securing adequate funding, improving healthcare infrastructure, and fostering political commitment are essential to ensure that research efforts translate into meaningful healthcare improvements. Recently, the Indian Council of Medical Research (ICMR) formed a National Task Force (NTF) for research on snakebite in India. ...
Endometriosis and adenomyosis are major gynaecological conditions affecting women of reproductive age-group,
particularly in low- and middle-income countries. This Health Policy outlined research priorities for India and Sri
Lanka, derived from a structured debate during the ‘Future Directions in Endometriosis and Adenomyosis Research’
workshop. Researchers from both countries emphasise the need for nationally representative data, improved diagnostic tools, and comprehensive care models. Shared priorities include developing patient registries and improving
healthcare access. India focuses on multidisciplinary care centres, advanced diagnostic research, and public education, while Sri Lanka highlights integrating traditional medicine and assessing economic impacts. Both countries
prioritise non-invasive diagnostics to address diagnostic delays and healthcare limitations. Establishing patient registries and consortiums for large-scale studies could inform healthcare strategies. Collaborative research among
Asian countries could generate tailored regional solutions. Coupled with a strong political will, and adequate funding,
the initiative can potentially improve diagnosis, treatment, and quality of life for affected women.
... The aftermath of the COVID 19 pandemic and the Sri Lankan economic crisis poses significant challenges to the delivery of health services and the management of healthcare facilities, due to budget constraints and limited resources (Gamage et al., 2022). Another issue arising in this context is the deterioration of mental health, due to challenges arising from the economic crisis (Matthias & Jayasinghe., 2022). ...
Standard medical curricula typically consist of fixed
courses, often leave little room for students to
meticulously study subjects of particular
interest. The incorporation of electives within the
medical curriculum addresses this issue as it
facilitates self-directed learning, allowing
students to customize learning experiences to
meet their diverse needs and personal interests
in the ever-evolving field of medicine.
... However, the psychological well-being of construction professionals has received comparatively less attention. Existing literature has acknowledged the detrimental effects of economic crises on mental health, particularly in developing countries (Matthias and Jayasinghe, 2022). Still, studies on the specific stressors construction professionals face in Sri Lanka during the crises remain sparse. ...
Purpose-Socioeconomic and political situations in a country significantly impact employment conditions across all sectors, placing employee well-being at risk during challenging times. This study aims to investigate work-related stress, coping strategies and their impact on the well-being of construction professionals in Sri Lanka amidst the ongoing economic crisis. Design/methodology/approach-A questionnaire survey was conducted among professionals employed by builders in major cities in Sri Lanka to assess their contemporary work stressors, mental health status and coping methods. A total of 105 usable responses were collected and analysed using statistical techniques such as t-tests, ANOVA and Pearson correlation. Findings-The study reveals that construction professionals in Sri Lanka experience moderate levels of stress and anxiety, primarily driven by five key stressors: time pressure, long work hours, excessive workload, insufficient pay and work-life imbalance. Among the professionals, technical officers are the most affected, followed by quantity surveyors and project managers. Additionally, employees in larger organisations experience higher levels of stress. Despite severe work stressors and economic challenges, including high inflation, the mental well-being of professionals remains only moderately affected, attributed to their consistent use of positive coping strategies such as spirituality, planful action and positive reappraisal. Originality/value-The findings have significant practical implications. Construction organisations should adopt tailored strategies to address identified stressors, such as implementing flexible work schedules, optimising workloads and providing adequate pay scales. Policies promoting work-life balance and supporting family and personal time can help foster a healthier work environment. Furthermore, professional development programs focusing on positive coping strategies, such as psychological training and peer support, can mitigate stress. Occupational health and safety authorities should recognise work stress as a critical health issue and integrate its management into regulations, encouraging socially responsible practices.
... [1][2][3][19][20][21][22][23] Sri Lanka is a LMIC currently struggling through an economic crisis. 24 The country, however, has a unique public healthcare delivery model funded by the government that offers services free of charge at the point of service delivery. 25 Dental services are integrated into the existing public health services. ...
Background
Dental radiography is an essential diagnostic tool in paediatric dentistry.
Aim
To explore attitudes, knowledge, and related factors of paediatric dental radiography among parents who attended the radiology department of a premier public dental hospital.
Design
The study was conducted at the National Dental Hospital (Teaching) Sri Lanka among 124 parents whose children (<13‐years) underwent dental radiographic examination. Data on sociodemographic characteristics, radiographic investigations, and parental knowledge and attitudes on paediatric dental radiography were collected using an interviewer‐administered questionnaire. Data were entered and analyzed using the SPSS‐21 statistical software package.
Results
The mean score (95% CI) of parental attitudes and knowledge on paediatric dental radiography were 17.55 (17.64–18.45) on a scale from 7 to 35 and 3.73 (3.34–4.13) on a scale from −7 to +7, respectively. Significant differences in parental knowledge were evident by child's age ( p = 0.046), ethnicity ( p = 0.035), and parental attitudes ( p = 0.024). Binary logistic regression analysis revealed a significant independent association between parental attitudes with parental knowledge: OR (95% CI) = 2.413 (1.098–5.302) ( p = 0.028).
Conclusions
Parents demonstrated less favorable attitudes but sufficient knowledge on many aspects of paediatric dental radiography. Therefore, interventions are needed to improve parental attitudes on paediatric dental radiography especially by providing child‐friendly services.
... The recent economic crisis in Sri Lanka has further strained the health system, leading senior clinicians to advocate for greater reliance on "clinical judgment" and reduced dependence on laboratory investigations. 73 Our web application can supplement such clinical judgment as a lowcost tool that relies on self-reported symptoms and background characteristics and potentially triages patients for further investigation. ...
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. Thirteen machine learning algorithms, including Logistic Regression, Support Vector Machine, Decision Tree, Random Forest, Naïve Bayes, K-Nearest Neighbors, Gradient Boost, XGBoost, AdaBoost, CatBoost, LightGBM, Multi-Layer Perceptron, and Probabilistic Neural Network, are employed. Results: A hybrid version of Logistic Regression and LightGBM outperformed other models, achieving an AUC of 0.9062 and 79.85% sensitivity. Key predictive features for asthma include wheezing, breathlessness with wheezing, shortness of breath attacks, coughing attacks, chest tightness, nasal allergies, physical activity, passive smoking, ethnicity, and residential sector. Conclusion: Combining Logistic Regression and LightGBM models can effectively predict adult asthma based on self-reported symptoms and demographic and behavioural characteristics. The proposed expert system assists clinicians and patients in diagnosing potential asthma cases.
... For instance, the healthcare system of Sri Lanka was hit by a double burden of COVID-19 and economic downfall due to political instability which led to an increase in people's need for healthcare and reduced access, especially the most vulnerable groups in the society. The shift of patients from out-of-pocket expenditure to public hospitals further stressed the burden on the healthcare system [4]. In a situation where the demand for public healthcare is growing and difficult to meet, the importance of medical research becomes more apparent. ...
... Sri Lanka is a low-income South Asian country recovering from decades of conflict 21 and is currently suffering from an economic crisis 22 . Whilst the country is rapidly reconstructing its healthcare system, evidence is needed on how to ensure optimal management of AF, including early diagnosis, stroke-preventative medication, and reduction of risk factors in normal times and in times of crises. ...
Background
Early diagnosis and continuity of care is vital for atrial fibrillation (AF), to reduce stroke ; There is a lack of understanding of when and how AF is being diagnosed and managed the care pathway) in in low- and middle-income countries (LMICs). We aimed to identify the AF care pathway in Northern Province, Sri Lanka and determine how the COVID-19 pandemic impacted the care pathway.
Methods
This descriptive longitudinal study utilised two quantitative questionnaires to evaluate the AF pathway: The first questionnaire (baseline) was used to identify where AF was being diagnosed and the second questionnaire (3 months following baseline) was used to identify where and how often AF follow-up care was being received. How the COVID-19 pandemic impacted the care pathway was asked in the second questionnaire. We aimed to recruit 236 adults (≥18 years) with AF from Jaffna Teaching Hospital. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics.
Results
151 participants were recruited (median age 57 years; 70% female). Most participants were diagnosed in the accident & emergency (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AF-related healthcare visits per person for a month; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants’ care: healthcare visits were reduced or, delayed or medications were unattainable, and longer intervals between blood tests were experienced; however, 24% of participants were able to receive their medication by ambulance, public health staff or post during lockdowns.
Conclusions
Primary care was not involved in the diagnosis of AF, indicating that most diagnoses occurr after a medical emergency. The frequency of blood tests was lower than the guideline recommendations of one per month which could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises.
Background:
Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014-16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession.
Methods:
In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick-Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied.
Findings:
Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09-0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698-33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15-0·80]), men (0·67 [0·22-1·13]), and individuals aged 30-59 years (0·43 [0·16-0·69] per 1 percentage-point increase in the unemployment rate. No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15-29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed.
Interpretation:
The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally.
Funding:
None.
Sri Lanka is facing demographic and epidemiological transitions. This demographic transition will result in the population of the elderly increasing rapidly over the next few decades. This group is likely to have a high prevalence of age-related chronic diseases and disabilities. The country also faces an epidemiological transition and the prevalence of Non Communicable Diseases (NCD)s is already showing signs of rapid increase in the young and the elderly. The provision of care for the chronically ill will increase costs of health care. This includes direct medical costs for treatment and direct non-medical costs such as transport costs to attend clinics. Indirect costs include loss of earnings as a result of illness and absenteeism and decreased productivity because of ill health. The state sector hospitals and clinics provide health care free at the point of delivery. However, studies indicate that households incur considerable out-of-pocket expenses during illness, partly because of transport costs and for accessing private healthcare. Costs incurred by households for specific illnesses indicate that the expenses can be several-fold of the average per capita income. Formal support for illnesses is limited and that too is through a multitude of institutions. The type of support provided is mostly limited to cash transfers and the linkages between social services and the health sector are weak. As a result, the health sector rarely interacts with the social services and therefore finds it tedious to direct the needy persons towards available social resources. Thus, households and families often carry the burden of chronic diseases and illness with little social support. With changing family structures (e.g. lesser number of children, migration of young adults and female employment), households will increasingly face difficulties in caring for the chronically ill. Comprehensive social policies are therefore essential to meet the growing needs of people with chronic illnesses. Formal linkages between the social service sector and the health sector are essential and can be increased by having cadres of medical social workers.