The success of maternal and child health care can be seen by the coverage of these primary health care services at national level and its ultimate impact in the health indices. Over the past years maternal mortality ratio dropped from 265 in 1935 to 5.3 per 10000 live births in 2003 and infant mortality rate from 263 in1935 to 11.2 per 1000 live births in 2003. The improvement of these health indicators paved the way to the demographic changes led to an aging population. With the prolongation of life expectancy the human beings are exposed to a wider range of risk factors for a longer duration of period. The transitions of economic, social and demographic determinants of health together with adoption of unhealthy lifestyles had led to an increase in non communicable diseases, which has surpassed the burden of communicable diseases. The rapid increase of non communicable diseases strongly affects the economy and social development of the country.

The five leading causes of hospital deaths in 2007 were ischaemic heart disease, neoplasms, pulmonary heart disease and diseases of the pulmonary circulation, cerebrovascular disease and diseases of the gastrointestinal tract which accounted for nearly 50% of hospital deaths (Department of Health Services 2008). The non communicable diseases account for the highest disability adjusted life years lost in Sri Lanka (Wijewardene & Spohr 2000). Alarmingly the present data indicates that the non communicable diseases have already infiltrated into the lower social sectors and higher diseases rates were observed in these groups compared to higher social class. The lower social categories are the main social categories living in rural and urban areas, and they have less access to quality health services.

Presently the Ministry of Health is exploring different avenues to combat the rise of non communicable disease. When considering such interventions it is important to identify the two main components of Sri Lankan Health system which are the curative sector and the preventive sector. Failure to appreciate the preventive health sector which delivers preventive primary health care will not yield successful results.

Department of Health Services, 2008. Annual Health Bulletin 2007. Colombo,  Department of Health Services.

Wijewardene, K. & Spohr, M., 2000. An attempt to measure burden of disease using disability adjusted life years for Sri Lanka. Ceylon Medical Journal, 45, 110-5.

Dr. A. Pubudu de Silva

MBBS (Colombo), MSc Community Medicine (Colombo), MD Community Medicine (Colombo)

Dr. A. Pubudu De Silva is a graduate of the Faculty of Medicine, University of Colombo who has done his MD thesis and Post Doctoral work in the area of Public Health.  He has delivered award winning papers both in and outside Sri Lanka. He is currently working in the Medical Service Division of the Ministry of Health and lives with his family in Colombo.