Illness and social protection: An agenda for action in Sri Lanka

Abstract

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.