Advancing primary health care reforms in Sri Lanka through global technical collaboration

Primary Health Care (PHC) is the engine of Universal Health Coverage, where prevention meets early detection, where continuity of care reduces avoidable hospital demand, and where communities experience the health system as accessible, trusted and responsive. Against the backdrop of an ageing population, a growing burden of noncommunicable diseases, and ongoing economic pressures, Sri Lanka is taking forward a major reorganization of PHC, with Arogya Health and Wellness Centres expected to anchor a more people-centered model of care.

To support this transition, WHO Sri Lanka welcomed a high-level mission of seven international experts from India, Japan, Australia, the United Kingdom and Thailand on 20 April 2026. Through a week-long engagement, the mission’s purpose was not simply to review progress, but to help translate reform ambition into practical choices, aligning governance, financing, workforce arrangements, information systems and service delivery with what is feasible to implement and scale.

The week opened with strategic policy dialogue with the Hon. Minister of Health and Mass Media, Dr Nalinda Jayatissa, focused on how Arogya Health and Wellness Centres can function as the operational backbone of the reorganized PHC system. Discussions placed particular emphasis on the system pressures driving reform - population ageing, rising NCDs and equity gaps - alongside the need to strengthen digital health and data use so services can be planned and delivered around people and communities.

From the outset, the mission reinforced a core PHC reality: systems change is delivered by people. Consultations with health leaders including the actg. Secretary, Ministry of Health and Mass Media, Director General of Health Services, examined how multidisciplinary teams can be strengthened in practice, especially through the evolving roles of nursing and allied health professionals. The conversations focused on what is required to make team-based care work consistently: fit-for-purpose training, clear responsibilities across cadres, and the coordination mechanisms that allow patients to move smoothly through prevention, screening, diagnosis, treatment and follow-up.

Policy intent becomes credible when it withstands frontline reality. On day 2, a field visit to Ratnapura District offered the mission team a grounded view of implementation at service level through the Ethoya Arogya Health and Wellness Centre and the Ratnapura Town Primary Medical Care Unit (PMCU). The mission observed how outreach and routine service delivery are being operationalized, including the completion of household population surveys that support more proactive, population-based care. At the same time, discussions with frontline teams highlighted operational constraints that must be addressed as reforms scale, ranging from workflow and staffing pressures to the everyday system factors that shape quality, continuity and patient experience.

As the mission moved from service delivery to the broader system architecture, consultations with the Sri Lanka Medical Association (SLMA) and professional medical colleges focused on how care pathways can be reorganized more efficiently. 

Engagements with Sri Lanka Medical Council (SLMC) and Academia also examined the enabling environment required for PHC to function reliably: aligning education and training with PHC-oriented competencies and strengthening health professional regulations. Discussions also focused on equitable and affordable access to medicines and medical products at the point of care.

PHC reform is fundamentally cross-cutting, touching all aspects of the health system and communities. Meetings with the UN Resident Coordinator and UN agencies (including UNICEF, UNFPA, WFP, IOM and UNDP), alongside discussions with development partners such as the World Bank, ADB and JICA and KOFIH reinforced a shared objective: align technical and investment support around nationally led priorities, reduce fragmentation, and accelerate implementation in ways that strengthen the system rather than create parallel approaches. The mission also met with the European Union and the Ministry of Finance, Planning and Economic Development, reaffirming shared priorities and continued collaboration to support health sector reforms in Sri Lanka.

Civil society engagement brought an essential reality check: services strengthen when communities understand them, trust them and shape them. Discussions highlighted community-level gaps and the potential value of volunteer engagement at the grassroots, pointing to the importance of community ownership in making Arogya Health and Wellness Centres effective and sustainable. 

The week concluded with a debriefing to the Ministry of Health, focused on practical implementation pathways, how to prioritize within resource constraints, how to sequence change, and how to optimize existing capacity so that people-centred care can be delivered consistently.

Across the week, the mission’s consultations, spanning national leadership, frontline services, professional bodies, regulators, partners and civil society, were not standalone engagements. Together, they helped consolidate a coherent picture of what PHC reorganization will require to deliver results: stronger governance and referral pathways, a prepared workforce and functioning multidisciplinary teams, dependable medicines and supplies, and smarter use of digital tools and data to manage defined populations and improve continuity of care.

This shared direction was consolidated on 06 May 2026, when the WHO Representative to Sri Lanka, Dr Rajesh Sambhajirao Pandav, handed over the report “Transforming Primary Health Care as the Foundation for Healthier Communities in Sri Lanka” to the Hon. Minister of Health and Mass Media, Dr Nalinda Jayatissa, in the presence of the Hon. Deputy Minister of Health.

The report is the outcome of WHO’s two-phase health system review, undertaken with support from an international team of experts at the request of the Hon. Minister. It provides strategic recommendations to advance Universal Health Coverage through a people-centred, PHC-oriented approach, with a strong focus on strengthening Arogya Health and Wellness Centres as the foundation of comprehensive PHC in Sri Lanka.

With the report now formally handed over, the emphasis shifts from diagnosis to delivery, translating recommendations into sequenced implementation, supporting provinces and facilities to operationalize changes, and strengthening the system functions that make quality care possible every day. 

WHO's ability to carry out this nationally significant activity was made possible through the catalytic backing of UHC partnership Phase V funding.

WHO reaffirms its commitment to working with the Government of Sri Lanka and partners to translate this shared vision into action, building a more integrated, resilient and community-responsive health system for all.