Access to Care in a Plural Health System: Concerns for Policy Reforms

Objectives:
To examine accessibility to first contact healthcare in rural Sri Lanka in terms of physical proximity to service provider and out of pocket cost on such services in order to provide insights for future policy directions.

Methodology:
A community based and an institutional based survey was carried out in a rural district. A total of 1200 households were included in the community survey and 2221 patient encounters in both western and Ayurveda / traditional medical facilities were selected for institution based survey. Data was collected from the chief female occupant of the household and patients in the health institutions using an interviewer administered questionnaire.

Results:
On average all possible healthcare facilities were located within 6km of a household while most frequently visited facility indicated bypassing of a closer facility. Cost of seeking treatment from private facilities was over 7 times higher than the state facilities, less than 5% utilized of non western healthcare facilities.

Conclusion:
Physical proximity of facilities to the households and free of charge services of state health services may not guarantee their utilization. There is also a possibility of disappearance of plural nature of the health system in Sri Lanka giving away to a single dominant system.

Key words:  Sri Lanka; Accessibility; Plural medicine; Health system; Health seeking

DOI: 10.4038/jccpsl.v14i1.2947

Journal of the College of Community Physicians of Sri Lanka Vol.14(1) 2009 39-45