Ensuring Tertiary Care Services to All: A Strategic Approach in the Socio-economic Context of Sri Lanka

Sri Lanka's health system is internationally recognized for achieving impressive health indicators at a relatively low cost, a testament to its robust primary and secondary healthcare networks. However, a significant challenge remains in ensuring equitable access to high-cost, technology-intensive tertiary care services, which are often concentrated in major urban centers. This disparity poses a barrier to the nation's commitment to Universal Health Coverage (UHC). This perspective article analyzes existing frameworks and proposals within the Sri Lankan health system to outline a strategic approach for decentralizing and democratizing tertiary care. We argue that instead of replicating high-cost infrastructure, Sri Lanka can adopt a more sustainable and efficient model based on networked resources, digital integration, and strengthened care pathways. Key strategies explored include the development of "hub-andspoke" models for high-technology services like cardiology and oncology, where district-level resources are shared among multiple institutions to maximize utilization. Furthermore, we examine the critical role of telemedicine and digital platforms in extending specialized expertise in fields like emergency medicine, community paediatrics, and mental health to peripheral settings. The National Organ Donor Coordination Programme is presented as a case study in effective, resource-conscious national coordination. The article concludes that by integrating these strategies—underpinned by robust Health Technology Assessment—Sri Lanka can create a resilient, equitable, and economically viable model for tertiary care delivery that aligns with its socio-economic context and reinforces its commitment to health for all.