Introduction

3Key Challenges in Human Capital Development

CHILD AND ADULT SURVIVAL AND STUNTING

INTRODUCTION

The critical importance of health and nutrition to human capital development is reflected in the Human Capital Index (HCI). Health is not just a component of human capital; it also contributes to other elements of it. Being unhealthy at any stage of the life cycle hinders productivity and has impacts on human capital. This chapter analyzes the policy framework of Sri Lanka’s health care system in relation to the variables of the HCI: stunting, child survival, and adult survival. Special attention is paid to stunting and the underlying causes of undernutrition, which has been a long-standing issue in Sri Lanka. Based on the analyses, the chapter sets forth a set of recommendations for the country’s future development of human capital.

Sri Lanka has a track record of providing effective health services that have resulted in relatively strong health care indicators. Life expectancy at birth, which stood at 75 years as of 2016, was higher than the South Asian average of 69 years. In terms of maternal and child health (MCH) indicators, Sri Lanka’s neonatal, infant, and under-five mortality rates in 2018 were 6.5, 9.1, and 10.6 per 1,000 live births, respectively, and the maternal mortality ratio was 39.3 per 100,000 live births in 2017 (Sri Lanka, FHB 2019). Sri Lanka was certified by the World Health Organization (WHO) as having eradicated polio in 2014 and malaria in 2016. Public health care services are provided through a network of 1,118 government institutions operating at three levels. The primary level of composed of the primary medical care units and divisional hospitals, the secondary level of district general hospitals and base hospitals, and the tertiary level of national hospitals, teaching hospitals, and provincial general hospitals. Specialized care is provided by secondary- and tertiary-level institutions. A unique feature of the Sri Lankan health care system is that patients can opt to bypass primary-level institutions and obtain services directly from secondary- and tertiary-level institutions.

Although public health care services in Sri Lanka are provided free of charge, a significant portion of health services are provided by the private sector. It accounts for over 50 percent of total health spending (Amarasinghe, Dalpatadu, and Rannan-Eliya 2018). Out-of-pocket (OOP) funding accounts for 87 percent of private health spending (that is, approximately 45 percent of total health spending).