Publication:
Multisectoral Preventive Health Services in Sri Lanka : Lessons for Developing Countries in Providing Public Goods in Health

Loading...
Thumbnail Image
Files in English
English PDF (611.47 KB)
623 downloads
English Text (128.88 KB)
167 downloads
Published
2013-08
ISSN
Date
2015-02-23
Editor(s)
Abstract
What can other developing countries learn from Sri Lanka on achieving good health at low cost? While its well-organized medical and maternal-child health services have been documented elsewhere, this paper fills a gap in documenting how it organizes services to reduce the population's exposure to disease -- a pure public good. The key factors underlying the effectiveness of these services are (1) strong focal points in the central Health Ministry for supporting preventive services; (2) pro-active outreach by the health line agency to collaborate with other sectors / agents whose work influences public health outcomes; and (3) community-level delivery institutions with well-trained multivalent Public Health Inspectors -- all underpinned by (4) assured tax-based financing. This paper describes this system in some detail such that other countries can learn from Sri Lanka's successful approach to improving population health. It also makes some recommendations for strengthening the system in response to changing conditions.
Link to Data Set
Citation
Das Gupta, Monica; Dalpatadu, K.C.S.; Shanmugarajah, C.K.; Herath, H.M.S.S.D.. 2013. Multisectoral Preventive Health Services in Sri Lanka : Lessons for Developing Countries in Providing Public Goods in Health. Policy Research Working Paper;No. 6558. © http://hdl.handle.net/10986/21475 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Report Series
Other publications in this report series
  • Publication
    The Economic Value of Weather Forecasts: A Quantitative Systematic Literature Review
    (Washington, DC: World Bank, 2025-09-10) Farkas, Hannah; Linsenmeier, Manuel; Talevi, Marta; Avner, Paolo; Jafino, Bramka Arga; Sidibe, Moussa
    This study systematically reviews the literature that quantifies the economic benefits of weather observations and forecasts in four weather-dependent economic sectors: agriculture, energy, transport, and disaster-risk management. The review covers 175 peer-reviewed journal articles and 15 policy reports. Findings show that the literature is concentrated in high-income countries and most studies use theoretical models, followed by observational and then experimental research designs. Forecast horizons studied, meteorological variables and services, and monetization techniques vary markedly by sector. Estimated benefits even within specific subsectors span several orders of magnitude and broad uncertainty ranges. An econometric meta-analysis suggests that theoretical studies and studies in richer countries tend to report significantly larger values. Barriers that hinder value realization are identified on both the provider and user sides, with inadequate relevance, weak dissemination, and limited ability to act recurring across sectors. Policy reports rely heavily on back-of-the-envelope or recursive benefit-transfer estimates, rather than on the methods and results of the peer-reviewed literature, revealing a science-to-policy gap. These findings suggest substantial socioeconomic potential of hydrometeorological services around the world, but also knowledge gaps that require more valuation studies focusing on low- and middle-income countries, addressing provider- and user-side barriers and employing rigorous empirical valuation methods to complement and validate theoretical models.
  • Publication
    It’s Not (Just) the Tariffs: Rethinking Non-Tariff Measures in a Fragmented Global Economy
    (Washington, DC: World Bank, 2025-10-22) Taglioni, Daria; KEE, Hiau Looi
    As tariffs have declined, non-tariff measures (NTMs) have become central to trade policy, especially in high-income countries and regulated sectors like food and green technologies. Although NTMs may serve legitimate goals, they could also sort countries and firms into or out of markets based on compliance capacity and differences in product mix. Documenting recent advances in the estimation of ad valorem equivalents (AVEs), this paper uncovers new patterns of use and exposure of NTMs. High-income countries rely more heavily on NTMs relative to tariffs, while low- and middle-income countries face steeper AVEs on their exports. Firm-level evidence shows that NTMs disproportionately affect smaller firms, leading to market exit and concentration. Poorly designed NTMs can harm productivity and welfare, while coordinated, capacity-aware use can deliver inclusive outcomes. Policy design, transparency, and diagnostics must evolve to reflect the growing role—and risks—of NTMs in a fragmented global trade landscape.
  • Publication
    Monitoring Global Aid Flows: A Novel Approach Using Large Language Models
    (Washington, DC: World Bank, 2025-11-04) Luo, Xubei; Rajasekaran, Arvind Balaji; Scruggs, Andrew Conner
    Effective monitoring of development aid is the foundation for assessing the alignment of flows with their intended development objectives. Existing reporting systems, such as the Organisation for Economic Co-operation and Development’s Creditor Reporting System, provide standardized classification of aid activities but have limitations when it comes to capturing new areas like climate change, digitalization, and other cross-cutting themes. This paper proposes a bottom-up, unsupervised machine learning framework that leverages textual descriptions of aid projects to generate highly granular activity clusters. Using the 2021 Creditor Reporting System data set of nearly 400,000 records, the model produces 841 clusters, which are then grouped into 80 subsectors. These clusters reveal 36 emerging aid areas not tracked in the current Creditor Reporting System taxonomy, allow unpacking of “multi-sectoral” and “sector not specified” classifications, and enable estimation of flows to new themes, including World Bank Global Challenge Programs, International Development Association–20 Special Themes, and Cross-Cutting Issues. Validation against both Creditor Reporting System benchmarks and International Development Association commitment data demonstrates robustness. This approach illustrates how machine learning and the new advances in large language models can enhance the monitoring of global aid flows and inform future improvements in aid classification and reporting. It offers a useful tool that can support more responsive and evidence-based decision-making, helping to better align resources with evolving development priorities.
  • Publication
    The Macroeconomic Implications of Climate Change Impacts and Adaptation Options
    (Washington, DC: World Bank, 2025-05-29) Abalo, Kodzovi; Boehlert, Brent; Bui, Thanh; Burns, Andrew; Castillo, Diego; Chewpreecha, Unnada; Haider, Alexander; Hallegatte, Stephane; Jooste, Charl; McIsaac, Florent; Ruberl, Heather; Smet, Kim; Strzepek, Ken
    Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.
  • Publication
    The State of Global Services Trade Policies: Evidence from Recent Data
    (Washington, DC: World Bank, 2025-10-28) Baiker, Laura; Borchert, Ingo; Echandi, Roberto; Fernandes, Ana M.; Hans, Ishrat; Magdeleine, Joscelyn; Marchetti, Juan A.; Colomer, Ester Rubio
    The economic environment for services trade has changed dramatically over the past 15 years, driven by rapid technological progress that has expanded the possibilities for exchanging services. How has trade policy responded to these changes? How do policy stances in a wide range of service sectors compare across economies? With its unprecedented global coverage, the Services Trade Policy Database and the associated Services Trade Restrictions Index, developed jointly by the World Bank and the World Trade Organization, help address these questions. This paper makes three principal contributions. First, it offers an in-depth discussion of the current state of services trade policies and their differences across 134 economies and 34 services subsectors. Second, the paper reveals how recent (2016–22) changes in policy stances have seen progressive liberalization by lower-income economies but stabilization or even slight policy reversals in high-income economies. This dynamic differs fundamentally from the trend that unfolded after the Great Recession over 2008–16. Third, the paper shows the implications of policy changes over the past six years on services trade costs, and it showcases how the Services Trade Policy Database’s regulatory information can inform trade negotiations, regulatory analysis, and policy making. Alongside these contributions, the paper documents updates to the Services Trade Policy Database’s economy and sector coverage and explains the latest methodological improvements made to the World Bank–World Trade Organization Services Trade Restrictions Index.
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    How to Improve Public Health Systems : Lessons from Tamil Nadu
    (2009-10-01) Das Gupta, Monica; Desikachari, B.R.; Somanathan, T.V.; Padmanaban, P.
    Public health systems in India have weakened since the 1950s, after central decisions to amalgamate the medical and public health services, and to focus public health work largely on single-issue programs - instead of on strengthening public health systems broad capacity to reduce exposure to disease. Over time, most state health departments de-prioritized their public health systems. This paper describes how the public health system works in Tamil Nadu, a rare example of a state that chose not to amalgamate its medical and public health services. It describes the key ingredients of the system, which are a separate Directorate of Public Health - staffed by a cadre of professional public health managers with deep firsthand experience of working in both rural and urban areas, and complemented with non-medical specialists with its own budget, and with legislative underpinning. The authors illustrate how this helps Tamil Nadu to conduct long-term planning to avert outbreaks, manage endemic diseases, prevent disease resurgence, manage disasters and emergencies, and support local bodies to protect public health in rural and urban areas. They also discuss the system s shortfalls. Tamil Nadu s public health system is replicable, offering lessons on better management of existing resources. It is also affordable: compared with the national averages, Tamil Nadu spends less per capita on health while achieving far better health outcomes. There is much that other states in India, and other developing countries, can learn from this to revitalize their public health systems and better protect their people s health.
  • Publication
    How Can Donors Help Build Global Public Goods in Health?
    (2009-04-01) Das Gupta, Monica; Gostin, Lawrence
    Aid to developing countries has largely neglected the population-wide health services that are core to communicable disease control in the developed world. These mostly non-clinical services generate "pure public goods" by reducing everyone's exposure to disease through measures such as implementing health and sanitary regulations. They complement the clinical preventive and treatment services which are the donors' main focus. Their neglect is manifested, for example, in a lack of coherent public health regulations in countries where donors have long been active, facilitating the spread of diseases such as avian flu. These services can be inexpensive, and dramatically reduce health inequalities. Sri Lanka spends less than 0.2% of GDP on its well-designed population-wide services, which contribute to the country's high levels of health equity and life expectancy despite low GDP per head and civil war. Evidence abounds on the negative externalities of weak population-wide health services. Global public health security cannot be assured without building strong national population-wide health systems to reduce the potential for communicable diseases to spread within and beyond their borders. Donors need greater clarity about what constitutes a strong public health system, and how to build them. The paper discusses gaps in donors' approaches and first steps toward closing them.
  • Publication
    How Might India’s Public Health Systems Be Strengthened?
    (2009-11-01) Das Gupta, Monica; Shukla, Rajendra; Somanathan, T.V.; Datta, K.K.
    The central government s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry s capacity for stewardship of the nation s public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship, and re-vitalizing the states public health managerial cadres as well as the grassroots public health workers. The central government could consider linking its fiscal support to states with phased progress in four areas: (1) the enactment of state Public Health Acts; (2) the establishment by states of separate public health directorates; (3) the re-vitalization of grassroots public health workers; and (4) health department engagement in ensuring municipal public health. The central focal point could provide the needed support, oversight, incentives, and sanctions to ensure that states build robust public health systems. These measures can do much to help governments use public funds more effectively for protecting people s health.
  • Publication
    People, Pathogens, and Our Planet : Volume One - Towards a One Health Approach for Controlling Zoonotic Diseases
    (World Bank, 2010-01-01) World Bank
    Whether living in urban or rural environments, humans tend to perceive the world around them as being shaped by culture and industry more than by natural history. Humans, however, are part of a biological continuum that covers all living species. Charles Darwin's 200th birthday in 2009 could serve to remind us of this. All animals, including humans but also plants, fungi, and bacteria, share the same basic biochemical principles of metabolism, reproduction, and development. Most pathogens can infect more than one host species, including humans. In 1964, veterinary epidemiologist Calvin Schwabe coined the term "one medicine" to capture the interrelatedness between animal and human health, and the medical realities of preventing and controlling zoonotic diseases or "zoonoses" -diseases that are communicable between animals and humans. One medicine signaled the recognition of the risks that zoonotic diseases pose to people, their food supplies, and their economies. Given the interrelatedness of human, animal, and ecosystem health, the rationale for some form of coordinated policy and action among agencies responsible for public health, medical science, and veterinary services is quite intuitive. Later, the term "one health" came into use, and later still, the broader concept of "one world one health," which is today used to represent the inextricable links among human and animal health and the health of the ecosystems they inhabit.
  • Publication
    Animal and Pandemic Influenza : A Framework for Sustaining Momentum, Fifth Global Progress Report July 2010
    (New York: United Nations, 2010-07) UN System Influenza Coordination; World Bank
    Global efforts continue to work towards ensuring a world capable of preventing, detecting, and responding to animal and public health risks attributable to zoonoses and animal diseases. Drawing on achievements and experiences of the past five years, the fifth global progress report was produced to support the discussions and to provide a record of key outcomes from international ministerial conference on animal and pandemic influenza (IMCAPI). This report presents a framework for sustaining momentum which was agreed by delegates at the April 2010 IMCAPI. The framework offers three streams of work that need sustained attention by national, regional, and global authorities despite the inevitable waning of public interest in pandemic-related issues. The three work streams are: (a) prevention and control of highly pathogenic avian influenza (HPAI), (b) adoption of one health approaches, and (c) readiness for response to influenza pandemics. For each, the framework envisages two expected outcomes and identifies the actions which contribute to these expected outcomes. It identifies the incentives and institutional arrangements needed to sustain momentum, highlights systems for monitoring progress, and spells out investment priorities particularly to support institutions and systems in the least developed countries. To realize these goals, policy makers are moving away from tackling avian and pandemic influenza through emergency projects or special initiatives. Instead they aim for longer term capacity building through pursuit of effective strategies within existing programs, and the mainstreaming of pandemic readiness skills. The right incentives to achieve this transformation need to be identified and used backed with strategic political and financial support, novel institutional arrangements, and easily applied monitoring systems.

Users also downloaded

Showing related downloaded files

  • Publication
    World Development Report 2006
    (Washington, DC, 2005) World Bank
    This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.
  • Publication
    Classroom Assessment to Support Foundational Literacy
    (Washington, DC: World Bank, 2025-03-21) Luna-Bazaldua, Diego; Levin, Victoria; Liberman, Julia; Gala, Priyal Mukesh
    This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.
  • Publication
    Digital Africa
    (Washington, DC: World Bank, 2023-03-13) Begazo, Tania; Dutz, Mark Andrew; Blimpo, Moussa
    All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.
  • Publication
    Doing Business 2014 : Understanding Regulations for Small and Medium-Size Enterprises
    (Washington, DC: World Bank Group, 2013-10-28) World Bank; International Finance Corporation
    Eleventh in a series of annual reports comparing business regulation in 185 economies, Doing Business 2014 measures regulations affecting 11 areas of everyday business activity: Starting a business, Dealing with construction permits, Getting electricity, Registering property, Getting credit, Protecting investors, Paying taxes, Trading across borders, Enforcing contracts, Closing a business, Employing workers. The report updates all indicators as of June 1, 2013, ranks economies on their overall “ease of doing business”, and analyzes reforms to business regulation – identifying which economies are strengthening their business environment the most. The Doing Business reports illustrate how reforms in business regulations are being used to analyze economic outcomes for domestic entrepreneurs and for the wider economy. Doing Business is a flagship product by the World Bank and IFC that garners worldwide attention on regulatory barriers to entrepreneurship. More than 60 economies use the Doing Business indicators to shape reform agendas and monitor improvements on the ground. In addition, the Doing Business data has generated over 870 articles in peer-reviewed academic journals since its inception.
  • Publication
    World Development Report 2011
    (World Bank, 2011) World Bank
    The 2011 World development report looks across disciplines and experiences drawn from around the world to offer some ideas and practical recommendations on how to move beyond conflict and fragility and secure development. The key messages are important for all countries-low, middle, and high income-as well as for regional and global institutions: first, institutional legitimacy is the key to stability. When state institutions do not adequately protect citizens, guard against corruption, or provide access to justice; when markets do not provide job opportunities; or when communities have lost social cohesion-the likelihood of violent conflict increases. Second, investing in citizen security, justice, and jobs is essential to reducing violence. But there are major structural gaps in our collective capabilities to support these areas. Third, confronting this challenge effectively means that institutions need to change. International agencies and partners from other countries must adapt procedures so they can respond with agility and speed, a longer-term perspective, and greater staying power. Fourth, need to adopt a layered approach. Some problems can be addressed at the country level, but others need to be addressed at a regional level, such as developing markets that integrate insecure areas and pooling resources for building capacity Fifth, in adopting these approaches, need to be aware that the global landscape is changing. Regional institutions and middle income countries are playing a larger role. This means should pay more attention to south-south and south-north exchanges, and to the recent transition experiences of middle income countries.