Sri Lanka’s primary health care system pre-dates Alma Ata and has been the foundation of the country’s remarkable health achievements, well above its income group. With a shift underway in both demographic and epidemiological profiles,
Sri Lanka’s focus now is reforming PHC to address aging and premature deaths due to non-communicable diseases (NCDs).
Sri Lanka has taken a proactive step through the Healthy Cities initiative to enhance its population’s overall quality of life. With support from UNICEF and WHO, this initiative is one of the first in South-East Asia to promote health, equity, and sustainable development through a multisectoral approach. The Jaffna Healthy City Programme, for example, introduces opportunities for healthy choices such as increased physical activity, improved hygiene and reduced waste production at city schools, workplaces, and public spaces. The programme follows the “PHC as a whole-of-society approach to health” including multisectoral action, empowerment of communities and a focus on primary prevention.
As part of the programme, WHO and UNICEF have drawn on and coordinated their technical expertise in health and leading youth-oriented initiatives, respectively, to help revitalize water, sanitation, and hygiene facilities at local schools. The programme
also promotes gender equality to boost the attendance and well-being of female students.
Students of Vembadi Girls’ High School participating in the Menstrual Health and Hygiene Workshop, January 2022. © Sri Lanka/Veneka Logenthiran.
Like most countries, Sri Lanka has struggled to maintain its hard-earned Sustainable Development Goal (SDG) achievements due to the shift in priorities since the beginning of the COVID-19 pandemic. To support a comprehensive and resilient recovery, UNICEF
and WHO partnered with the government, nongovernmental organizations (NGOs), and academia in Sri Lanka to initiate the Jaffna Healthy City Programme. An increasing trend of NCDs has been observed in Sri Lanka, attributable to life-style risk factors
such as unhealthy diet and weight, lack of exercise, smoking, alcohol and drug consumption, and stress. With strengthened collaboration, mutual learning and effective allocation of shared resources, the agencies helped to place health high on the
social and political agenda of the city. Currently, over 600 000 citizens have access to a healthier lifestyle with more exercise, improved mental well-being, more equitable educational opportunities, and improved environmental choices.
The Jaffna Healthy City Programme is jointly implemented by the Department of Community and Family Medicine at the University of Jaffna, the Jaffna Municipal Council, the Departments of Health Services and Education of the Northern Province, with technical and financial support from GAP agencies UNICEF and WHO.
To kick the initiative off, WHO convened an advocacy meeting to promote the concept of Healthy Cities to the Mayor of Jaffna City and multisectoral stakeholders. UNICEF and WHO provided technical guidance on strategic approaches at regular meetings with leads on developmental aid and health promotion, respectively. The agencies have been successful in initiating activities to create an environment conducive to health in schools, workplaces, and public spaces. WHO guided the needs assessment, prioritizing actions based on its guidance for Healthy Cities, while UNICEF led school-based interventions.
For the work in schools, the agencies supported revision of regulations at 10 schools with more than 8000 students and nearly 500 teachers to develop an environment more supportive of healthy choices. A programme to promote frequent engagement in physical activities was launched. Water, sanitation, and hygiene facilities within these schools were improved, and workshops conducted to raise awareness on menstrual hygiene and puberty. This in turn empowered girls and women by addressing barriers to equal opportunity for female students.
At the workplaces, healthy eating habits and keeping physically fit was encouraged. Interventions in public spaces involved an effort to reintroduce the culture of cycling and reduce motorized vehicles as a mode of transport. Sustainable waste management was promoted in all settings.
PHC strengthening in Sri Lanka provides a platform for coordinating multi-agency initiatives and programmes. The Jaffna Healthy City Programme includes all three components of PHC through an integrated strategy that aims to meet people’s health
needs throughout the life-course, address broader determinants of health, and empower families and communities to take charge of their own health. Sri Lanka’s experience may serve as a model for other developing countries in building cities
that promote better health and well-being for all.
Some key achievements following the strong collaboration among GAP agencies in the Jaffna Healthy City Programme are:
- Introduction of an integrated strategy to respond to the rising burden of NCDs by emphasizing disease prevention and health promotion;
- Empowerment of women through measures that enhance gender equality; and
- Establishment of a mechanism for engaging multisectoral stakeholders from health and non-health sectors including government at all levels, NGOs, universities, and communities on issues that affect health and well-being.
Challenges faced during the collaboration include:
- GAP agencies experienced competing priorities in Sri Lanka due to the need for public health and social measures to contain COVID-19; and
- Government officials rotate every two years, creating continuity challenges.
Moving forward, the following are needed to ensure sustainable recovery:
- A joint technical assistance plan is needed among development partners that is aligned with national priorities;
- Consistent use of national coordination mechanisms by the partners; and
The Jaffna Healthy City Programme’s output and outcome indicators need to be identified to monitor progress and assess outcomes and impact of the programme.
School workshop on Menstrual Health and Hygiene in Jaffna City gives confidence to females to place themselves at equals with their male counterparts
Note: names have been changed to protect privacy
Shreya and Sanaya are eleventh grade students at the Vembadi Girls’ High School in Jaffna City, Sri Lanka. They are highly ambitious and aspire to pursue careers in medicine and artificial intelligence. Besides their competitive academic standings, they often beat their male cousins at chess and badminton. However, there is a time when they don’t feel equal – during menstruation.
Since reaching puberty, Shreya and Sanaya have experienced energy variations, mood fluctuations and physical discomfort during their menstrual cycles. Because these issues are rarely discussed, they were embarrassed to express themselves and sometimes felt repelled by their own bodies. Their self-esteem was lowered, preventing them from reaching their full potential. Myths circulated that eating fruits such as pineapples and papayas would increase bleeding, depriving them of a balanced diet and worsening their energy levels.
In early 2022, their school held a workshop on menstrual health and hygiene as a part of the Jaffna Health City Programme, supported by UNICEF and WHO. In addition to exposing myths and providing information on menstrual hygiene, the workshop explained puberty for both sexes. The teenage participants were relieved to learn that their male counterparts also underwent puberty, despite differences in physiology.
“Before coming to the workshop, I did not realize how normal puberty is!” Shreya said. “We have been sharing knowledge among our friends and families so that the females don’t feel ashamed of their bodies and carry on all activities without hesitation during menstruation, just like the males do!”, said Sayana.
What is the SDG3 GAP?
The Global Action Plan for Healthy Lives and Wellbeing for All (SDG3 GAP) is a set of commitments by 13 agencies that play significant roles in health, development and humanitarian responses to help countries accelerate progress on the health-related SDG targets.
The added value of the SDG3 GAP lies in strengthening collaboration across the agencies to take joint action and provide more coordinated support aligned to country owned and led national plans and strategies. A “recovery strategy” (Oct 2021) serves as a strategic update on the SDG3 GAP in the context of achieving an equitable and resilient recovery from the COVID-19 pandemic to the health-related SDG targets.
The purpose of GAP case studies is to monitor SDG3
GAP implementation at country level.