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Research Project Update: Primary Health Care in Sri Lanka

Posted on 6 August 2015

An update from the Centre’s Dr Margaret Jones on her research on the 'Local Bases of Global Health' project

Dr Margaret Jones is a research fellow working on the major, Wellcome Trust-funded project ‘The Local Bases of Global Health: Primary Health Care in South Asia and Beyond, 1945-2010’. Dr Jones is researching the development of primary health care services and the impact of international initiatives in Sri Lanka, 1950-2000. She is exploring how this commitment by the new nation was operationalised through a history of its primary health care facilities from 1950 to the present. This also includes an examination of the complex interactions between local and national actors and with the global initiatives of the World Health Organization.

Margaret writes: “I am engaged in a Wellcome Trust funded research project on primary health care in Sri Lanka from its independence in 1948 to the first decade of this century. Aside from the intellectual challenges that this project poses, I have also needed to overcome a number of practical difficulties. I have previously researched health care in colonial Sri Lanka and although this did include research in Sri Lankan and American archives, the meticulous documentation of the British Imperial government – its reports and correspondence – held at the National Archives in Kew –provided the spine around which to weave the colonial story. Independent Sri Lanka does not have the resources to replicate that kind of documentation. As one Sri Lankan doctor put it to me on one of my research trips: they were too busy ‘doing’ their work to be writing reports or filing paperwork. Political turmoil and economic depression no doubt contributed to this situation. Political turmoil certainly added to my difficulties on occasion. In January 1999 when I set out to visit the National Archives in Colombo during the civil conflict I was told that it was closed. A bomb had exploded outside the building being unhappily placed as it was, opposite such an obvious target as the military barracks. Finding material in Sri Lanka can be a serendipitous and uncertain process.

This can be very frustrating for the historian. However, these inherent difficulties in themselves provide the opportunity for many happy encounters. As a foreigner it is well nigh impossible to do this kind of research on your own. I have a graduate of the University of Colombo as Research Assistant who is doing most of the hard work of searching out materials. Being Sri Lankan she is much more able than I would be to negotiate with librarians and archivists to access material. Yet when I have visited the country I have received much willing help from health administrators, academics and doctors. Although, very busy people in their own right, they managed to squeeze in talks with me in between meetings and other tasks. Some of these people I count now as my friends and the insights they give me into their culture are invaluable to my understanding of Sri Lankan culture and the place of health within it. The Sri Lankans I met, whilst acknowledging its limitations, are rightly proud of their health care system that has produced, and continues to produce, health indicators on a par with the developed world.

Trainee public health nurses at the National Institute of Health Sciences, Kalutara. Credit: Margaret JonesImage: Trainee public health nurses at the National Institute of Health Sciences, Kalutara. Credit: Margaret Jones

As I have written in Health for All. The Journey to Universal Health Coverage,[1] and as my research so far on this project has uncovered, there were deep roots to the development of primary health care services in Sri Lanka, dating back to the colonial period, and it represented an example of what could be done without the levels of expenditure common in developed countries. Sri Lanka´s experience was an essential part of the debate on primary health care which took centre stage at international level in the 1970s and was influential in the Alma Ata declaration of 1978. Its example has remained prominent since that time, for example, and as my research suggests, in maternal and child health and in tuberculosis control its achievements have been considerable. However, the very success of its health care services can in itself present a problem. As a Sri Lankan health planner observed to me when I interviewed her, it had induced a certain complacency that made it difficult to bring about necessary changes to those services. At the moment with its changing demography and resulting double disease burden of communicable and non-communicable disease, Sri Lanka’s health care services are faced with new and urgent problems. An effective primary health care service is crucial for dealing with this. It would be the worst kind of hubris to assume that my historical research could provide answers for this task but I believe that uncovering what has happened in the past can  help in facing up to the challenges of the future.

is a historian of medicine and colonialism in Sri Lanka and Jamaica. She joined the History Department at York after six years at the Wellcome Unit for the History of Medicine at Oxford University as a Research Officer and then as a Wellcome Trust Research Fellow. She has worked extensively on the development of public health policies and the medical services of colonial Sri Lanka and Jamaica. She is currently working on the development of primary health care services and the impact of international initiatives in Sri Lanka, 1950-2000.

The Wellcome Trust-funded ‘The Local Bases of Global Health: Primary Health Care in South Asia and Beyond, 1945-2010’ project forms a detailed study of the global movement for primary health care (PHC), which represented a most ambitious effort to expand health coverage fairly around the world. This study will afford new perspectives into the development of PHC alongside existing universal healthcare structures in South Asia. The programme of research will examine the provision of universal healthcare within India, Ceylon/Sri Lanka and Bangladesh; it will also look at the impact of the transnational spread of ideas as a result of work carried out by global health agencies in South Asia.

[1] Margaret Jones, ‘The Sri Lankan path to health for all from the colonial period to Alma Ata, in Alexander Medcalf, Sanjoy Bhattacharya, Hooman Momen, Monica Saavedra and Margaret Jones, eds, Health for All. The Journey to Universal Health Coverage (Hyderabad: Orient BlackSwan, 2015), 19-21.