In 2021 Sri Lanka continued its swift response to the COVID-19 pandemic with a coordinated whole-of-society approach. The UN in Sri Lanka, together with international and national partners, supported the government in this response, strengthening the country’s health system and thereby ensuring the most vulnerable can continue receiving the health services they need, when they need it. In this regard, universal health coverage and health security are complementary and crucial to the achievement of SDG 3: ensuring healthy lives and promoting well-being at all ages.

Sri Lanka has a Primary Health Care-oriented system that enabled sustained delivery of essential health services with minimal disruption at the beginning of the pandemic, as shown in tailored global WHO Pulse surveys which compare such disruptions in over a dozen essential health indicators across countries. The UN, with WHO in the lead and supported by national and international partners, played a key role in providing Sri Lanka with strategic, technical, and operational support to ensure the continuity of essential health services outside of pandemic-related needs.

Assisting with evidence-based health policy development including documentation, the UN supported the Sri Lankan Government’s establishment of more than 20 strategies, plans, and guidelines. These range from enhancing essential health services across most provinces, to managing validations for the elimination of mother-to-child transmission of HIV and syphilis, and enhancing community health though relevant evaluations. Studies on tobacco use were conducted in over 7,100 households in different regions, along with studies on drownings, establishing a midwife training system, tuberculosis among health staff, salt intake in foodstuffs, and a social behaviour change strategy on breast and cervical cancers. Other studies focused on nutrition for older persons, including a joint study with the Medical Research Institute on nutrition and energy consumption gaps.

To increase access to quality essential health services, medicines, and vaccines, the UN supported development of a delivery model for non-communicable diseases. Support was also provided for rehabilitation services, care for people with disabilities, and older persons, issuing relevant equipment listings, manuals, and training. UNHCR, for its part, helped hospitals to assist refugees and asylum seekers through provision of needed equipment totalling over $100,000. Children with disabilities were supported through the design and piloting of the Inclusive Early Childhood Development Programme targeting 400 health staff, while WHO at the global, regional, and local levels helped with an institutional development plan for the medicine regulatory authority.

Multisector partnerships were key to addressing social determinants of health. Continuing services for survivors of gender-based violence during COVID-19 represented a considerable challenge. UNFPA and its international and national partners supported the provision of accommodation, food, security, psychosocial counselling, and recovery to beneficiaries of six shelters across Sri Lanka, strengthening their infrastructure and staff capacity. Aided by support to the Ministry of Health, family planning supplies totalling some 34,000 injections and implants were distributed to clinics across the country that had been disrupted by the pandemic. The UN, through UNFPA, UNICEF, and UN Women, also collaborated on delivering gender-based violence prevention training and materials to over 6,000 midwives and 350 medical staff.

To better serve vulnerable and at-risk populations, the UN helped equip specialised health centres to improve access to health information, education, and services among young people, reaching some 100,000 of them on topics including COVID-19, gender, and youth-friendly health services. Other initiatives included providing support to design a WASH assessment and training for health officers in health care facilities, conducted by UNICEF and WHO.

Promoting healthy settings and reducing risk factors figured in other work, with the UN and its partners promoting health and well-being and preventing injuries and accidents across populations, especially youth. IOM, in partnership with WHO, introduced a digital solution for continuation of health care and counselling throughout the migration cycle, from pre- departure health screening to re-integration into the health system upon return. Further, a low-salt cooking challenge was organised by the UN and partners, reaching out to policymakers, restaurant owners, and chefs.

Together with civil society partners, the UN reached over 275,000 people in more than 75 rural communities including community leaders and field facilitators. Some 10,000 people in low-income urban settings benefitted from hygiene promotion programmes covering hand washing, waste handling, and initiatives targeting public health inspectors, waste workers, and medical officers. Technical support and trainings were also conducted on management and rehabilitation of people with substance use disorders.

2021 was the Year of Health and Care Workers, with the UN and partners accordingly providing support towards their well-being. The year was also marked with commemorative postage to honour their efforts and dedication during the pandemic. ILO and WHO supported the design and issuance of a new bipartite dispute prevention and resolution mechanism for the health sector, while a collaboration targeting over 240 professionals helped boost infection prevention and control and healthcare waste management skills. Protective equipment during COVID-19’s third wave, along with mental health well-being packages, were provided to over 2,000 frontline health workers and their families.

During 2021, the UN along with the Sri Lankan government and other partners helped strengthen the country’s health security and emergency preparedness. The 2020 Sri Lanka international health regulations State Party Annual Report (SPAR) for emergency showed an improved score of 62 per cent core capacities against 54 per cent in 2019. Drafting of the national mental health in emergency plan was initiated, and WHO support enabled the expansion of the mental health helpline. International search and rescue standards were met with UN support, along with equipment for disaster preparedness and response. Capacity for whole genome sequencing was also strengthened, including through training on Oxford nanopore technology, and surveillance equipment against viruses and microorganisms was provided to different laboratories. Through the work of FAO with other agencies and partners, the country’s antimicrobial resistance self-assessment was completed, together with relevant advocacy campaigns.

The identification and structuring of health-related priorities in Sri Lanka by the UN and its partners during 2021 and beyond will inform the new Cooperation Framework (2023-2027) and will be guided by national health priorities and the achievement of health-related Sustainable Development Goals towards 2030.