• 1,000 new Arogya centres to be established over three years
• Family doctors to become first point of care for patients
• Reforms aimed at easing pressure and overcrowding at major hospitals

The Government plans to establish 1,000 new Arogya Health and Wellness Centres over the next three years as part of a wider effort to introduce a family doctor-based primary healthcare system across the country and reduce the growing burden on major hospitals, Consultant Medical Administrator and Director of Primary Care Services (Primary Health) at the Health Ministry, Dr Sarathchandra Kumarawansa, said.

Dr Kumarawansa, speaking to The Daily Morning yesterday (7), said the Government’s health policy envisages providing a medical team, including a family doctor, for every 10,000 people, with patients first being assessed and treated at the primary healthcare level before being referred to secondary or tertiary hospitals when specialised treatment is required.The proposed system is expected to help reduce unnecessary visits and overcrowding at the outpatient departments of major hospitals by ensuring that patients receive appropriate care at the primary level and are referred to higher-level institutions only when necessary.Explaining the referral pathway, Dr Kumarawansa said that patients would initially receive care at the primary level, while those requiring specialist services would be referred to a secondary-level hospital. If further specialised treatment is required, patients would then be referred to a tertiary-level hospital.

He said that at least 2,000 primary healthcare institutions would be required to provide a family doctor and medical team for every 10,000 people.“There are currently around 1,000 primary healthcare institutions. Therefore, we need another 1,000. The additional 1,000 institutions are what we call Arogya Health and Wellness Centres,” he said.Of the 1,000 new centres, around 80% would be developed using existing clinical centres where Family Health Service Officers are currently working, while the remaining 20% would be newly constructed.Dr Kumarawansa said that each newly constructed unit would cost a maximum of Rs 50 million and would be equipped with basic medical equipment and the required information technology facilities.

He stressed that the program would not focus only on establishing the 1,000 new centres, but would involve upgrading and developing all 2,000 primary healthcare institutions.The 1,000 new centres would be established over three years, with 300 planned for the first year, 400 in the second year and 300 in the third year.Dr Kumarawansa said that the pilot project for the Arogya concept had already commenced this year (2026) and was being evaluated monthly and quarterly.“So far, we have received good results,” he said.

He said that Health Minister Dr Nalinda Jayatissa had requested the World Health Organization (WHO) to evaluate the pilot sites and that the WHO had conducted a comprehensive assessment involving five consultant specialists from Japan, the United Kingdom, Thailand, India and Australia.The WHO had recommended the Arogya model as a suitable model for the country, while also making several recommendations, he said.Dr Kumarawansa said that the Ministry had continued its own evaluations of the pilot centres and identified several shortcomings, which would be addressed when the program is implemented more widely.He said that the primary healthcare program would mainly focus on the prevention and early detection of non-communicable diseases (NCDs), particularly diabetes and hypertension.Annual screening for diabetes and hypertension would be compulsory for everyone over 30 years of age, with screening expected to be increased to every six months at a later stage, he said.The program would also include compulsory screening for common cancers, including oral, breast and cervical cancers, while people over 60 would be screened annually for 10 common conditions.

In addition, the primary healthcare package would include palliative care, rehabilitation, primary mental healthcare, eye care and oral healthcare services, Dr Kumarawansa said.Dr Kumarawansa said that if the full benefits of the free healthcare system are to reach patients, major structural changes are needed across the health system, from primary to tertiary care.However, he said that it should not be forgotten that Sri Lanka, despite being a lower-income developing country, had maintained health indicators at a level comparable with developed countries for more than 100 years, largely due to its strong human resources.

He said that there are also certain changes that need to take place on the patients’ side.“Recently, the President said that people cannot simply go to whichever hospital they want, and that is correct. However, the Government has the primary responsibility for creating awareness among the public about this,” he said.“At the same time, we cannot simply stop patients who currently come directly to hospitals. An attitudinal change needs to be created among patients as well, covering the entire system from primary to secondary and tertiary care,” he added.Meanwhile, the President of the Medical and Civil Rights Professional Association of Doctors organisation, Dr Chamal Sanjeeva, said that the family doctor concept should be gradually introduced into Sri Lanka’s health system to reduce overcrowding at the outpatient departments of major hospitals.

He said that the concept could serve as a basic mechanism to regulate patient referrals, with patients first being assessed by a family doctor and referred to a higher-level facility when specialised treatment is required.He said that successive Governments had been reluctant to introduce the family doctor concept partly because it was not a popular political slogan and because of strong resistance from health-sector trade unions.The 2015 Government had begun the initial stages of introducing the concept but had failed to turn it into a practical system due to the socio-political environment at the time, he said.While describing the present Government’s efforts to introduce the concept as commendable, Dr Sanjeeva said that the Government should first pay close attention to the efficiency of the existing health system, including the utilization of budgetary and donor funds, the duplication of projects, bureaucratic delays, procurement and tender procedures, and the implementation of health policies.

He stressed the need to consider both the State and private health sectors when reforming the system, as the two sectors are closely connected.He also noted the need for a stronger national policy framework covering areas including medicines, antimicrobial medicines, regional healthcare, human resources, salaries, recruitment, and the training and skills development of health professionals.