Access to PrimAccess to Primary Health Care within Sri Lanka’s Universal Health Coverage Agenda: Current Reforms, Persistent Gaps and Priorities for Effective Coverage – A Narrative Reviewary Health Care within Sri Lanka’s Universal Health Coverage Agenda

Abstract

Abstract Sri Lanka’s commitment to universal health coverage (UHC) rests on a long-standing tax-funded health system that provides public-sector services without user charges at the point of care. However, universal entitlement does not necessarily ensure effective access to timely, continuous and coordinated primary health care. This narrative review examines current developments in access to primary health care in Sri Lanka, with emphasis on reforms relevant to first-contact curative care, noncommunicable disease management, referral, continuity, and financial protection. A targeted literature search was undertaken in September 2026 using PubMed and publisher-indexed sources, supplemented by authoritative documents from the Ministry of Health, the World Health Organization and the World Bank. The evidence indicates a persistent mismatch between the formal availability of free public care and the organization of ambulatory care. Primary medical care institutions remain underused in some settings, while higher-level hospitals carry substantial outpatient demand and private providers remain important for ambulatory care. Weak referral and back-referral, incomplete longitudinal records, gaps in NCD follow-up and diagnostic access, and costs associated with private consultations, investigations, medicines and travel can reduce effective coverage. Recent reforms seek to address these constraints through shared-care clusters, population empanelment, personal health records, broader service packages, strengthened primary medical care institutions and renewed national policy attention to first-contact primary care. The central implementation challenge is to convert these reforms into trusted, accessible and continuous care at community level while preserving equity and financial protection.