This success story is based on findings from the Monitoring and Evaluation activities conducted under the Health System Enhancement Project (HSEP) by the Sri Lanka Business Development Centre (SLBDC) on behalf of the Ministry of Health and the Asian Development Bank.
Imagine a healthcare system where your local clinic knows your medical history, your grandparents can access quality care right in their neighborhood, and visiting a hospital doesn’t mean financial hardship for your family.
Through the Health System Enhancement Project (HSEP), in partnership with the Ministry of Health and the Asian Development Bank, this vision is becoming a reality across nine districts in Sri Lanka.
By pioneering a visionary "Shared Care Cluster System," the project set out to modernize Primary Health Care (PHC) institutions, making them the first and best choice for local communities. To measure the true impact of this journey, the project's independent Monitoring and Evaluation (M&E) programme, implemented by the SLBDC, tracked progress from the baseline assessment in 2021 to the comprehensive endline evaluation conducted in early 2026.
The results speak for themselves: HSEP has served as a powerful catalyst for a healthier, more equitable Sri Lanka.
- Bringing Care Back Home: A Surge in Local Clinic Usage
Historically, many patients bypassed local primary care clinics, traveling long distances to overcrowded specialized hospitals. The HSEP cluster reform set out to change that by rebuilding trust in local care.
The M&E data reveals a remarkable shift in patient choices:
- A Massive Leap in Trust: In the pilot clusters, the utilization of local outpatient services nearly doubled, skyrocketing from 29.1% in 2021 to 52.7% by 2026.
- Caring for Our Elders: The most heartwarming growth was among the elderly population (aged 65+), where local clinic utilization surged from 27.0% to 55.9%. Instead of exhausting journeys, our elders are now receiving continuous care for conditions like hypertension and diabetes right in their communities.
- Smart Referrals: Local clinics are no longer isolated. Today, 80.6% of cluster-linked clinics have established formal referral pathways to secondary care hospitals, ensuring patients transition smoothly when advanced care is required.
- Dignity, Comfort, and Inclusivity: Gender-Responsive Upgrades
A key pillar of Universal Health Coverage is ensuring that healthcare environments are welcoming, safe, and accessible to everyone, regardless of gender or physical ability.
HSEP’s infrastructure transformation has set a new benchmark:
- Dignified Spaces: Out of 135 targeted local health institutions, 111 have been completely renovated and upgraded with gender-responsive designs. Today, over 77% of these pilot facilities feature separate toilets for men and women.
- Healthcare for All: Inclusivity was built into the very foundations of these renovations. 80.6% of cluster facilities now feature ramp access at their entrances, and 70.1% provide full wheelchair access across all internal service areas, including restrooms.
- Holistic Care: Beyond infrastructure, 86.6% of the pilot facilities are now officially certified as providers of a "gender-responsive and inclusive essential care package," which includes expanded services like family planning and dietary counseling.
- Lightening the Financial Burden on Families
When healthcare is distant or uncoordinated, families often face severe financial strain. One of the proudest achievements highlighted by the M&E comparative data is the drastic reduction in Catastrophic Health Expenditure—instances where families are forced to spend 40% or more of their household budget on health needs.
Thanks to the availability of reliable, free care closer to home, catastrophic health spending among families in the pilot cluster areas was cut exactly in half, dropping from 6.3% to just 3.2%.
- Embracing the Digital Future
The project has laid the groundwork for a modern, digitally connected health system. HSEP initiated the use of Unique Patient Identification Numbers (HID), creating a future where a patient's medical records can be securely accessed across different clinics within a cluster.
While the nationwide digital rollout is an ongoing journey, pioneering blueprints are already thriving. Fully functional Electronic Health Information Systems have been successfully established in the Dambulla Cluster (Matale District) and the Thambuttegama Cluster (Anuradhapura District), serving as a scalable model for the rest of the country.
Looking Ahead: The Journey Continues
The data collected between 2021 and 2026 proves that structural and systemic reforms can successfully shift public preference toward local primary healthcare. Patients are more satisfied, services are more responsive (with satisfaction and responsiveness ratings jumping significantly to around 70%), and the infrastructure is more inclusive than ever before.
As we celebrate these incredible milestones, the M&E findings also point the way forward. While the physical clinics and clinical networks are stronger than ever, our next collective step must focus on continuous community engagement and health literacy—ensuring every citizen knows about, trusts, and fully utilizes the incredible resources available at their doorstep.
The HSEP Pilot Cluster reform has proven to be more than a project; it is a scalable blueprint for an efficient, equitable, and compassionate national health system for Sri Lanka.