Frontline medical officers delivering preventive healthcare in Sri Lanka experienced extensive disruptions to service accessibility and routine operational processes during the nation’s severe economic downturn, according to a descriptive cross-sectional survey published in BMC Health Services Research. The study examined the delivery of preventive services managed through Medical Officer of Health offices across the Western Province, capturing direct reports from administrative clinicians who managed primary care functions as national economic instability intensified following the COVID-19 pandemic.

As outlined by the research team, national economic crises pose a direct threat to Universal Health Coverage by impeding community access to essential medical services, undermining household financial protection, and degrading the overall quality of care delivered across public systems. In Sri Lanka, the economic crisis deepened acutely in 2022, precipitating severe countrywide shortages of essential medicines, fuel supplies, and financial resources. These mounting shortages directly affected the operational capacity of frontline preventive health units that coordinate community-based healthcare and disease prevention programs.

To quantify the extent of these service disruptions, investigators carried out a descriptive cross-sectional survey utilizing a census approach across the three administrative districts of Sri Lanka’s Western Province: Colombo, Gampaha, and Kalutara. Eligible study participants comprised Medical Officers of Health and Additional Medical Officers of Health who had occupied their official roles for at least six months during the 2022 to 2023 period. Out of a total census of 146 eligible officers identified across the three districts, 130 individuals completed and returned the structured, self-administered survey questionnaire, yielding an overall response rate of 89.0 percent. The collected survey data were evaluated using descriptive statistical methods and reported as frequencies and percentage distributions.

The survey data documented notable structural alterations to routine clinic schedules and marked reductions in patient attendance. Among the 130 responding medical officers, 26.9 percent reported that local field clinics had to be combined to maintain operations, while 6.9 percent reported an outright decrease in the scheduled frequency of clinic sessions. Furthermore, 40.0 percent of the surveyed officers reported reduced patient attendance at their preventive health clinics. Responding officers identified rising public transportation costs and competing household economic demands as the primary factors deterring community members from attending routine appointments.

The delivery of clinical care was further impeded by acute inventory shortages affecting preventive medical supplies. A substantial majority of respondents, representing 61.5 percent of the surveyed officers, reported reduced availability of routine clinic medicines necessary for daily patient care. In addition, 42.3 percent of the clinicians reported reduced availability of Thriposha, a specialized nutritional supplement provided through Sri Lanka’s public health system.

The survey also evaluated selected operational aspects of service quality, identifying widespread breakdowns in administrative supervision, documentation, and community outreach. Exactly half of the respondents, or 50.0 percent, reported that the prescribed number of routine supervisory visits had not been completed during the crisis period. In addition, 52.3 percent of the officers documented incomplete administrative record-keeping within their facilities. Field activities performed outside the clinics also declined noticeably: 29.2 percent of respondents reported a reduction in routine home visits conducted by Public Health Midwives, and 33.8 percent documented a decline in field investigations. Across all operational domains, responding medical officers cited fuel scarcity, restricted transportation, funding shortages, and broader logistical constraints as the primary causes of these implementation failures.

The authors concluded that Sri Lanka’s economic crisis imposed substantial strains on the accessibility and operational integrity of frontline preventive health services, characterized by pervasive medicine and nutritional supplement deficits, diminished clinic attendance, compromised supervisory oversight, and restricted field operations. Because the investigation was restricted to provider reports gathered from Medical Officer of Health offices within the Western Province, the findings reflect administrative healthcare perspectives within this specific geographic jurisdiction. To preserve preventive healthcare delivery during future economic shocks, the study authors emphasized the necessity of establishing protected health financing mechanisms, building resilient procurement and supply chains, securing transportation and fuel logistics, reinforcing supervisory structures, and instituting adaptable models of service delivery.

Subject of Research: Preventive health service disruptions during Sri Lanka's economic crisis

Article Title: Provider-reported disruptions to access and selected operational aspects of preventive health services during Sri Lanka’s economic crisis: a cross-sectional survey

Article References: Arnold, M., Gunawardana, U., Karunapema, P., Aathirayan, S., Galappatti, D. I., Mahesh, P. K. B., & Wijesekara, N. (2026). Provider-reported disruptions to access and selected operational aspects of preventive health services during Sri Lanka’s economic crisis: a cross-sectional survey. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15612-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15612-w

Keywords: preventive health services, Sri Lanka, economic crisis, health services research, Universal Health Coverage, clinic operations, public health supervision, medical supply shortages, Provider-reported, disruptions, access, selected