Challenges in maintaining and extending Sri Lanka's record on health - with special reference to international trade in services

Abstract

Sri Lanka is looking to the future and planning for economic growth and development. As much as it is important to innovate and introduce new and more effective policies, it is equally important to identify, maintain and promote current good practices while informing ourselves of future challenges in areas where we could build on our successes. Sri Lanka's health indicators have been vastly superior to those of neighbouring countries, despite low expenditure on health and the long-term conflict. Studies by trade and economic development experts have often pointed out Sri Lanka as an example of the benefits of public health services for human development. Yet, changes in the global economic policy environment could mean that the lessons of Sri Lanka's success story are not shared and can even be "unlearned". In this context it is important to consider the possible impact of the rules of the World Trade Organization (WTO),particularly the General Agreement on Trade in Services (GATS), on the Sri Lankan health policy environment - and to determine what needs to be taken into account to successfully face the challenge of promoting health policies for human development and to continue to be a beacon for the region on this matter. Methodology: This paper is a legal and policy analysis. It discusses some of the possible implications of the provisions of the WTO General Agreement on Trade in Services (GATS) for policies on health services provision, especially in light of the obligation for progressive liberalization of trade in services; the human development approach; the right to development and the right to health; and Sri Lankan approaches to economic and social rights. Comparative studies of law and policy in other jurisdictions focusing on their approaches to public health services and WTO obligations will also be discussed. Conclusion: Health policy-makers in Sri Lanka need to be aware of the general implications of the WTO system for health policy. The contraction of the existing policy space by making specific WTO GATS commitments to liberalize health and health-related services should be avoided, if at all possible. If this can be done, it could be possible to maintain and extend good policies and practices in health services provision while continuing to be a model in this area for Asia and other developing and developed nations.