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

Economic crises can threaten Universal Health Coverage by disrupting access to essential services, weakening financial protection and compromising quality of care. Sri Lanka’s economic crisis, which intensified in 2022 following the COVID-19 pandemic, resulted in shortages of medicines, fuel, and financial resources. This study assessed provider-reported disruptions to the accessibility and selected operational aspects of preventive health service quality delivered through Medical Officer of Health offices in the Western Province of Sri Lanka during the economic crisis. A descriptive cross-sectional survey was conducted among Medical Officers of Health and Additional Medical Officers of Health working in the Colombo, Gampaha and Kalutara districts. Officers who had served in their current role for at least six months during 2022–2023 were eligible. A census approach was used. Of 146 eligible officers, 130 completed a structured self-administered questionnaire, giving a response rate of 89.0%. Data were analysed using descriptive statistics and are presented as frequencies and percentages. Among the respondents, 26.9% reported that field clinics had been combined and 6.9% reported reduced clinic frequency. Reduced clinic attendance was reported by 40.0%, mainly because of increased transport costs and competing economic demands. Reduced availability of routine clinic medicines was reported by 61.5%, while 42.3% reported reduced availability of Thriposha nutritional supplements. Regarding selected operational aspects of service quality, 50.0% reported that the prescribed number of supervisory visits had not been completed, 52.3% reported incomplete record-keeping, 29.2% reported reduced home visits by Public Health Midwives and 33.8% reported reduced field investigations. Transport, fuel, funding and logistical constraints were commonly reported reasons for these disruptions. Frontline preventive health medical officers reported substantial disruptions to service accessibility and selected operational processes relevant to preventive health service quality during Sri Lanka’s economic crisis. Medicine and nutritional-supplement shortages, reduced clinic attendance, inadequate supervision and interruptions to field activities were prominent concerns. Protected financing, resilient supply chains, transport and logistical support, strengthened supervision and adaptable service-delivery arrangements are needed to maintain preventive services during future economic shocks.