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Health service delivery reforms during and after economic crisis

A rapid evidence review and country case study analyses for informing Sri Lankan health policy

Event date
Wednesday 6th September 2023
Event time
Event address

Sri Lanka is facing its most profound economic and financial crisis since independence. The economic crisis has compounded health system pressures arising from the COVID-19 pandemic, leading to reduced provision of public services, increased unmet need, growing out-of-pocket expenditure, and increased risk of catastrophic health expenditure and impoverishment.

Health system reforms to restore essential service provision will require judicious use of scarce resources. Past economic shocks and recoveries may offer important lessons and opportunities for reform. In this presentation, Laura will discuss how her team worked with the Sri Lankan Ministry of health and the Sri Lankan World Health Organisation (WHO) Country office to conduct a rapid review of grey and empirical literature from four countries – Indonesia, Thailand, Vietnam and Greece – to identify health service delivery reforms implemented to improve health system efficiency and support universal health coverage in the context of economic shocks. This rapid evidence synthesis was commissioned by the WHO Sri Lanka office to appraise existing evidence on health system efficiency interventions taken by countries in the context of an economic crisis.

The country case studies highlight a process of reforms over many years, some of which can be directly attributed to crisis events, but the majority were independent of specific crises. Nonetheless, all countries took actions during their respective crises which have had enduring impacts on the resilience of their health systems to future shocks, including the COVID-19 pandemic.

The findings from each case study suggest that a ‘long-haul’ perspective on health reform is needed to build health system resilience – defined as the ability to prepare for, manage (absorb, adapt and transform) and learn from economic shocks.


Laura Downey photo

Dr Laura Downey
Senior Research Fellow in health economics and policy at the George Institute for Global Health Australia, and at the School of Public Health at Imperial College London, UK

Dr Laura Downey is a Senior Research Fellow in health economics and Policy at the George Institute for Global Health Australia, and at the School of Public Health at Imperial College London, UK. She also holds a position as Conjoint Senior Lecturer in the School of Population Health at UNSW, Australia.

Her research is focused broadly on evaluating health system performance in relation to Universal Health Coverage goals, and developing innovative solutions to support equitable access to high quality, affordable care for the world’s most vulnerable populations.

Dr Downey is a member of the Health Economics expert advisory group to the UK Infected Blood Inquiry (2020-2023), whose work will directly inform recommendations made by the Inquiry Chair to the UK Government on behalf of the tens of thousands of individuals who were infected with HIV and HCV during the 1960s and 1970's through interaction with the National Health Service. Previously, she was a technical advisor in global health in the Global Health and Development Group at Imperial, and a core member of the International Decision Support Initiative (iDSI)– an international collaborative platform that assists governments in low- and middle-income countries (LMICs) to use evidence to improve the value for money of healthcare investment.

Dr Downey has been closely involved in numerous health system reforms in India (2015 and 2020), and remains a health policy mentor for the Indian Council of Medical Research and a distinguished fellow for the Indian Institute of Public Health in north-east India. She has worked with country partners across Asia, Africa, and Europe in partnership with global institutions such as the World Health Organisation, and the World Bank.

Dr Downey has over 70 peer-reviewed publications and continues to actively contribute to research in health economics, particularly in relation to healthcare investment and priority-setting in LMICs. She has held research and policy positions at the National Institute of Health and Care Excellence, University College London, and the University of New South Wales, Australia.


Opinions expressed by individuals at this event are solely of those of the individual/s and do not necessarily represent the views or opinions of the Kirby Institute or UNSW.