A new year full of happiness prosperity and health -The Team PSSP
we are ready to talk about Small grants and benefits for the country
Speakers and the topics
Evaluation of the Health Care Access and Financial Risk Protection of Universal
Health Coverage among residents of Kaluthara. Dr Naveen De Soysa, Registrar in
Community Medicine, NIHS
Household Economic Burden and Lost Earnings due to NCDs Dr Anuji Gamage,
Consultant Community Physician, KDU
Assessment of the Prevalence and Risk Factors of Glaucoma in Sri Lanka, Dr Lalitha.
Senarath, Consultant Eye Surgeon, TH Karapitiya
Pilot study on validity of Toluidine Blue test as diagnostic tool for early detection
of oral cancer in primary dental health care settings, Prof Ruwan Jayasinghe, Prof in Oral Medicine, Department of Oral Medicine and Periodontology, Faculty of Dental
Science, University of Peradeniya
We will inform the date,time , and venue soon.
Dengue update -22.11.2022
Total of 31162 suspected dengue cases for the year 2020 and 54900 suspected dengue cases were reported to the Epidemiology Unit from all over the island from January 2022 to up to now, . Latest Disease Trends,
Approximately 41.6 % of dengue cases were reported from the Western province. The highest numbers of dengue cases were reported during the 29th week of 2017.
The outbreak situation in 2017 warranted extensive and regular removal of possible mosquito breeding sites from the environment, along with strengthened patient education on management of fever which resulted in a relatively low mortality.
It is very important to seek medical attention in the event of fever and to do relevant laboratory investigations at least by day three of the illness.
PSSP - Planning meeting to the future. How to support for the sri Lankan community during the critical situation in Sri Lanka
Implementation Support Mission for the Primary Health Care System Strengthening Project (P163721)
July 25-August 4, 2022
Aide-Memoire
Introduction
1. An Implementation Support Mission for the Sri Lanka Primary Health Care System Strengthening
Project (PSSP) took place from July 25 to 29, 2022. The objectives of the mission were to: (i) review
the progress of the ongoing activities under the PSSP and assess the possibility of achieving project
development objectives by project closure in December 2023; (ii) review achievements against all
project indicators (both disbursements linked indicators and intermediate result framework
indicators); (iii) review the progress of project activities and innovation grants under the Component
II; (iv) review project design and implementation and assess the status of implementation and
suggested relevant revisions and modifications of the country of the project’s components given the
current macro-fiscal environment; (v) review fiduciary arrangements: project audit, disbursements
trends, financial reporting; (vi) review status of implementation of project’s legal covenants and
compliance; (vii) report progress of the Emergency Expenditures under the Contingent Emergency
Response Component (CERC) pool activities, and (iii) agree on the next steps for implementation.
2. The World Bank (WB) team1 would like to acknowledge the Government of Sri Lanka’s (GoSL)
continued commitment and efforts toward ensuring the continuity of primary health care (PHC)
services despite the challenges and pressures on the health system in light of the COVID-19 pandemic.
The WB team held meetings with officials of the Ministry of Health (MoH) Ministry of Public
Administration, Home Affairs, Provincial Councils and Local Government (MPCLoG), the Ministry of
Finance (MoF), the Department of National Planning (NPD), the Department of External Resources
(ERD) and the Department of Project Management and Monitoring (DPMM).
3. This Aide Memoire was discussed with the Secretary Ministry of Health, the Additional Secretary to
the Ministry of Public Administration, Home Affairs, Provincial Councils and Local Government, the
Director Department of Project Management and Monitoring, and other related ministry officials at
the wrap-up meeting on August 16,
,2022.
Table 1: Overall Project Implementation Status
Project Ratings Previous
Jan 2022
Current
July
2022
Project Development Objective (PDO) S S
Implementation Progress (IP) S S
Component 1: Implementation of the PHC System Reorganization and
Strengthening Strategies (US$185.0 million)
S S
Component 2: Project Implementation Support and Innovation Grants
(US$14.22 million)
MS MS
1 The team consisted of: Deepika Attygalle (Senior Health Specialist and Team Leader), Bushra Binte Alam (Senior Health
Specialist and Co-Team Leader), Di Dong (Senior Economist, Health and co-Team Leader), Anjali Vitharanage (Senior Procurement
Specialist), Enoka Wijegunawardene (Senior Financial Management Specialist), Shanek Mario Fernando (Social Development
Specialist), Nadeera Rajapakse (Environmental Specialist), Cheshika Fernando (Consultant), Bhakthi Abeysooriya (Team
Assistant), and Renu Warnasuriya (Consultant).
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Component 3: Contingency Emergency Response Component (US$ 0
million)
S S
Project Management S S
Procurement S S
Financial Management (FM) MS MS
Environmental safeguards NA NA
Social safeguards NA NA
4. Economic crisis and medical situation update: Sri Lanka is currently facing its worst economic crisis
in decades and year-on-year inflation has accelerated to 45.3 percent in May 2022. The crisis has led
to shortages of essential food and medicine, and the lack of foreign exchange has also constrained Sri
Lanka’s ability to import enough fuel to meet its energy needs, resulting in rolling power cuts. This has
affected emergency health services and interrupted safety net programs. To support the continuation
of health services, the World Bank repurposed US$23 million of the ongoing COVID-19 Emergency
Health Project-ERHSP (P173867) in April 2022. The repurposing allocated more funds for the
purchasing of emergency medicines and consumables within ERHSP project boundaries.
5. The project was progressing well with overall project disbursement of US$110.02 million or 55.01
percent as of August 1, 2022. Based on CMU projection, results for another disbursement will be
verified in October 2022, worth US$27.31 million. The remaining balance of US$57.81 million will be
disbursed in another two tranches before the project closes in December 2023. The project team will
constantly follow up on the adequacy of budget provisions by the Ministry of Finance to the Ministry
of Health and then provincial directorates and ensure budget replenishment as soon as the budget is
utilized, as this becomes essential for uninterrupted project implementation.
6. Project restructuring completed in May 2022: To account for the impact of COVID-19 on service
delivery and based on the Mid-Term Review (MTR) outcomes, the GoSL submitted a request for
restructuring on February 22, 2022. The restructuring was completed in May 2022, and adjusted the
project’s results framework (RF), with no changes in the PDO indicators. The changes in RF refined the
operational definitions of some Disbursement Linked Indicators (DLI) stated in the verification
protocols and adjusted the target of a non-DLI indicator where planned activities have not been
achieved to the scale expected due to the pandemic. Furthermore, the restructuring has added a new
intermediate result indicator to reflect the investments made under the project to strengthen the
emergency COVID-19 response capacity at PMCIs.
Progress
7. Overall project PDO and Intermediate indicators are progressing well. Progress towards the Project
Development Objective (PDO) and intermediate results indicators is on track. Of the 4 PDO indicators,
targets have been achieved under 3 indicators and one is partially achieved. Of the 24 intermediate
results indicators 18 are fully achieved, 4 are partially achieved, 2 are likely to achieve,
Component 1
8. As of June 2022, the project's overall disbursement ratio stands at 55 % as of mission with the recent
disbursement that was processed recently amounting to US$11.8 Mn for DLI achievements. Of the
total disbursements by the WB of US$110 Mn, US$103.5 Mn is on account of Component 1 & US$ 2.4
Mn is on account of Component 2. There is also US$ 4.9 Mn disbursed on account of emergency
expenditures under the CERC components. The last disbursement of US$11.835 million was
authorized in July 2022 based on the verified results of DLIs 4.1, 6.3, 6.5, and 7.4. Results include the
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number of enhanced services at PMCIs reaching 871 as of March 2022 (DLI 4.1); 93 percent of annual
procurement by the Medical Supplies Division (MSD) being less than or equal to defined procurement
benchmarks (DLI 6.3); the use of urgent procurement procedures as a total percent of medical
supplies procurement being reduced from the established baseline amounting to 100 percent (DLI
6.5); and the publication of the consolidated annual report for the health sector grievance redressal
mechanism by the MoH (DLI 7.4).
9. PMCI Capacity: DLI 3.2 involves the availability of at least 4 required capabilities at PMCIs, and as of
June 2022, 332 PMCIs had 4 required capabilities. This includes 125 PMCIs with the minimum cadre
assured, 303 PMCIs with essential drugs available, 349 PMCIs with minimum equipment availability,
352 PMCIs with essential lab tests available, and 347 PMCIs where at least 3 supervision visits were
conducted. Additionally, Personal Health Records have been issued by 194 PMCIs (DLI 5.2), Friends of
the Facility (FFC) committees have been established at 309 PMCIs (DLI 7.5), and a total of 75,783
women between the ages of 35-45 have been screened for cervical cancer (DLI 8.1) and the study on
cervical cancer has been completed (DLI 8.2). Regarding the progress of DLI 6.2, the Director General
of Public Finance is currently awaiting cabinet approval for the revised procurement guidelines. It has
been noted that DLR 3.2 related to the availability of essential drugs at PMCIs has been affected by
the drug shortage in the country and the interruption in drug supply since February 2022. As such, the
PMU has requested the flexibility of reporting the said DLR for the period of June 2021 – February
2022 to reflect the country's context2
.
10. Medical Supplies Management Information System (MSMIS): 59 PMCIs are currently connected to
and using the MSMIS. As noted in the previous mission, the MoH is also in the process of developing
a new platform which is expected to be completed by October 2022. The new system will be piloted
in 350 PMCIs and is expected to be rolled out to the remaining PMCIs by March 2023.
11. The project has also made significant progress with non-DLI indicators and has exceeded targets for
many of the intermediate result indicators. 42 percent of PMCs have transport facilities to dispatch
laboratory samples to apex laboratories, 41 percent of PMCs have capabilities for the primary
detection and management of Dengue, 45 percent of PMCIs provide a standard primary oral health
care package, 65 percent have basic emergency care facilities, and 32 percent have capabilities for
Tuberculosis screening and referral. 70 percent of Medical Officer of Health areas offer mental health
services in at least one PMCI. Targets have not been met for two non-DLI indicators. Only 31 percent
of schools are implementing health promotion programs compared to a target of 35 percent, primarily
due to extended school closures in the last year. 37 percent of Medical Officers have been trained in
Non-Communicable Diseases compared to a target of 40 percent.
Progress of Component 2
12. With US$9 million re-allocated to a common CERC pool created during the COVID-19 pandemic, the
allocated financing for Component 2 was reduced to US$5.22 million. A total of 11 innovation grants
were awarded under Component 2. Among those, 2 were withheld, 5 have been completed and 4 are
in progress (detailed are provided in Annex 4). The final reports of the 5 completed studies will be
shared with the World Bank and a dissemination workshop has been scheduled for October 2022 to
share the key findings. Moreover, several studies have led to the development of new national
policies, for instance on HPV screening, and food composition charts. Those experiences of evidence-
based policy-making will also be disseminated at the workshop. Detailed progress of the innovation
2 The verification criteria for this DLR considers a stock out if a particular drug is not available at a PMCI for 5 days
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grants is provided in table 1 below. To date, US$2.4 million has been disbursed under Component 2
and another US$2.82 million remains to be disbursed. The PMU will provide a detailed forecast of
planned activities and expenditures under Component 2.
13. Capacity building programs conducted under Component 2 include 4 foreign pieces of training, 2 local
programs, 2 travel grants, and 2 online programs. The project has also supported programs for 16
professional colleges in improving the capacity of the health professionals and field health staff on
timely related topics and provided funding for 5 institutes.
14. The pilot study on Quality Management Systems for Primary Medical Care is in progress and the
situation analysis and desk reviews, have been completed. A pilot study in a selected PMCI
(Weeraketiya District Hospital) is in progress (details provided in Anenx 7).
15. Component :3 Contingent Emergency Response Component (CERC):
Based on the request of the MOF, the WB triggered the CERC on June 17, 2020, and US$9 million from
Component 2 of the project were re-allocated to a common CERC Pool through a restructuring
approved on January 10, 2021. Accordingly, the PDO and the intermediate results have been revised.
In May 2021, the MoF revised the sectoral CERC pool budget allocations by a total of US$56 million,
and in October 2021 the following additional changes were made: (a) the completion date was moved
from December 31, 2021, to December 30, 2022, and (b) the Emergency Action Plan (EAP) and CERC
Emergency Operation Manual (EOM) were revised to reflect changes related to the revised budget
allocations and completion date.
16. As of March 2022, an expenditure of US$31.01 million was reported, and close to US$44.62 million,
or about 80 percent of the total amount allocated to the CERC Pool has been disbursed to the
implementing agencies for expenditure and as advance. Implementation progress has slowed down
significantly due to the ongoing and volatile country situation including price escalations, shortage of
material and labor in the market, currency fluctuations, delay in bid evaluation, unresponsive market,
supply chain issues, unexpected bad weather, shortage of power supply and fuel, as well as ongoing
COVID-19 pandemic. As of March 2022, out of US$ 9 million of the PSSP finances, US$7.13 million has
been disbursed on account of emergency expenditures under the identified sectors, namely
agriculture, education, information and communication technology, transport, and disaster
management activities. Indicators related to CERC are still on track, and all CERC Pool activities are
planned to be completed by the CERC Pool closing date of December 30, 2022. PDO indicators of the
PSSP have not been impacted by the said reallocation of funds from Component 2.
17. Impact of the ongoing crisis on project implementation, challenges, and changes needed
Certain activities under the PSSP have been hampered by the restrictions and mobility issues caused
by the economic crisis, which has led to some implementation challenges at the provincial level.
a) The fuel crisis in the country has affected the mobility of the general public and health staff and
has led to some level of disruption in routine health services as well as NCD screening and
registration. Moreover, the lack of fuel limits the public’s ability to access health care.
b) PMCs have been affected by shortages of drugs and essential medical equipment due to import
restrictions and resulting supply chain disruptions in the country. The shortage of drugs and
essential medical supplies, including certain NCD drugs, blood glucose strips, and cholesterol
strips has impacted routine NCD screening and management. However, MoH, Directorate of NCD
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has issued the guidelines for NCD screening based on the clinical and other biometric parameters
to ensure the continuity of the screening. The project is planning to explore the procurement
options to purchase the required Glucose strips and cholesterol strips for Healthy Lifestyle Clinics
(HLC)/ PMCIs which is vital to support DLI achievement under the project.
c) Frequent power outages have caused difficulties in maintaining the cold chain supply of vaccines
and the lack of fuel to power generators has affected the maintenance of ICU facilities and
operating theatres. Health authorities are also facing difficulties conducting routine maternity
clinics and preventive measures to control communicable diseases like Dengue.
18. Considering the current context, provincial authorities have prepared a contingency plan, listing
priority areas for support to maintain essential health services during the crisis. These include (a)
supplying nutritional supplements for vulnerable groups, such as pregnant mothers and young
children; b) purchasing laboratory materials, reagents, and test kits and stripesfor basic investigations
at PMCIs; (c) the provision of essential medical equipment and drugs; (d) the installation of solar
power units for selected hospitals to manage power outages; (e) ensuring a continuous supply of fuel
to power generators in Intensive Care Units and operating theatres, (f) Provisions for maintaining
utility services, in recurrent nature, including repairing existing utility vehicles to provide
uninterrupted services. All these activities could be supported through the allocations given to the
provinces under the PSSP given that project disbursements are executed through budget support.
19. The PMU is also collaborating with health authorities to develop mitigation strategies to overcome
these implementation challenges. Mobile screening clinics will be conducted at the district level to
screen the population at the PMCIs with high population empanelment. Until physical travel is
possible, the PMU will conduct online discussions with Friends of the Facility (FFC) committee leaders
and empower leaders to conduct in-person communication at the village level. Steps are being taken
to print PHRs through government printers. To overcome the laboratory reagent shortage, it was
recommended that project funding (component 1) be used to settle outstanding payments for
provincial reagent bills to help restore the regular supply of reagents to provinces. The Bank team
emphasized the importance of those mitigation measures and assures the PMU that the above-
proposed activities are eligible for support using project funding.
20. The next IVA and disbursement are planned for late August/September 2022. The next verification
will verify achievements on DLIs 3.2, 5.2, 6.2, 7.5, 8.1, 8.2, and 9.1 and the expected disbursement will
be US$ 27.31 million by October 2022. A few modifications in methods will be incorporated in the
verification, following discussion and agreement of the MoH, World Bank, and the IVA. For DLI3.2 on
PMCIS staff, Assistant Medical Officers (AMO) will also be counted as MOs for verification. AMO is an
old cadre for doctors without MBBS training before MBBS training was formalized in Sri Lanka. Since
AMOS perform similar tasks to MOs in PMCIs, they will be counted as MOs in the verification. For
patient records, paper records will be accepted in addition to HMIS records, as the ongoing HMIS
update work is taking longer than expected due to PMCI connectivity issues. Details of future
disbursements are in Annex 1.
21. FM Performance: Financial Management: Overall FM performance rating continues to be
“Moderately Satisfactory” due to the overdue audit report of component 1 for FY 21 which is delayed
and is expected to be submitted to the Bank in the forthcoming period. The mission notes that there
are no overdue IUFRs. The project's overall disbursement ratio stands at 55% as of mission with the
recent disbursement that was processed in June 2022 amounting to US$11.8 Mn for DLI
achievements. Of the total disbursements by the WB of US$110 Mn, US$103.5 Mn is on account of
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Component 1 & US$ 2.4 Mn is on account of Component 2. There is also US$ 4.9 Mn disbursed on
account of emergency expenditures under the CERC component. The project must follow up on the
adequacy of budget provisions required for FY22 and FY23 as it is essential for uninterrupted project
implementation.
22. Procurement: The Project's procurement accomplishments have been evaluated remotely as of July
29, 2022, based on mission discussions and STEP updates. The procurement performance is rated as
"Satisfactory" and the risk rating remains "Moderate." The PMU affirmed that previous staffing
arrangements remain in place.
23. STEP updates The STEP updates reveal that 51 activities have been launched and 18 have been
canceled, leaving 33 ongoing activities. There are 3 in the 'pending implementation' stage and 3
activities in the 'under implementation stage, with all of them exhibiting implementation delays. 12
contracts have been "signed," and 15 have reached the completion stage.
24. Currently, the contract for Supply, Installation, Commissioning, and Maintenance of Digital Signage
systems for 600 Hospitals under LK-MHNIM-153616-GO-RFB is being implemented, albeit with
considerable delay. The mission advised preparing a report detailing the procurement process
followed, the delivery status at the hospital level, and the planned efforts to expedite the delivery.
25. Next Steps The mission wishes to underline that:
Within two weeks after the conclusion of the mission, the Project must present an updated
Procurement Plan that anticipates all future needs via the STEP system.
The Project must monitor pending and ongoing activities to ensure that the scheduled dates are met.
The Project must take proactive steps to ensure the smooth implementation of 'signed' contracts.
The Project must upload all documents before contract completion in the STEP completion milestone.
The Bank will begin the procurement post-review audit in the upcoming months; therefore, it is
essential to upload the documents to STEP.
26. Safeguards: The overall implementation and management of environmental and social safeguards are
rated as being ‘satisfactory’ (details provided in Annex 6).
27. The project’s GRM continues to function effectively as the national GRM for the health sector which
is now functional island-wide including its MIS. Grievances can be received through postal mail, e-mail
(This email address is being protected from spambots. You need JavaScript enabled to view it.), short cord hotline (1907), and social media including WhatsApp &
Viber (details are provided in Annex 5).
28. Timing of the Next Mission: The next implementation support mission is proposed for December
2022. In the interim, the Bank team will continue to provide implementation support through
technical and operational discussions in support of the achievement of the project outcomes.
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Annex 1 - Details of FM Performance
Component 1
Staffing: The mission notes that MPCLG has assigned staff from its finance unit on a part-time basis to
handle the project FM requirements under the oversight of the MPCLG Chief Accountant and this
arrangement is acceptable to Bank for Component 1 activities. The related FM activities include the
preparation of the six monthly interim unaudited financial statements, annual financial statements for an
external audit, coordinating with the external auditor in the completion of the external audit process until
the final external audit report is submitted and actively supporting the capacity building initiatives planned
under the project.
Budgetary provision
FY 2021: For FY 21 GoSL budget estimates were made available & mission notes that below are the budget
provisions for the respective entities for FY 21 as reflected in the budget estimates of FY 21 which were
made available in the public domain.
MoH (component 1) = Rs. 1,250 Mn (approx. US$6.75 Mn)
MoH (component 2) = Rs. 250 Mn (approx. US$1.25 Mn)
Provinces = Rs. 3,000 Mn (approx. US$16 Mn)
Total = Rs. 4,500 Mn (approx. US$24 Mn)
FY 2022: required budget allocations for FY 2022 should be available for the project as this will be very
essential to implement the planned activities during the FY. Hence, it’s important for a project to diligently
follow up with MoF on the adequacy of the required budget provision for 2022 to ensure the smooth
completion of the ongoing project activities. For FY 22 GoSL budget estimates that were made available
as reflected in the budget estimates of FY 22 in the public domain is as follows.
MoH (component 1) = Rs. 599 Mn (approx. US$1.6 Mn) (utilized so far 141 Mn)
MoH (component 2) = Rs. 101 Mn (approx. US$0.27 Mn) (utilized so far 65 Mn)
Provinces = Rs. 5,000 Mn (approx. US$13.7 Mn)
Total = Rs. 5,700 Mn (approx. US$15.4 Mn)
FY 2023: required budget allocations for FY 2023 should be available for the project as this will be very
essential to implement the planned activities during the FY. Hence, it’s important for the project to
diligently follow up with MoF on the adequacy of the required budget provision for 2023 to ensure the
smooth completion of the ongoing project activities.
Fund flow & intermediate indicator
As component 1 is a budget support operation, the sector relies on the funds released by the Treasury
against the requested amount by the spending units. The fund releases by treasury against the requested
amounts for 2019, 2020 & 2021 need to be analyzed and information to be compiled. The mission is
proposing to carry out this review soon by a combination of desk reviews & also by visiting provinces as
possible. Monitoring the intermediate results indicator during the project life is required. The mission
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would like to request to assistance & cooperation of MoH & MPCLG & for them to spearhead this review
to be carried out in due course.
Semi-annual Unaudited Financial Management Reports (IFRS)
In line with the financial covenants of the project, the MPCLG has submitted the required Interim
unaudited financial report (IUFRs), with the last one being for the period ending March 31, 2022. These
have been reviewed by the Bank and found to be in order. The mission reminded us that the next IUFR
for the quarter ending June 30, 2022, is expected by August 15, 2022, from MPCLG for Component 1.
Annual Audited Financial Reports
The project's external audit is carried out by the National Audit Office of Sri Lanka (NAOSL).
FY 20: Under component 1, the Bank team notes that the finalized consolidated annual financial
statement of FY 20 was submitted by MoH with a significant delay on October 22, 2021. As per the PAD &
DFIL, the original due date for submission of the audit report was June 30, 2021. However, the audit report
of component 1, reached the Bank only on February 18, 2022, in comparison to the due date of June 30,
2021. The audit report was acceptable. The audit opinion was qualified. There appeared to be no serious
issues or accountability aspects raised in the audit report related to FM. The Management Letter (ML)
was also issued for this consolidated audit report on February 15, 2022. The Bank advised the project to
take corrective measures as appropriate may be taken for audit observations in the ML also.
FY 21: Mission notes that the finalized consolidated annual financial statement was submitted by MoH to
NAOSL on July 25, 2022, to Secretary MoH's office. This needs to be submitted to the Auditor General
through the Secretary without any further delay & PMU is required to follow up on the same. As per the
PAD & DFIL, the due date for submission of the audit report was June 30, 2022. However, due to the
emergency prevailing in the country & other issues within the agencies under the project, the submission
has got significantly delayed. The bank team advises the project to submit the consolidated audit report
at the earliest to Bank, for component 1 along with the ML.
FY 22: for Component 1 under provincial level activities, the finalized consolidated annual financial
statement should be submitted by MoH including the MPCLG part to NAOSL latest by March 31, 2023.
Bank would be closely monitoring the submission of audited financial statement, audit report &
Management Letter by June 30, 2023. The project is advised to take all possible measures to avoid delays
in the audit process encountered in the past years, especially the delays experienced in FY 19, FY 20 & FY
21 audit processes. All agencies responsible to maintain the required supporting documentation & report
back to MoH need to be advised & monitored for compliance. Any issue that is prevalent & contributes to
delays needs to be highlighted on a real-time basis & steps needed to be taken to resolve the same without
waiting until the audit process is commenced.
Financial Management – Component 2
Currently, the total cumulative advances received by the PMU at MoH to date is US$2.4 Mn. The total
expenditure documented in the Client Connection (CC) System is US$1.8 Mn. The outstanding advances
pending documentation as per the CC system as of the review date amount to US$0.5 Mn.
PMU at MoH has a full-time accountant to implement the FM activities under Component 2. There is an
internal auditor also that has been recruited since October 2021. Bank advises to follow up on timely
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internal audit process & also share the internal audit reports with the Bank. The last IUFR submitted by
the PMU was for the quarter ending March 31, 2022, which was reviewed & concurred by Bank. The
related Withdrawal application (WA )is also processed by the PMU.
External Audit:
A separate audit report is required to be prepared for this component.
FY 21: The Bank notes that the final accounts for FY 21 were submitted by PMU at MoH to NAOSL on April
30, 2022. As per the originally agreed timelines in PAD & DFIL, the due date for submission of the audit
report was June 30, 2022. Accordingly, the audit report reached the Bank on July 25, 2022, in comparison
to the due date of June 30, 2022. The audit report of component 2 was acceptable to Bank and it is noted
that it has an unqualified opinion. The ML was also submitted this time by MoH on July 25, 2022. In
general, all weaknesses stated in ML need to be carefully managed by the PMU & corrective actions need
to be taken.
The main areas of improvement required in the project as reflected in ML are noted to be below:
i) Physical performance: Operational delays in the project
ii) Systems & Controls: Asset management/board of survey
iii) Compliance with laws ruled & regulations
FY 22: for Component 2, the finalized annual financial statement should be submitted by PMU at MoH to
NAOSL on March 31, 2023. The due date for submission of the audit report & ML would be June 30, 2023.
Sri Lanka has had a sound primary healthcare approach since the mid-1920s (even before the Declaration of Alma-Ata in 1978). Sri Lanka has made notable progress in key healthcare indicators. Life expectancy at birth, maternal and child health as well as neo-natal, infant and under-5 mortality rates are higher than the South Asian average.
