By Martin Raiser (Vice President for the South Asia Region, World Bank Group)

In the rural town of Morawaka located in Southern Sri Lanka, home to lush tea estates and paddy fields, Ramya is finally mother to a beautiful baby girl. She was born after a harrowing experience of an umbilical cord prolapse, a condition where the umbilical cord gets out of the body before the baby and risks cutting off the baby’s blood and oxygen supply. Ramya’s daughter was thankfully born safe—although in a surprising twist—aboard an ambulance, one of the world’s most digitally advanced and free ambulance services in Sri Lanka called ‘1990 Suwa Seriya’. 

Since its launch in 2016, 1.8 million Sri Lankan citizens in distress have dialed 1990 , and a Suwa Seriya ambulance has rushed them to the nearest hospital or primary care facility within 12 minutes of their call, one of the fastest response rates in the world for an ambulance service. In these seven years, Suwa Seriya has saved countless lives—providing citizens the highest level of pre-hospital care, reducing complications caused by delayed care, and enabling them to get back into the workforce in record time—making a positive contribution to the country’s economy.

South Asia is home to many development innovations, including in the delivery of social services through government-private sector-and civil society partnerships, and so 1990 Suwa Seriya stands in a proud tradition. What can we learn from its experience, so it can be replicated and scaled across other countries in the region?

Championing a unique operational model

Established through a dedicated Act of Parliament in 2018, 1990 Suwa Seriya is a government entity that operates with the agility and independence of a private sector organization, resulting in remarkable efficiency and setting new standards for government-delivered services. I remember first hearing about this service when I met with MP Harsha De Silva—he described the project as a testament to the power of bipartisan support, above the political fray and focused uniquely on saving lives.

To enable this single pointed focus, 1990 Suwa Seriya’s operation is end-to-end process driven, with technology as its backbone. We see that in its commitment to continuous improvement—from its logistical operations on how to fuel ambulances in record time and its R&D on how to integrate Artificial Intelligence into its emergency response system, to keeping an eye on continuous learning for staff on new systems and technologies and finding innovative funding streams so as to not strain public finances. Being governed by a board comprised predominantly of private sector volunteers and insulated from the typical constraints of public sector operations helps the organization make swift, informed decisions that are crucial for saving lives. 

Unlocking digital innovation

We know that digitization is a game changer for South Asia. 1990 Suwa Seriya has tapped into this potential by leading digital innovation in health and emergency services. Its trademark speed and efficiency come from digital integration into its processes and operations—from using specific algorithms to identify the fastest (not the nearest) ambulance that can be deployed to an emergency, to tracking callers’ locations through an app, to digitally tracking fuel levels in its vehicles.

A new ambitious pilot initiative called Connected Ambulance takes digital health to new heights by incorporating Artificial Intelligence and Mixed Reality to allow physicians to treat a patient in real time on board an ambulance. Suwa Seriya’s success is an example of how technology can help revolutionize service delivery in developing countries.

Bridging access to primary healthcare

By filling a critical gap in pre-hospital care and improving connectivity between emergency ambulance service and primary care facilities, 1990 Suwa Seriya is strengthening Sri Lanka’s primary healthcare system and giving a second chance at life to the millions who are critically injured. The ambulance service also complements the work done by the World Bank-financed Primary Healthcare Strengthening Project to enhance Sri Lanka’s primary healthcare services. My colleague, Anna Bjerde, most recently wrote about how this project has significantly enhanced primary healthcare services in about 1,100 institutions across the country. Pre-hospital ambulance services such as Suwa Seriya would greatly complement such ongoing and comprehensive efforts in healthcare services reform in Sri Lanka.

Also of note is the speed of the Suwa Seriya service, which counts in a nation where 34% of public deaths are from coronary heart disease and the window to save a life is short. The service was particularly indispensable during the COVID-19 pandemic, with Suwa Seriya transporting close to 175,000 COVID-19 patients to the hospital. 

In addition, the service has also improved healthcare access in hard-to-reach rural areas such as in Ramya’s case above, ensuring equitable access of emergency services to vulnerable citizens, and reducing overall morbidity and mortality in the country. Earlier, being transported to the hospital on a three-wheeler or a tuk tuk would result in more cases of blood loss, hemorrhages, and even death.  Today, 63% of Suwa Seriya’s emergency calls are from rural residents.

Supporting local partnerships

The growth of Suwa Seriya is a testament to homegrown innovation and local funding.  The technology that drives the service was all developed through Sri Lanka’s software development community, underscoring the need for countries to invest in digital skills. 

Initially funded by a grant from India, 1990 Suwa Seriya has since been supported by the Sri Lankan government. However, it deliberately seeks private donors and sponsors to fund its digital innovations so as to not rely solely on public funding in a resource-constrained environment. In its largest fundraiser yet, Suwa Seriya raised an impressive LKR 750 million in private funding via its “adopt an ambulance” campaign. 

South Asia has been hard hit by several shocks in recent years, from devastating natural disasters and economic crises to pandemics and political upheavals. However, initiatives like 1990 Suwa Seriya show that countries can be resilient and innovative even during crises, displaying homegrown creative solutioning at its best and how it can be replicated and expanded to create widespread benefits for the entire population. (NewsWire)

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World Bank Vice President for South Asia, Martin Raiser has reaffirmed the World Bank Group’s continued support to help Sri Lanka navigate economic challenges, implement critical reforms, and chart a path towards a resilient and inclusive recovery.

Issuing a statement, the World Bank stated that Martin Raiser made the assurance after concluding his four-day visit to Sri Lanka on 28th February 2023.

During his visit, Raiser met with Sri Lanka’s President and Minister of Finance Ranil Wickremesinghe, Secretary of the Treasury, Governor of the Central Bank, senior government officials, development partners, and key opinion leaders including members of Sri Lanka’s political opposition, thinks tanks, civil society organizations and academia.

“The people of Sri Lanka have been deeply affected by the macro and debt crisis affecting the country. The depth of the crisis has made it clear that Sri Lanka needs a new development model, but this requires greater confidence in and understanding of the government’s reforms”, said Martin Raiser. “Improved communication and consistent implementation of the reform and adjustment program is urgent, as is faster international debt relief and financial support to ensure people don’t lose patience and the opportunity for a change isn’t lost.”

The World Bank statement further said during the visit, Raiser discussed progress on reforms to transform economic governance in Sri Lanka through strengthened institutional and fiscal oversight and better debt management. He also stressed that greater transparency, improved governance, support for job creation, as well as better targeted protection for the poorest are critical to garnering and sustaining public support for reforms.

Raiser also visited North Central and Northwestern Provinces to observe first-hand World Bank-funded projects in the health and agriculture sectors, and to engage with a broad range of stakeholders on Sri Lanka’s development needs.

The World Bank was among the first to respond to Sri Lanka’s economic crisis. The Bank’s emergency response repurposed $325 million from existing projects to protect the poor and vulnerable from the worst impacts of the crisis. In December, the Bank approved Sri Lanka’s request to access concessional financing from the International Development Association (IDA). This type of financing, offered at low-interest rates, will enable the country to implement its government-led reform program to stabilize the economy and protect the livelihoods of millions of people facing poverty and hunger.

The World Bank statement added that the World Bank Group has started preparing a new Country Partnership Framework for the next four years (2023-2026) with a focus on private sector-led job creation, inclusion, preservation and strengthening of human and natural capital, improved governance, and a shift towards a greener growth path. (NewsWire)

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By Martin Raiser, Vice President for the South Asia Region, World Bank Group

Sri Lanka is at a critical moment in its history. Years of economic mismanagement, weak governance, poor policy choices, and the impacts of external shocks such as the COVID-19 pandemic and the Russian invasion of Ukraine, plunged the country into its worst-ever crisis in 2022.

Economic collapse and political instability have devastated lives and livelihoods across the board, dealing the heaviest blow to the poorest and most vulnerable. Regular climate-induced disasters add to Sri Lanka’s fragility. The depth of the crisis has made it clear that Sri Lanka needs a new development model. But the road to recovery is challenging and the necessary fiscal adjustment measures can be painful. Debt relief from Sri Lanka’s creditors and fresh financing from international financial institutions are thus urgent to ensure people don’t lose patience with reforms and the opportunity for a change isn’t lost.

The economic crisis has left deep scars. Poverty nearly doubled in Sri Lanka between 2021 and 2022, climbing from 13 to a staggering 25 percent (using a poverty line of US$ 3.65 per person per day), and is projected to increase by more than 2 percentage points in 2023. In the same time frame, urban poverty tripled from 5 to 15 percent. Sri Lanka’s people have been forced to quickly adapt to a new reality where prospects for a good job are limited, incomes are lowered and eroded by inflation, and opportunities for a better future are becoming increasingly rare.

In 2022, at least half a million people lost their jobs, most of which were in the industry and services sectors and employed women. Those already classified as poor saw a 65 percent increase in their cost of living, while the increase was 57 percent for the non-poor, highlighting the significant loss of welfare for all Sri Lankans.

In times of crisis, people often cope by adopting detrimental survival strategies.  For instance, they limit their intake of nutritious foods, forego education and preventive health investments, or take up informal and subsistence work. These negative coping mechanisms can erode decades of progress in human capital with impacts that could last generations. Worsening food insecurity is already translating into an increase in child malnutrition and stunting, which increased from 7.4 to 9.2 percent between 2021 and 2022.

The international community must help Sri Lanka strike the right balance between pursuing critical reforms to get the economy back on track and ensuring that people have access to safety nets, better jobs, and economic opportunities. Complementing the government’s initiatives to stabilize the economy, the World Bank is helping transform economic governance and increase public sector transparency. This will prevent repeating past mistakes through strengthened fiscal oversight and debt management, and by tackling the sources of the heightened financial sector vulnerabilities. And we are helping Sri Lanka transition towards a more private sector-driven and outward-looking economy by supporting SOE reforms, reducing the cost of trade, and making it easier for the private sector to invest. 

Although they are necessary, these reforms can negatively impact people if their immediate effects are not mitigated.  To prevent further welfare losses, a more effective social protection system is a priority.  Our support focuses on redesigning existing cash transfer programs and improving the social registry to provide targeted cash assistance to those most in need. In addition to cash transfers, the World Bank has been supporting the lives and livelihoods of the people by supplying essential goods such as medicines and school meals.

Strengthening human capital requires building a more inclusive society. The government is drafting legislation that will strengthen the institutional framework for gender equality and women’s empowerment. These positive developments should help level the playing field for women to participate in the workforce and protect women and girls from gender-based discrimination.

As Sri Lanka recovers, it is essential not only to help people escape poverty and vulnerability, but also to strengthen their resilience to future shocks in an increasingly volatile world. Linking cash transfer beneficiaries to economic opportunities and complementary measures—such as skills training, job coaching, and access to finance—can make Sri Lankans more employable, enabling them to rebuild their assets and improve their economic well-being.  These interventions can be catalyzed by measures that promote job creation through an improved business environment and access to finance, especially to support small and medium firms that are prevalent across Sri Lanka. 

With every crisis comes an opportunity. For Sri Lanka, this pivotal moment is a chance to reset its development model towards green, resilient, and inclusive growth. Sri Lanka has begun its journey towards this goal. What is important now is sustaining the reform momentum, rebuilding trust in public institutions through greater transparency and accountability, and protecting the livelihoods of those most affected by the crisis. Such efforts deserve support from Sri Lanka’s international partners.

Link: https://blogs.worldbank.org/endpovertyinsouthasia/sri-lankas-crisis-offers-opportunity-reset-its-development-model

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