The Sri Lankan health system is recognized regionally and globally as a high impact, low-cost model. This achievement was built on the foundations of a health-care system that has been free at the point of delivery; adopting key primary health-care principles since 1926 significantly in advance of the Declaration of Alma-Ata in 1978. The health system of Sri Lanka has a proven track record of satisfactory performance and has achieved commendable health outcomes above what is commensurate with its income level.

However, Sri Lanka’s health outcomes were threatened even before the COVID-19 pandemic with increasing health demands associated with the rising burden of noncommunicable diseases and the growing population of elderly and disabled citizens. In this backdrop, Sri Lanka was planning on reorienting service delivery with a focus on strengthening PHC through a shared care cluster approach.

However, COVID-19 had a significant impact on the progress of the above activities at a critical juncture and continues to have a fundamental and long-term impact on population health. Superimposed on COVID-19 now is the most catastrophic economic and financial crisis to hit the country since independence.

The above poly-crises have re-emphasized the importance of identification of evidence-based and high impact interventions for health system strengthening and reforms. Sri Lanka’s success in achieving good health outcomes has been centered around PHC and is based on public investment in public health. Adjusting the health system to the country’s evolving needs and towards resilience must always be done preserving the PHC backbone.

In this context, the Center for Health Systems Policy and Innovation (CHSPI) is being established to support policy and innovations focusing on national health priorities related to health systems and primary health care.