Sri Lanka
A South Asian country with free public healthcare and strong primary coverage, which isolates regulation from access to a clinician.
8 domains reviewed · 8 high-confidence · 1 dated estimate · 9 material gaps
WHO region: South-East Asia. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 8 of 9
- Hospice: 1 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 11
- Newest source 2026
Lessons from Sri Lanka
- Free care and a strong primary system did not move prescribing beyond physicians, and physicians themselves cite low confidence and shortage. Reform should budget for prescriber confidence as well as regulatory change.74
- A large community cadre can carry home symptom care before any change to prescribing law. Countries with a salaried community health worker programme have a structural equivalent.75
- Free drugs and visits did not remove the cost of reaching a clinic. Home and community delivery closes a gap that free provision leaves open.76
- Asking patients about religious practice and traditional remedies can help clinicians align pain care with the coping strategies patients already use.386
- A brief structured early palliative care package, partly delivered at home by public health nurses, can reduce distress in patients with cancer in a middle-income health system.571
Palliative care
Is morphine available in Sri Lanka?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 0.90 mg per personSOURCE-CHECKED · 2020 DATA
Morphine consumption, Sri Lanka, 202052
Last checked 2026-09-24.
As reported in a 2025 review of Nepal, on the same basis as its Nepal figure.
Cite this figure: - 58.80 percentSOURCE-CHECKED
Surveyed physicians citing drug shortage as a reason not to prescribe, Sri Lanka, 202474
Last checked 2026-09-24.
Lack of confidence was cited by 60.7 percent. Multiple answers allowed.
Cite this figure:
Oral morphine is described as restricted for fear of abuse, and drug shortage was among the leading reasons physicians gave for not prescribing it.77,74
Is oral morphine stocked at base hospital level, and did the 2022 foreign exchange crisis interrupt it?
Help answer it:Search PubMedHow does Sri Lanka regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
- 62.50 percentSOURCE-CHECKED
Surveyed physicians who want the morphine prescribing regulations changed, Sri Lanka, 202474
Last checked 2026-09-24.
Cite this figure:
Physicians attribute underuse partly to restrictive national regulation of narcotics.74
Which statute and which authority license a hospital pharmacy to stock morphine, and when was it last amended?
Help answer it:Search PubMedWho can prescribe morphine in Sri Lanka?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
- 23.80 percentSOURCE-CHECKED
Surveyed physicians who had prescribed morphine for palliative care, Sri Lanka, 202474
Last checked 2026-09-24.
One teaching hospital in the Northern Province.
Cite this figure: - 10.20 percentSOURCE-CHECKED
Public health nurses reporting morphine administration, Sri Lanka, 202575
Last checked 2026-09-24.
Administration of a physician's prescription. Palliative home visits were reported by 94 percent.
Cite this figure:
Prescribing is limited to physicians. Public health nurses make palliative home visits and administer prescribed morphine but are not legally permitted to prescribe. Free provision has not widened prescribing.75,74
Is there any protocol under which a nurse may prescribe or titrate morphine?
Help answer it:Search PubMedHow does palliative care reach patients in Sri Lanka?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 217 nursesSOURCE-CHECKED
Public health nursing officers nationally, Sri Lanka, 202575
Last checked 2026-09-24.
Against 8,612 public health midwives.
Cite this figure:
Services sit in selected tertiary hospitals, such as the palliative clinic at the national cancer hospital. The national strategic framework for 2019 to 2023 pushed home-based care, carried by public health midwives and a public health nurse cadre reintroduced in 2018.76,75
How many hospital or district palliative teams exist nationally?
Help answer it:Search PubMedWho pays for palliative care in Sri Lanka?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
The tax-funded state sector provides care free at the point of use and delivers most inpatient care. Patients and families still report travel cost and lost income as the main barrier to clinic attendance.77,76
Is there a budget line for opioid procurement, and was it cut during the 2022 crisis?
Help answer it:Search PubMedHow are palliative care clinicians trained in Sri Lanka?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
A national survey of doctors graduating in 2017 found no registered academic palliative care department, specialist or programme in any medical school.78
When was the postgraduate diploma in palliative medicine established, and does the Medical Council recognise it as a subspecialty? It was found only in a search result.
Help answer it:Search PubMedHow does Sri Lanka prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Among 216 physicians at Teaching Hospital Jaffna, mean confidence in starting morphine was 4.84 out of 10, and reasons for not prescribing included unfamiliarity with palliative care, drug shortages and refusal by patients or relatives. A regional review notes some recent progress in opioid access in Sri Lanka while pain remains grossly undertreated across South-East Asia.74,540
What controls govern opioid prescribing in Sri Lanka, and are opioid agonist treatment and naloxone available?
Help answer it:Search PubMedHow do children get palliative care in Sri Lanka?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
What pediatric palliative care services exist in Sri Lanka, how many children do they reach, and are child-appropriate morphine formulations available?
Help answer it:Search PubMedHospice care in Sri Lanka
How the hospice model works here, who can use it, who pays and who it reaches. Covered 1 of 4.
What does hospice care look like in Sri Lanka?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Does Sri Lanka have dedicated inpatient or home hospices distinct from hospital palliative care units, and who runs them? PubMed articles read in this session did not describe one.
Help answer it:Search PubMedWho can get hospice care in Sri Lanka?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
If hospices exist in Sri Lanka, what admission criteria and referral routes do they use?
Help answer it:Search PubMedWho pays for hospice care in Sri Lanka?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
Who pays for hospice-type care in Sri Lanka: the free public system, charities or families?
Help answer it:Search PubMedHow many people reach hospice in Sri Lanka?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Palliative care providers at a Sri Lankan cancer center describe a shortage of hospice care. They say patients whose families cannot give care at home are left with hospice as a last resort. This comes from four provider interviews at one hospital.76
How many hospice beds exist in Sri Lanka, and who runs them?
Help answer it:Search PubMedWhat fills the gap in Sri Lanka
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Among 226 informal caregivers of patients with advanced cancer at one hospital, 60% were female and 49% had elevated depressive symptoms. Symptoms were linked with caregiving hours, financial strain and lower family and social support.387
Single-site evidence- Faith communities
Buddhist patients at a national cancer hospital pain unit often understood cancer pain as the result of karma from previous births. Many increased religious practice after falling ill, such as offering flowers and lighting oil lamps to the Buddha, and described it as a source of relief.386
Single-site evidence- Traditional and complementary healers
Some patients used Sinhala medicine from a vedamahaththaya, Ayurvedic kashaya, massage or ritual practices alongside clinic pain medication. Family members helped, for example by applying oils or massaging a patient's legs during pain.386
Single-site evidence
Sources cited here
- 77Jayarajah U, Abeygunasekera AM.
Cancer services in Sri Lanka: current status and future directions. Journal of the Egyptian National Cancer Institute 2021;33:13. DOI 10.1186/s43046-021-00070-8. The state sector provides free universal care and most inpatient care; oral morphine described as restricted for fear of abuse.
- 74Nisahan B, Raviraj S, Navaratnam S, Nadarajah R.
Physicians' views of the use of morphine in palliative care: a cross-sectional survey from a tertiary care centre in Northern Sri Lanka. BMC Research Notes 2025;18:165. DOI 10.1186/s13104-025-07247-7. Survey of physicians at Teaching Hospital Jaffna in 2024: share who had prescribed morphine, reasons for not prescribing, and views on the national regulations.
- 52Shrestha R, Shrestha S, Shrestha S, Shrestha A, Paudel BD, Munday D.
Opioid accessibility for palliative care in Nepal: a review of achievement and remaining challenges. Indian Journal of Palliative Care 2025;31(1):74-78. DOI 10.25259/IJPC_118_2024. Oral morphine licensed for domestic manufacture since 2009 and produced by a single manufacturer that imports all raw material from Europe; prescribing limited to registered medical practitioners; national morphine consumption and fentanyl patch cost against the minimum daily wage.
- 75Senadheera L, Priyanthi N, Warnasekara J.
The scope of public health nursing practice in Sri Lanka: a cross-sectional study. BMC Nursing 2026;25. DOI 10.1186/s12912-026-04398-1. National sample of public health nursing officers: palliative home visits, administration of prescribed analgesics including morphine, and national headcounts for public health nurses and midwives. States that these nurses are not legally permitted to prescribe.
- 76Deduwela RS, Athauda LK, Sirribaddana PA.
Patients' and healthcare providers' perceptions in outpatient palliative cancer care services at a tertiary care hospital in Sri Lanka: prospects for adoption of a digital health intervention. BMC Health Services Research 2026;26. DOI 10.1186/s12913-026-14528-9. Palliative outpatient clinic at the national cancer hospital; cites the National Strategic Framework for Palliative Care Development 2019 to 2023 and describes travel cost and lost income as the burden on patients and families.
- 78Fernando GVMC, Prathapan S.
What do young doctors know of palliative care; how do they expect the concept to work? BMC Research Notes 2019;12:419. DOI 10.1186/s13104-019-4462-2. National survey of the 2017 graduating cohort; reports no registered academic palliative care departments, specialists or programmes in any medical school.
- 540Vallath N, Rajagopal MR, Perera S, et al.
Access to pain relief and essential opioids in the WHO South-East Asia Region: challenges in implementing drug reforms. WHO South East Asia J Public Health 2018;7(2):67-72. Regional review of opioid access in the WHO South-East Asia Region, covering India's NDPS Act and its 2014 amendment and noting progress in Bangladesh, India, Nepal and Sri Lanka; authors include palliative care advocates. Abstract read.
- 387Weeratunga EB, Goonewardena S, Meegoda L
Prevalence and Associated Factors of Depressive Symptoms among Informal Caregivers of Patients with Advanced Cancer who Received Palliative Care in Sri Lanka. Asian Pac J Cancer Prev 2025;26(6):1997-2007. Cross-sectional survey of 226 conveniently selected informal caregivers at Apeksha Hospital, Maharagama; single hospital. Abstract read.
- 571Ratnasekera N, Perera I, Perera S, et al.
Early palliative care for patients with oral cancer in Sri Lanka: A non-randomized controlled trial. PLOS Glob Public Health 2026;6(3):e0005985. Non-randomized controlled trial of an early palliative care package for 110 patients with oral cancer at four Sri Lankan tertiary units. Abstract read.
- 572Ramadasa U, Silva S, Udumulla U, et al.
Caregiver strain among patients of palliative care in Sri Lanka: validation of modified caregiver strain index - Sinhala version. BMC Palliat Care 2023;22(1):172. Validation of a Sinhala Modified Caregiver Strain Index among 200 caregivers at three Sri Lankan teaching hospitals. Abstract read.
- 386Edirisinghe NP, Makuloluwa PTR, Amarasekara T, et al.
Coping with cancer pain: a qualitative study to explore pain perception and self-coping strategies of patients with cancer in Sri Lanka. BMJ Open 2024;14(11):e085510. Interviews with 21 Sinhala-speaking patients, mostly Sinhala Buddhists, at the pain unit of Apeksha Hospital, Maharagama; single institution. Full text read.