Authors : Chathurtha Seneviratne; H. M. N. Pushpa Kumari; Nadarasamoorthy Gandharupan; Eranda Senevirathna; Yathavan Selvarajan

Volume/Issue : Volume 11 - 2026, Issue 6 - June

Google Scholar : https://tinyurl.com/2mzyttn5

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DOI : https://doi.org/10.38124/ijisrt/26jun421

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Abstract : Background Sri Lanka has achieved notable improvements in maternal health through a strong public healthcare system supported by skilled healthcare workers and extensive institutional coverage. Divisional Hospitals (DHs) play an important role in providing maternal health services, particularly in rural and semi-urban areas. However, variations in workforce distribution, infrastructure availability and service utilization across districts may affect the efficiency and equity of maternal healthcare delivery. Objective To assess the distribution of healthcare workforce and its relationship with maternal service utilization in Divisional Hospitals in Sri Lanka through a district-level comparative analysis. Methods A descriptive cross-sectional analytical study was conducted using secondary aggregated data from Divisional Hospitals across 26 districts and the National Institute of Health Sciences for the year 2025. Data included the number of Divisional Hospitals, Medical Officers, Nursing Officers, Supporting Staff, Midwives, Labour Rooms and institutional deliveries. Descriptive and comparative analyses were performed using Microsoft Excel. Key performance indicators, including deliveries per hospital, deliveries per midwife, deliveries per labour room and staff-to-hospital ratios, were calculated to evaluate workforce allocation and service utilization. Results A total of 494 Divisional Hospitals, 1707 Medical Officers, 3019 Nursing Officers, 3909 Supporting Staff, 616 Midwives and 344 Labour Rooms were identified. Overall, 262 deliveries were reported during the study period. Kandy District recorded the highest number of deliveries (88), while several districts reported very low or no deliveries despite having healthcare personnel and labour room facilities. National averages were 0.53 deliveries per hospital, 0.43 deliveries per midwife and 0.76 deliveries per labour room. Considerable disparities were observed between districts, with evidence of underutilized resources in some areas and high service demand in others. The findings indicate a mismatch between workforce and infrastructure allocation and actual maternal service utilization. Conclusion Significant district-level disparities exist in workforce distribution, maternal health infrastructure and service utilization within Sri Lanka’s Divisional Hospitals. The low utilization of maternity services despite substantial resource availability suggests inefficiencies in resource allocation and possible bypassing of primary-level maternity care facilities. Strengthening evidence-based workforce planning, optimizing resource distribution and improving utilization of existing maternal health services are essential to enhance the efficiency and equity of maternal healthcare delivery.

Keywords : Maternal Health Services, Divisional Hospitals, Health Workforce Distribution, Maternal Service Utilization, Midwives, Labour Rooms, Healthcare Resource Allocation.

References :

1. Senanayake L, Ranathunga A, Kaluarachchi A. Maternal health in Sri Lanka: 75 years of    national commitment towards excellence. Ceylon Med J. 2023;68(S1):46–52.
2. Siriwardhana DD, Pathmeswaran A, Wickremasinghe AR. Socioeconomic inequality and determinants of postnatal home visits made by public health midwives in Sri Lanka. PLoS One. 2019;14(4):e0215816.
3. Gunathunga W, Fernando DN. Assessment of community maternal care performance of public health midwives in Sri Lanka. Southeast Asian J Trop Med Public Health. 2000;31(2):310–8.
4. De Silva, A., Lissner, C., Padmanathan, I., Liljestrand, J., Martins, J. M., Rajapaksa, L. C., Singh, P. J., & Selvaraju, S. (2002). Investing in Maternal Health in Malaysia and Sri Lanka. World Bank. https://doi.org/10.1596/0-8213-5362-4
5. Farley, J. M., Suraweera, I., Perera, W. L. S. P., Hess, J., & Ebi, K. L. (2017). Evaluation of flood preparedness in government healthcare facilities in Eastern Province, Sri Lanka. Global Health Action, 10(1), 1331539.  https://doi.org/10.1080/16549716.2017.1331539

6. Pallegedara, A., & Grimm, M. (2017). Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka. Health Policy and Planning, 32(9), 1267–1284. https://doi.org/10.1093/heapol/czx085
7. Senarath, U., Fernando, D. N., & Rodrigo, I. (2006). Factors determining client satisfaction with hospital‐based perinatal care in Sri Lanka. Tropical Medicine & International Health, 11(9), 1442–1451. https://doi.org/10.1111/j.1365-3156.2006.01698.x
8. Singh, P. K., Kumar, C., Rai, R. K., & Singh, L. (2013). Factors associated with maternal healthcare services utilization in nine high focus states in India: a multilevel analysis based on 14 385 communities in 292 districts. Health Policy and Planning, 29(5), 542–559. https://doi.org/10.1093/heapol/czt039