As the COVID-19 pandemic continued into its second year, the emergence of new variants and global inequities in vaccine access and supply made it increasingly difficult to predict the path and the scale of the crisis. The public health emergency stretched the Sri Lankan health system, prompting rapid mobilisation across the country’s 1,103 government hospitals. These hospitals continued to provide free healthcare, even as underlying capacity challenges became apparent during moments of peak demand. National rollout of the COVID-19 vaccination programme has contributed to easing the burden on the health system and has been among the fastest in the region: by February 2022, more than 95 per cent of the Sri Lankan over-12 population had received one dose of a COVID-19 vaccine, and more than 80 per cent had received two doses. 

The Sri Lanka Preparedness and Response Plan (SPRP), the key framework for collaboration between the UN and Sri Lankan authorities, continued to guide health sector response to the COVID-19 outbreak. UN support in 2021 was spearheaded by WHO in collaboration with UNICEF and other UN entities and national and international partners such as the World Bank, the Asian Development Bank, professional associations, academic centres, and others. This support stemmed from the UN Socioeconomic Response Advisory Paper, complemented by the SPRP for relevant health sector response. Additional resources were made available by the UN’s Multi-Partner Trust Fund. In this context, the UN led response, coordination, and support efforts to provide evidence-based strategic and technical guidance to the government and its partners.

Sri Lanka saw a coordinated UN response to successive waves of the pandemic in 2021, with WHO leading on the provision of evidence-based guidance and mobilisation of additional resources. Health authorities were assisted with updating their COVID-19 plan, convening and coordinating regular meetings to align responses from different stakeholders and donors, and facilitating timely communication to address the urgent need for equipment, diagnostics, and supplies.

Further health sector support included boosting key public health areas such as strengthening the country’s epidemiological surveillance system; increasing laboratory testing capacity and the health system’s capacity to manage cases; addressing the “infodemic;” and strengthening community engagement on public health and social measures, in tandem with helping accelerate vaccination across the country.

Enabling equitable access to essential health services while prioritising vulnerable groups and those most at risk was an overarching priority for the UN and its partners during the pandemic. Research was commissioned and facilitated by WHO regarding COVID-19’s impact on the continuity of essential health services for noncommunicable and communicable diseases—such as tuberculosis, HIV, hepatitis, dengue fever, and malaria—and to track how countries in the region (including Sri Lanka) responded to mitigate challenges and recover services. 

Infectious waste management, especially in COVID-19 facilities, was a priority during the third wave starting in April 2021. WHO and partners assisted Sri Lankan authorities with addressing logistical challenges to safe waste disposal and reducing infections in treatment centres.

Specialised equipment was facilitated by WHO for the management of COVID-19 patients who needed critical care in 10 higher-level centres and 68 intermediate ones. This equipment included high-dependency units, B-PAP machines, multiparameter monitors, and oxygen concentrators. Emergency equipment such as X-ray machines, autoclaves, and infusion pumps was also provided to both primary health and COVID-19-specific facilities. As the pandemic subsides, this equipment will be integrated into the primary health care system. 

Other support facilitated by the UN and international partners, with WHO and UNOPS in the lead and provided by national and local authorities, included key genomic sequencing machines for the detection and identification of different virus variants. Through the support of international partners, procurement of medical and laboratory equipment plus oxygen plants worth over $18 million was facilitated by UNOPS, aiming to limit virus transmission and reduce secondary infections among healthcare personnel.

Support also included sanitation and water purification facilities and personal protective equipment (PPE) for over 10,000 vulnerable plantation workers—a majority of them women—and frontline workers, an effort coordinated by UN Habitat.

The Ministry of Health, facilitated by UNFPA in different health and SGBV centres, distributed over $660,000 worth of PPE to health care workers—especially staff working on maternal and child health—to prevent COVID transmission.

UNICEF coordinated the provision of a wide range of technical and material support to different health centres, with a notable focus on maternal health. This included high-dependency units; maternity kits; studies on oxygen needs across the system; a nationwide assessment and specialised training and equipment on vaccine management; the integration of COVID-19 prevention in rural water safety schemes; and the upgrade of water, sanitation, and hygiene facilities in different rural maternity centres. This multi-pronged support benefited over 6,700 women and children.

UNHCR helped provide essential medical services and distance learning support to refugees and asylum seekers, while also providing protective equipment to staff at the Disaster Management Centre.

WHO and UNICEF joined together to support the Ministry of Health on the National Vaccine Deployment Plan, which became an essential tool in prioritising the vaccination of target groups and providing overall guidance for immunisation plans.

In related efforts, Sri Lanka received some five million doses of COVID-19 vaccines as part of COVAX to boost its supply. UNICEF-led efforts provided technical and financial support to the Ministry of Health to ensure adequate and optimal cold chain capacity by updating specialised equipment and identifying gaps hindering rapid rollout of the vaccination programme across the country—and, in the long term, improving its overall immunisation programme. WHO, for its part, worked with the health care sector to provide further support on the NVDP, including training on data entry, visualisation, and analysis for health administrators, epidemiologists, and medical officers; providing technical assistance in the development and regulatory approval of different vaccines; and supplying some two million syringes for mass vaccinations drives. The UN in Sri Lanka also helped develop one of the world’s first COVID-19 information management systems, with the capacity to analyse and visualise data from vaccination centres at national and subnational levels. The primary data source for COVID-19 vaccination information in the country, this tool was further upgraded to issue a “Smart Vaccine Certificate” that can be verified globally.

Another priority area of work during the pandemic was the integration of telemedicine solutions for COVID-19 cases. The UN, led by WHO, helped establish a centrally managed, digital home-based care system for asymptomatic and mildly symptomatic patients. Over 165,000 patients were served at the peak of the third wave, contributing to a significant reduction of the burden on health institutions and providing psychosocial benefits to patients and their family members being managed at home under a qualified medical professional.

Communication played a key part in community engagement and vaccination efforts, with UNICEF and WHO taking the lead in helping the Ministry of Health to disseminate clear and relevant messaging in coordination with Sarvodaya and other civil society partners. A mix of traditional and digital media was used to distribute evidence-based messaging, local and regional situation reports, and trilingual risk communication materials such as infographics and videos. In total, over 600 materials supported by the Ministry of Health and other partners reached 15 million people across the country, raising awareness and mitigating the spread of the virus, as well as improving vaccine intake.

Specialised messaging on prevention of sexual and gender-based violence (SGBV) reached over 100,000 people across vulnerable populations in plantations.

2021 saw alternative means of education carried out in various capacities for 4.2 million students in Sri Lanka, with schools moving to television or online-based learning. The UN worked in partnership with the government to support continuity of education and manage widening gaps in learning outcomes resulting from inconsistent access to remote learning. In response to the sudden shift in learning modalities, the UN, led by UNICEF, developed a practice guide for teachers to introduce the concept of learning environments underpinned by children’s ideas and interests, active and exploratory early childhood pedagogy, and civic competencies, complementing the forthcoming redevelopment of national and provincial education curricula. A 10-week competency enhancement programme for 6,500 teachers of preschool-aged children on Infection Prevention and Control guidelines was also launched, including what to do if a child becomes sick at school or a new COVID-19 diagnosis is reported.

The country’s digital transformation and innovation agenda was also boosted, accelerated in part by COVID-19.

In 2021, the Sri Lankan Ministry of Justice introduced legal provisions on conducting court proceedings using remote technology. This effort built on the success of a UNDP-led pilot project that facilitated remote court hearings for 950 e-bail applicants in the Colombo High Court.

UNFPA has also contributed to increasing the digital capacity of government and CSOs, investing more than US$55,000 in upgrading digital capacity, IT equipment, and internet-enabled communications for activities focusing on Sexual and Gender-Based Violence, and the protection and well-being of women and girls. UNICEF also supported the Sri Lanka Health Promotion Bureau to send critical child health and nutrition information to parents via cellphone-based messaging during periods of movement restrictions to ensure continuity of monitoring and management of child undernutrition.

UN partners also addressed the effects of the COVID-19 pandemic on nutrition and food systems in Sri Lanka. Curfew orders and import restrictions severely disrupted food systems and supply chains, impacting the availability, pricing, storage, and quality of food.

In January 2021, WFP stepped in to support urgent efforts by the State Ministry for Women and Child Development to procure maize and support production of 978 tonnes of fortified, nutrition-rich foods, distributed to over 600,000 mothers and children at risk of malnutrition.

In the wake of ongoing school closures and disruptions to the School Meals Programme, UNICEF provided a suite of nutrition-related communication tools to assist families in providing a more balanced diet with locally available ingredients. In 2022, the UN will work with the government to closely monitor international developments around the COVID-19 pandemic and continue its support in managing the public health and socioeconomic response.