Sri Lanka, a country in the tropical region, has experienced cyclical droughts of high intensity, occurring in intervals of three to four years. These droughts have had a series of adverse impacts on the economic and social life of people in the country. This study attempts to assess the economic costs of drought and farmers’ adaptation strategies to drought with the intention of informing the policies which address drought-related economic vulnerability among farm households in Sri Lanka. Data were drawn from 540 farm households in the North Central Province (NCP) in the dry zone of Sri Lanka, in 2015. Results indicate that drought weakens agricultural production, food consumption and the investment capability of farm households, while also increasing indirect costs such as those arising in relation to healthcare. Thus, immediate measures, particularly income mediating policies to provide compensation to drought-affected families, are required to avoid multiple impacts of drought to farm households and to the provincial economy.

Background: Ending preventable maternal deaths remains a challenge in low- and middle-income countries (LMICs). Society perceived causes and real-life observations can reveal the intangible causes of maternal deaths irrespective of formal maternal death investigations. This study reports complex patterns in which social determinants act towards paving the path to maternal deaths in a rural Sri Lankan setting. Methods: We conducted social autopsies for 15/18 maternal deaths (in two consecutive years during the past decade) in district A (pseudonymized). In-depth interviews of 43 respondents and observations were recorded in the same field sites. During thematic analysis, identified themes were further classified according to the World Health Organization framework for social determinants of health (SDH). The patterns between themes and clustering of social determinants based on the type of maternal deaths were analyzed using mixed methods. Results: Discernable social causes underpinned 12 out of 15 maternal deaths. Extreme poverty, low educational level, gender inequity, and elementary or below-level occupations of the husband were the characteristic structural determinants of most deceased families. Social isolation was the commonest leading cause manifesting as a reason for many other social factors and resulted in poor social support paving the path to most maternal deaths. A core set of poverty, social isolation, and poor social support acted together with alcohol usage, and violence leading to suicides. These core determinants mediating through neglected self-health care led to delay in health-seeking. Deficits in quality of care and neglect were noted at health institutions and the field. Conclusion: Social autopsies of maternal deaths revealed complex social issues and social determinants of health leading to maternal deaths in Sri Lanka, indicating the need for a socially sensitive health system.

Background: This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare.Methods: The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests.Results: The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (r_s = 0.095,p = 0.002) and the number of pregnancies (r_s = − 0.155,p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05).Conclusion: Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.

The issue of paddy marketing characterizes the paddy sector crisis, as farmers cannot realize the expected price at the harvesting period due to the bulk of supply. This paper attempts to study the effectiveness of a new marketing-based model – Warehouse Storage Receipt System (WSRS) - to solve the paddy sector crisis in Sri Lanka. Primary data for the study were drawn from field surveys conducted among farmers and traders in the Huruluwewa Agriculture Colonization Scheme in the Anuradhapura district, and in-depth interviews were conducted among the officers in the Upuldeniya WSRS in the scheme. A descriptive-analytical technique was employed in the study due to the nature of the investigated problem. The results first indicated that a majority of paddy farmers sell their harvest during the harvesting period at the lowest price, leading to inadequate net income from paddy farming. Secondly, the study revealed the oligopolistic nature of paddy marketing structure, since a few large-scale traders handle a substantial share of the farmers’ production. The lower financial capability of the farmers to cover variable costs of paddy farming and pre-modern economic characteristics of the paddy marketing channel have allowed large-scale traders to grab the farmers’ production at a minimum price during the harvesting period. Thirdly, WSRS evaluation has revealed that the farmers could enhance the net income of paddy farming by adequately marketing their harvest via the WSRS, as it improves the harvest holding capability of farmers until they realize a Farmer Expected Price (FEP). The study modelled that the WSRS leads to improve market competition through supply management, and thereby gradually increases the price at the harvesting period and shortens the price movement period to create equilibrium, which has been the farmers’ expectation.

Objectives This study aimed to assess the productivity loss and cost due to maternal ill-health conditions and its associated factors throughout pregnancy in rural Sri Lanka. Design A follow-up study of women registered in the Rajarata Pregnancy Cohort (RaPCo). Setting Anuradhapura district, Sri Lanka. Participants 1573 pregnant women who were followed up from pregnancy identification to termination. Primary and secondary outcome measures The primary outcome measures of this study are productivity loss due to maternal ill-health conditions expressed by days/month and productivity cost due to maternal ill-health conditions expressed in monetary terms (US$)/month. Data were collected monthly, and all pregnant women were asked to report the leading cause of maternal ill-health condition and the associated loss due to absenteeism and presenteeism. Results During the pregnancy follow-up, 3595 (81.5%) months had at least one episode of maternal ill-health condition. Of these, only 1729 (48.1%) episodes sought medical care. Assistance for lost routine work was reported in 1281 (35.6%) episodes. The absenteeism, presenteeism and gross and net productivity loss per month were 3.6, 4.5, 8.1 and 5.5 days/month, respectively. The corresponding productivity cost was US$15.26/month. Nausea and vomiting (NVP) reported the highest prevalence (n=1599, 44.5%) until the second month of the third trimester, presenteeism (5.5 days/month) and gross productivity loss (9.5 days/month). Pregnant women with vaginal bleeding reported the highest absenteeism (6.2 days/month) and net productivity loss (6.8 days/month). Pregnant women diagnosed with anaemia reported the highest productivity cost (US$26.98/month). Monthly household expenditure, poverty and receiving assistance were the associated factors of productivity loss (p<0.05). Conclusion Maternal ill-health conditions during pregnancy lead to productivity loss in rural Sri Lanka. NVP, vaginal bleeding and anaemia are the leading causes of productivity loss. Hence, controlling and preventing the leading causes are the recommended priorities.