The opinions of health and water service users in Sri Lanka

Despite a long process of liberalization, institutional reforms in Sri Lanka's health and water sectors have been very limited. Health care is still provided free at the point of delivery through an extensive network of public facilities and the primary responsibility for urban water supply rests with the National Water Supply and Drainage Board and local authorities. Reform in the water sector has taken the form of institutional development and graduate commercialization of the NWSDB and transfer to it of poorly managed local authority schemes. Subsidies benefit middle and higher income consumers with individual connections, although access by the poor is safeguarded by free provision of standpost supplies. Despite improved efficiency, continued subsidy has constrained capital investment, with adverse effects on the adequacy of piped water supplies. Consumers were resistant to privatization and increased direct charges as means of improving supply. However, there do not appear to be affordability obstacles to increasing charges to middle income consumers. While there would be strong resistance from both middle and low income users to ending free water provision to the poor and there are strong public health and equity arguments for maintaining this safety net provision, increased opportunities for individual connections could be provided to those who prefer a better quality service and can afford to pay for it. A legacy of public action and direct state provision has created many vested interests in existing government service delivery arrangements and a strong public perception that government's role should be to directly provide services, for the most part free at the point of delivery. While arguably middle income users could pay more for certain services, they expressed strong support for continued.