7.3. Shared Care Cluster System:
The Shared Care Cluster System is a key initiative under the Health System Enhancement Project (HSEP), a primary healthcare development program funded by the Asian Development Bank (ADB). This project aims to improve the efficiency, equity, and responsiveness of Sri Lanka’s Primary Health Care (PHC) system. By focusing on Universal Health Coverage (UHC) and a continuum of care, the project introduces a significant paradigm shift. It moves away from episodic treatment toward a continuous, family-centered digital health network that ensures all citizens have access to high-quality essential services.
To achieve these goals, the project focuses on planning and delivering essential services with a strong emphasis on equity. It supports government reforms designed to reduce the bypassing of local PHC facilities by offering more comprehensive care, particularly for Non Communicable Diseases (NCDs). By developing a formal referral system and integrating preventive and curative services, the project strengthens the overall healthcare structure. Additionally, it prioritizes access for underserved communities and addresses critical gaps in public health surveillance to meet International Health Regulations (IHR) standards.
7.3.1. What is a Health Cluster?
A cluster is a functional unit of healthcare providers where a Secondary Care Apex Hospital provides specialist support to a network of Primary Medical Care Institutions (PMCIs). This ensures that a patient's medical journey is tracked digitally, regardless of which facility they visit.
Primary Goal: To reduce "bypassing" of local hospitals and ensure specialist expertise at Apex hospitals is accessible to rural communities via digital referrals.
Key Implementation Zones
Under the Health System Enhancement Project (HSEP) funded by the ADB and World Bank, the system is being piloted in 9 districts across 4 provinces; Central (Kandy, Matale, Nuwara Eliya), North Central (Anuradhapura, Polonnaruwa), Sabaragamuwa (Ratnapura, Kegalle), Uva (Badulla, Moneragala).
7.3.2. Dambulla Cluster; A Model for Central Province:
The Dambulla Cluster is the flagship implementation for the Matale District. Managed by the RDHS Matale, this cluster serves a massive catchment area spanning Dambulla, Sigiriya, and Galewela.
The Apex Hospital; Base Hospital (A) Dambulla:
Provides specialized consultation, advanced laboratory backups, and inpatient specialist care. All clinical data from the feeder units is accessible here for consultations with other supportive systems:
- Shared Care Information System
- Centralized Radiology (Picture Archiving and Communication System - PACS)
- Centralized Laboratory Information Management System (LIMS)
Linked Primary Medical Care Institutions:
These institutions feed into the Dambulla Apex, sharing a unified Personal Health Record (PHR) for every registered citizen. Over 150,000 residents in Matale North are now "empanelled" (assigned) to these specific clinics for continuous health monitoring.