The government provides medical service free or at a nominal cost to almost everyone, but its health program is hampered by a worsening shortage of trained personnel and hospital beds. Medical standards, traditionally British, are considered excellent, but in recent years many Sri Lankan physicians and surgeons have moved their practices abroad—particularly to the United States and the United Kingdom, where remuneration is much higher. There are a limited number of private hospitals and medical practitioners. In 2000, 83% of the population had access to safe drinking water and the same percentage had adequate sanitation. As of 1999, total health care expenditure was estimated at 3.5% of GDP. As of 1999, there were an estimated0.4 physicians and 2.7 hospital beds per 1,000 people.
Malaria, smallpox, cholera, and plague have been virtually eliminated. Malnutrition, tuberculosis (3,405 cases in 1994), and the gastrointestinal group of infectious diseases are the chief medical problems. In 1991–95, 38% of children under 5 years of age were considered malnourished. In 1995, immunization rates for children up to one year old were tuberculosis, 89%; diphtheria, pertussis, and tetanus, 91%; polio, 91%; and measles, 88%. As of 1999 rates for DPT and measles were, respectively, 99% and 95%.
The infant mortality rate in 2000 was 16.1 per 1,000 live births while the maternal mortality rate was 60 per 100,000 live births for 1998. Birth control was used by 66% of married women in 1993. As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 16.4 and 6.4 per 1,000 people. Between 1984 and 1992, there were 32,000 civil war-related deaths. Other leading causes of death from 1990 statistics included communicable diseases and maternal/perinatal causes (232 per 100,000 people); noncommunicable diseases (459 per 100,000); and injuries (194 per 100,000). Average life expectancy in 2000 was 73 years. As of 1999, the number of people living with HIV/AIDS was estimated at 7,500 and deaths from AIDS that year were estimated at 490. HIV prevalence was0.07 per 100 adults.