The primary goal of the health services in Sri Lanka since its inception has been the provision of health care of good quality, free at the point of delivery and ensuring equitable coverage. However, the health system faces new challenges from the demographic, epidemiological and social transitions that the country is experiencing. Key issues that the health system is currently faced with are: underutilization of primary level curative care institutions, a culture of self-referral and lack of an effective referral mechanism which has resulted in bypassing the closest primary care institutions. Same time care provision is episodic and lacking in continuity.

The Government of Sri Lanka has shown continuing commitment towards improving Primary Health Care (PHC) through the primary care restructuring programme. The goal of these initiatives is to ensure universal health coverage to all citizens, relevant to the disease burden experienced in the country through a well-integrated, comprehensive and efficient health service.

DHQS as the apex body of healthcare quality and safety provided the task of preparing a supervisory tool and indicators that could evaluate the quality of care provided by the primary care institution at the provincial and RDHS levels.

DHQS developed the supervision tool with the participation of the relevant stakeholders based on the following:

• Cleanliness and other aspects of physical infrastructure based on checklists.
• Storage and availability of drugs.
• Waiting times for attention, time is taken for the whole process from entry to exit.
• Observation of client-provider interactions based on a checklist.
• Using records to examine compliance with appropriate guidelines.
• Client perceptions of the quality of care received.

RDHS needs to carry out supervisory visits and reports need to be sent to the DHQS quarterly basis for further analysis.