Sri Lanka

Sri Lanka does not operate population-wide dementia screening programs. Case identification is opportunistic and symptom-driven, occurring in primary care, hospital clinics, or via NGO contact. Standard cognitive screening tools (e.g., MMSE, MoCA) are used inconsistently and are not embedded in a national protocol for older adults.

CT and MRI are available in major public and private hospitals, but overall capacity remains limited. Estimates from earlier system assessments (~1.7 CT scanners and ~0.4 MRI scanners per million population) illustrate structural under-supply, and long queues in the public sector persist into the 2020s. As a result, families frequently self-refer to urban private imaging centers to expedite diagnosis. Advanced functional imaging (e.g., PET for dementia) is not part of routine clinical practice and is effectively unavailable within standard public pathways.

There is no national guidance recommending APOE genotyping or monogenic dementia testing. Where genetic testing is pursued, it occurs on a case-by-case basis through private or overseas laboratories, typically for early-onset or atypical presentations. Published Sri Lankan clinical reviews do not describe routine use of genetic testing within public dementia care.

Cerebrospinal fluid (CSF) biomarkers (Aβ, tau) and emerging blood-based biomarkers are not integrated into national diagnostic protocols. Their use, if present at all, is confined to isolated tertiary cases or research collaborations. Local academic literature consistently highlights gaps in dementia research infrastructure, laboratory capacity, and standardized diagnostic algorithms.

Sri Lanka does not operate a formal national memory-clinic network, and there is no dedicated dementia service tier comparable to those found in some European or East Asian health systems. Instead, dementia assessment, diagnosis, and longitudinal follow-up are embedded within teaching hospital neurology and psychiatry departments, particularly in large tertiary and academic centers. Key service nodes include the psycho-geriatric and general psychiatry services at the National Institute of Mental Health, as well as neurology and psychiatry units at Colombo South Teaching Hospital (Kalubowila), Colombo North Teaching Hospital (Ragama), and other university-affiliated hospitals in Kandy and Galle. These centers function as de facto specialist dementia hubs, combining outpatient clinics, inpatient consults, and trainee-led follow-up, but without standardized referral criteria, staffing ratios, or protected clinic time specifically for cognitive disorders.

Outside these teaching environments, access to specialist dementia expertise is uneven. District hospitals and peripheral facilities typically lack old age psychiatry subspecialists, neuropsychology services, or structured cognitive assessment clinics. As a result, continuity of dementia care often depends on informal referral relationships, repeat outpatient visits to the same consultant, or family-initiated re-presentations when symptoms worsen. This model places a high burden on caregivers and reinforces geographic inequities between Colombo and the rest of the country.

Non-governmental organizations partially fill support gaps rather than clinical ones. LAF operates a Day Centre in Colombo that provides cognitive stimulation activities, caregiver education, respite support, and basic navigation advice. While LAF does not deliver medical diagnosis or treatment, its role is significant in improving caregiver literacy, reducing stigma, and encouraging earlier help-seeking. However, NGO services remain urban-concentrated, donor-dependent, and small-scale, limiting their systemic impact.

Palliative and end-of-life care in Sri Lanka is governed by Ministry of Health frameworks, including a national palliative care strategy first articulated in 2018 and subsequently updated. These policies establish principles for symptom control, psychosocial support, and dignity at end of life, but dementia-specific palliative pathways are still underdeveloped. In practice, advanced dementia care often defaults to general medical wards, family caregiving at home, or ad hoc hospice support where available, rather than structured neuro-palliative services. This gap is increasingly salient as population aging accelerates and prolonged late-stage dementia becomes more common.

In principle, public sector dementia care is free at the point of use, including specialist consultations and medications that are stocked and dispensed through government hospitals. This reflects Sri Lanka’s universal health coverage model and its long-standing emphasis on equitable access to essential medicines. In practice, however, supply constraints and stock variability play a decisive role. When cognitive enhancers or adjunctive medications are unavailable in hospital pharmacies, families are required to purchase them privately, shifting costs directly onto households.

Private prescriptions, whether issued by private consultants or public sector specialists directing patients to private pharmacies, are paid entirely out of pocket. The cumulative financial burden can become substantial over time, particularly given the chronic, progressive nature of dementia and the need for long-term medication adherence. While Sri Lanka periodically revises its essential and priority medicines lists, procurement delays and budgetary pressures mean that continuity of free medication cannot always be guaranteed.

As a result, dementia treatment financing in Sri Lanka operates through a mixed public–private reality: universal entitlement in theory, but partial privatization in practice driven by shortages, waiting times, and the desire for faster or more predictable access. This dynamic mirrors patterns seen elsewhere in the Sri Lankan health system, but its impact is amplified in dementia care due to duration, caregiver dependence, and the absence of alternative community-based supports.

Sri Lanka does not provide a dementia-specific cash allowance or formal caregiver benefit, and care is overwhelmingly family-led, shaped by strong intergenerational norms and expectations of home-based support. Most people living with dementia are cared for by spouses or adult children without formal training, respite, or financial compensation. While national policies exist for older persons, covering pensions, social assistance, and elder rights, these frameworks are age-based rather than condition-specific and do not explicitly recognize dementia caregiving as a distinct, high-intensity and long-duration form of unpaid labor.

Practical caregiver support is therefore fragmented and largely non-state. The most consistent dementia-focused assistance is provided by LAF, which runs caregiver support groups, a Colombo-based Day Centre offering limited respite, educational programs, and a helpline. Some hospital-based initiatives also exist, such as Cognitive Stimulation Therapy (CST) groups linked to psychiatry services at Colombo South Teaching Hospital (Kalubowila), but these remain site-specific and non-standardized. In the absence of scalable respite services or caregiver allowances, families frequently experience burnout and financial strain as dementia progresses, reinforcing reliance on informal care rather than a structured community support system.

Sri Lanka does not have a stand-alone, published national dementia strategy or action plan. Dementia is addressed indirectly within broader policy frameworks focused on population ageing and older persons’ welfare, most notably the National Elderly Health Policy (2017) and the National Policy for Senior Citizens / Elders. Within these documents, cognitive decline is typically referenced as part of non-communicable diseases, mental health, or geriatric care, rather than as a condition requiring a dedicated, end-to-end pathway encompassing prevention, diagnosis, long-term care, caregiver support, and end-of-life planning. As a result, dementia policy in Sri Lanka remains diffuse and non-operational, lacking defined targets, timelines, or accountability mechanisms.

International partners and civil-society actors, ADI, have continued to advocate for the development of a national dementia plan aligned with global norms promoted by the WHO’s Global Action Plan on the Public Health Response to Dementia. Academic stakeholders, including geriatric and psychiatry faculties, have similarly emphasized that Sri Lanka’s rapidly aging demographic profile will make dementia an increasingly significant health system and social care challenge. Despite this recognition, dementia remains embedded within elder policy at a strategic acknowledgment level, rather than elevated to a policy priority with dedicated financing and implementation architecture.

While a dementia-specific strategy has not been publicly announced, several adjacent policy developments are relevant. The government has advanced national palliative care frameworks, beginning with the 2018 policy and followed by subsequent drafts and implementation guidance under the Ministry of Health. These initiatives strengthen principles of symptom control, dignity, and psychosocial support across serious illnesses, including advanced dementia, but stop short of defining dementia-specific palliative pathways or neuro-palliative services.

In parallel, the government has signaled a refresh of elderly and aging-related policy for the 2025–2035 period, referenced in parliamentary discussions and health-sector planning documents, alongside broader efforts to consolidate universal health coverage (UHC). This creates a potential policy window for integrating dementia more explicitly, particularly in areas such as early diagnosis, caregiver support, and long-term care planning. However, at present, dementia remains implicit rather than explicit within these forward-looking agendas, and no draft national dementia plan has been placed in the public domain.

The most notable area of innovation in Sri Lanka’s dementia landscape is non-pharmacological intervention, particularly the adoption and local adaptation of Cognitive Stimulation Therapy (CST). CST groups have been implemented and evaluated through psychiatry services at Colombo South Teaching Hospital (Kalubowila), with training and dissemination supported through international collaboration. Sri Lanka is explicitly referenced within the global CST network coordinated by University College London, highlighting local clinical leadership in rolling out structured psychosocial interventions in a resource-constrained setting. This focus on CST reflects both pragmatic constraints and strategic choice: CST is low-cost, scalable, culturally adaptable, and caregiver-inclusive, making it well suited to Sri Lanka’s health system. Its adoption represents a rare example of bottom-up service innovation gaining international visibility, even in the absence of a national dementia strategy.