The study team collected data from multiple sources, including a desk review of gray literature, key informant interviews, and empirical analysis of available data. We conducted a desk review of gray literature, including news articles, government documents and websites, circulars, and social media posts, to piece together the publicly available data on how the COVID-19 pandemic unfolded, the timeline of key responses, and the response of the health system in managing COVID-19 and essential health services delivery in Sri Lanka. We obtained additional documents and reports from colleagues within the health sector, sometimes after key informant interviews. Government websites and social media sites maintained by the Ministry of Health, Epidemiology Unit, and Health Promotion Bureau, were reviewed to obtain documents related to COVID-19 such as situation reports, guidelines, and data. As many COVID-19 updates were given on social media by the media and government departments, we used Facebook and Twitter to find specific information on key events.
The study team identified key informants involved in the COVID-19 response, including officials, politicians, health care workers, business and union representatives, and other experts. Some interviews were conducted later to clarify any discrepancies that arose as the study progressed. An interview guide was developed to inform the development of interview scripts. It grouped questions into the following key categories: essential health service maintenance; pharmaceuticals; public-sector hospitals; private-sector hospitals; vaccinations; testing, tracing, and isolation; quarantine processes; COVID-19 data and statistics; funding; and ambulance services. Questions were extracted from the interview guide and used to create guidelines for each informant based on their background and role. All informants were asked common questions relating to the challenges faced during the pandemic, the successes and failures, and their personal views on overall responses and strategies adopted during the pandemic.
Finally, the study team used existing data sets at the Institute for Health Policy, including COVID-19 metrics, processed mobility data, data from a private hospital survey, and an ongoing national phone survey—the Sri Lanka Health and Ageing Study (SLHAS) Wave 2—to provide supporting information. Data sets were compiled including data on COVID-19 cases, testing, mobility as tracked by Google and Facebook, mask wearing, and lockdown measures. The SLHAS was a critical primary data source providing information on population-level behavior and changes since 2019. The SLHAS is a Ministry of Health-approved, national longitudinal cohort study with two nationally representative sample surveys: Wave 1, which included data from 2018 and 2019 just before the pandemic started, and Wave 2, which included data from 2021 and 2022. The SLHAS provided crucial data on topics including the use of health services, health care access, public opinion, and vaccine uptake. Other data were sought from government agencies and the military, and the Institute for Health Policy Private Hospitals Survey 2022 was modified to collect additional data on COVID-19 activities from surveyed hospitals.