Background: In Sri Lanka, consumption of foods high in salt is high. Efforts are underway to tackle this issue, including the reformulation of fast foods to contain less salt. To succeed, understanding the practices in using salt among restaurant owners, cooks, and chefs are important. The objective of this study was to explore the challenges that may prevent the reformulation of foods to contain less salt in selected food premises in Sri Lanka.Methods: In a qualitative study design using semi-structured interviews and focus groups as data gathering tools, food premises from ten districts in Sri Lanka were selected; while owners of food premises, chefs and cooks were the study population.Results: The study recognised several key themes related to the study objective including awareness and practices on salt use, ‘eating outside’ behaviour, dominance of experience when using salt, commercial vs. domestic use of salt and catering to the demand. Findings included both supportive and resistive perceptions and attitudes.Conclusion: Fears of competition and consumer demands may prevent restaurant owners, chefs and cooks from taking decisive steps towards lowering salt use. Training them on ways of lowering salt, while maintaining the appeal for foods and building trust on equitable implementation of salt lowering policies may win industry support. However, such efforts must parallel approaches to changing consumer behavior towards salt containing foods.

Background Sri Lankan citizens consume almost double the recommended daily amount of salt. Objective of this study was to assess the knowledge, attitudes and practices related to health effects of dietary salt among adults and adolescents in Sri Lanka to inform a national behavior change communication campaign. Methods We conducted a descriptive household survey among adults (n=1016) and adolescents (n=505) in 10 districts. An, interviewer administered questionnaire was used for data collection. The approximate amount of dietary salt intake of the individuals was estimated based on household purchases. Findings The recommended salt limit was identified by 40% of the population. Majority, adults (90.8%) and adolescents (86.1%) knew the adverse health effects of high salt intake. Although household monthly purchase of salt indicated consumption is much higher than recommended, 48.3% of adults and 45.9% of adolescents believed that they consume ‘just the right’ amount. Discretionary salt added to home cooking was a major contributor to intake, with approximately half (50%) adding salt when cooking rice, the staple. For health-related information most preferred (adults - 72%, adolescents – 69%) media is television. Interpretation The study identified gaps as well strengths in knowledge, attitudes and practices of Sri Lankans related to salt and health and recommends that the communication campaign include specific messaging to address gaps and leveraging on strengths. The survey identified adult females to be a key target group for the campaign and television is recommended as the mode of delivery.

Since the late 1920s, the Sri Lankan health system has been based on a firm foundation of primary health care, and it has been recognized internationally as a highly successful low-cost model. However, rethinking the future health-care model has been essential, owing to the country having one of the fastest ageing populations in the world, coupled with a high premature mortality from noncommunicable diseases. To sustain past gains and meet new challenges, several models centred on an expanded primary health-care system have been trialled and refined in the past decade. Primary health care was identified as a key priority in the National Health Strategic Master Plan 2016-2025, and in 2018 the Cabinet approved the Policy on healthcare delivery for universal health coverage. This policy introduces the "shared care cluster" system, whereby an apex specialist institution serves the local primary care referral institutions. The catchment population is divided into populations of approximately 5000, for which one family doctor is responsible. Strengthening and retaining human resources at these primary-level curative institutions will be essential, especially in rural locations. Also critical will be initiatives to orient the population's health-seeking behaviours. Sustained political commitment, an effective communication strategy, a tailored health workforce policy, performance monitoring and evaluation, coordination mechanisms, and changes in administrative and financial regulations are some of the future factors that will be critical to realizing the full potential of primary health care and accelerating universal health coverage in Sri Lanka.