The expansion of health care coverage in Sri Lanka, with its focus on the poor, dates from the 1930s,
and many of the initial motivations continue to be important influences. By far the most important one
for health services has been democracy. In the 1920s, conditions in the island were much like those in
most other British colonies. Government intervention in health was limited to providing health care to a
small urban population that operated the colonial infrastructure and administration and an equally small
workforce involved in export agriculture, and to a sanitary regime designed to control major epidemic
threats such as cholera. Democracy based on universal suffrage was introduced in 1931 expressly to em
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power the poorer groups in society and women and to put pressure on the elites to pay closer attention
to social and health conditions.