By Dr. K. Ajith Kumara
Consultant Physician
President, All Ceylon Medical Officers Association

The prevailing economic situation in the country has resulted in many adverse effects on health of the Sri Lankans. A vast majority of people are unable to afford for health expenditure at personal levels while the health system is on the verge of collapse due to unavailability of many essential medications and surgical instruments on one hand and the frustrated health care staff on the other side.

Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity and it is a fundamental human right which means that everyone has the right to enjoy the highest attainable standards of physical and mental health. There are many determinants of health such as education, living condition, working environment, agriculture and food production, water and health care system. Although the health of the people cannot be ascertained by the health system alone, in an economic disaster of this kind, the government should take immediate measures at least to maintain health system at an acceptable functional level.

Failure to respond to this economic turmoil has resulted in near collapse of the health care delivery in the country with deleterious outcomes. Many essential items and medications are not available and surgeries are postponed. Many drugs including antibiotics are withdrawn due to quality failure. We have no idea of loss of lives or incapacity due to poor quality or unavailability of essential and lifesaving medications. Many patients followed up in clinics have poorly controlled non communicable diseases such as diabetes and hypertension due to intermittent unavailability of medications like insulin leading to complications such as chronic kidney disease and cardiac diseases ultimately further rising the health care demand.

Poverty has multifaceted grave effect on health. People do not seek medical attention and did not concern their chronic diseases such as diabetes until they get late complications as they are unable to afford. Instead of a balanced healthy diet, majority tends to rely on mainly carbohydrate rich unhealthy diet increasing the risk of diabetes, hypertension obesity and so on and, poorly controlled medical conditions for those who have got them already.

Productive workforce is a vital need for an economic stability. The workforce is the engine that drives the economy and supports the financial underpinnings of the health care system too. Therefore, an appropriate approach is to view health as a social investment to be leveraged rather than a cost to be justified. According to the Special Committee on Health, Productivity, and Disability Management of American College of Occupational and Environmental Medicine, improving the health of workers can reduce total costs (health-related productivity loss plus disability benefit costs plus medical/ pharmacy costs). Many researches by experts in occupational medicine have shown that a focus only on medical/pharmacy costs, as done by many nations, obscures the full benefits of truly improving the health of citizens of a country.

First of all, the Sri Lankan government should understand the gravity of consequences of this economic doom and gloom. Sri Lanka should immediately focus on short term scientific rational methods to identify national issues, health challenges and should encompass a holistic approach to educate the general public so that unnecessary or avoidable health problems such as accidents and dengue like communicable diseases can be minimised. Then, the government should take immediate steps to prioritise the essential services and government functions such as health, food security, stable echo system and education while changing the fiscal policy.

Sri Lanka’s total health care expenditure is 3.8% of GDP while the government spends only less than a half (1.54%) of it. Government spending on the health sector in Sri Lanka is mostly financed through domestic resources; that means in rupees. In the 2021 central-level approved budget, the domestic to foreign resources ratio in the health sector stands at 95% to 5%. If so, why cannot the health care be improved to some degree by increasing domestic resources when the country in a crisis of dollars? That means, we need urgent attention to minimise mismanagement of local income! Thereby, Sri Lanka should be able to reduce the out-of pocket expenditure (nearly around 50%) which should be lower for a better health system.

We have significant shortage of essential items and lifesaving medications. But there are plenty of imported unnecessary medications, me-too drugs, and counterfeit medications in the market spending dollars accounted in the national health budget. As Prof. Senaka Bibile suggested in his national drug policy, we should adhere to an updated essential drug list and make sure that they are available to save the lives of citizens. At the same time, centralisation of the purchase of rational drug list and shopping around the world and accepting low price-bid as bulks rather than finished products can save lot of money.

Finally, the government should address the prerequisites of health and determinants of health for a healthy nation. There should be a national plan to protect patients from economic hardships due to their chronic ill health too. According to the World Food Programme, 6.3 million people, or over 30 percent of Sri Lanka’s population, are “food insecure” and require humanitarian assistance. Of these, around 5.3 million people are either reducing meals or skipping meals, and at least 65,600 people are severely food insecure. This situation is likely to worsen as the crisis unfolds in the island nation due to higher inflation, rising electricity bills and so on. Therefore, there should be an urgent national plan to improve food production, reduce food waste and ensure proper distribution of agricultural products and secure safe food and healthy meals.