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Need urgent measures to save health of citizens

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File photo of a doctors’ protest against the deterioration of the public healthcare system

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 Many drugs including antibiotics are withdrawn due to quality failure.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.



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Opinion

Why Sri Lanka needs a National Budget Performance and Evaluation Office

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President Dissanayake presenting Budget 2026 in Parliament

Sri Lanka is now grappling with the aftermath of the one of the gravest natural disasters in recent memory, as Cyclone Ditwah and the associated weather system continue to bring relentless rain, flash floods, and landslides across the country.

In view of the severe disaster situation, Speaker Jagath Wickramaratne had to amend the schedule for the Committee Stage debates on Budget 2026, which was subsequently passed by Parliament. There have been various interpretations of Budget 2026 by economists, the business community, academics, and civil society. Some analyses draw on economic expertise, others reflect social understanding, while certain groups read the budget through political ideology. But with the country now trying to manage a humanitarian and economic emergency, it is clear that fragmented interpretations will not suffice. This is a moment when Sri Lanka needs a unified, responsible, and collective “national reading” of the budget—one that rises above personal or political positions and focuses on safeguarding citizens, restoring stability, and guiding the nation toward recovery.

Budget 2026 is unique for several reasons. To understand it properly, we must “read” it through the lens of Sri Lanka’s current economic realities as well as the fiscal consolidation pathway outlined under the International Monetary Fund programme. Some argue that this Budget reflects a liberal policy orientation, citing several key allocations that support this view: strong investment in human capital, an infrastructure-led growth strategy, targeted support for private enterprise and MSMEs, and an emphasis on fiscal discipline and transparency.

Anyway, it can be argued that it is still too early to categorise the 2026 budget as a fully liberal budget approach, especially when considering the structural realities that continue to shape Sri Lanka’s economy. Still some sectors in Sri Lanka restricted private-sector space, with state dominance. And also, we can witness a weak performance-based management system with no strong KPI-linked monitoring or institutional performance cells. Moreover, the country still maintains a broad subsidy orientation, where extensive welfare transfers may constrain productivity unless they shift toward targeted and time-bound mechanisms. Even though we can see improved tax administration in the recent past, there is a need to have proper tax rationalisation, requiring significant simplification to become broad-based and globally competitive. These factors collectively indicate that, despite certain reform signals, it may be premature to label Budget 2026 as fully liberal in nature.

Overall, Sri Lanka needs to have proper monitoring mechanisms for the budget. Even if it is a liberal type, development, or any type of budget, we need to see how we can have a budget monitoring system.

Establishing a National Budget Performance and Evaluation Office

Whatever the budgets presented during the last seven decades, the implementation of budget proposals can always be mostly considered as around 30-50 %. Sri Lanka needs to have proper budget monitoring mechanisms. This is not only important for the budget but also for all other activities in Sri Lanka. Most of the countries in the world have this, and we can learn many best practices from them.

Establishing a National Budget Performance and Evaluation Office is essential for strengthening Sri Lanka’s fiscal governance and ensuring that public spending delivers measurable value. Such an office would provide an independent, data-driven mechanism to track budget implementation, monitor programme outcomes, and evaluate whether ministries achieve their intended results. Drawing from global best practices—including India’s PFMS-enabled monitoring and OECD programme-based budgeting frameworks—the office would develop clear KPIs, performance scorecards, and annual evaluation reports linked to national priorities. By integrating financial data, output metrics, and policy outcomes, this institution would enable evidence-based decision-making, improve budget credibility, reduce wastage, and foster greater transparency and accountability across the public sector. Ultimately, this would help shift Sri Lanka’s budgeting process from input-focused allocations toward performance-oriented results.

There is an urgent need for a paradigm shift in Sri Lanka’s economy, where export diversification, strengthened governance, and institutional efficiency become essential pillars of reform. Establishing a National Budget Performance and Evaluation Office is a critical step that can help the country address many long-standing challenges related to governance, fiscal discipline, and evidence-based decision-making. Such an institution would create the mechanisms required for transparency, accountability, and performance-focused budgeting. Ultimately, for Sri Lanka to gain greater global recognition and move toward a more stable, credible economic future, every stakeholder must be equipped with the right knowledge, tools, and systems that support disciplined financial management and a respected national identity.

(The writer is a Professor in Management Studies, Open University of Sri Lanka and you can reach Professor Abeysekera at nabey@ou.ac.lk)

by Prof. Nalin Abeysekera ✍️

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Opinion

Comfort for some, death for others: The reality of climate change

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climate

The recent Cyclone Ditwah struck South and Southeast Asia in an unprecedented way, causing floods, landslides, deaths, displacement of thousands, and severe soil degradation. For many in Sri Lanka, the disaster is seen as a natural event that the government should have anticipated. Yet, the reality is that small countries like ours have little power to prevent disasters of this scale. Despite contributing minimally to global carbon emissions, we are forced to bear the consequences of ecological harm caused largely by wealthier nations. Excessive consumption and profit-driven production in capitalist economies fuel climate change, while the Global South suffers the resulting losses in lives, homes, and livelihoods. The dead, the disappeared, and the displaced from Cyclone Ditwah demand climate justice—a justice that addresses structural inequality, exploitation of nature for profit, and the failure of global powers to take responsibility.

The Role of Excessive Consumption

The environmental crisis is driven by excessive consumption, particularly in developed countries. Cars, electronics, clothing, and other consumer goods require immense energy to produce, much of it from fossil fuels such as coal, gas, and oil. The transportation of raw materials and finished products adds further emissions, while waste from overconsumption ends up in landfills, releasing methane, a potent greenhouse gas. This cycle of consumption, production, and waste underscores a systemic problem: climate change is not merely an environmental issue, but a symptom of an economic system built on profit, not sustainability.

Market-Based “Solutions” and Greenwashing

Neoliberal economies are not silent in the face of climate change—they perform “sustainability” while offering superficial solutions. Many corporations engage in green branding to appear environmentally responsible, even as their practices remain unchanged. Carbon trading, for example, allows companies to buy and sell the right to emit CO₂ under a capped system. While intended to reduce emissions, it often commodifies pollution rather than eliminating it, enabling wealthy actors to continue environmentally harmful practices. Since many developing countries do not strictly enforce carbon caps, wealthy corporations often relocate their factories to these regions. Meanwhile, the burden of “reductions” is shifted to marginalised communities, turning these areas into pollution havens that endure the worst effects of climate disasters despite contributing the least to the problem. Market-based solutions, therefore, frequently reinforce existing inequalities rather than addressing the structural causes of climate change.

International Agreements and Structural Limitations

The global community has reached multiple climate agreements, including the UNFCCC (1992), the Kyoto Protocol (1997), and the Paris Agreement (2015). Yet these agreements remain constrained by capitalist agendas and weak enforcement mechanisms. Most rely on voluntary national commitments, peer pressure, and reporting transparency rather than legally binding obligations. Countries can submit inadequate Nationally Determined Contributions (NDCs) and remain technically compliant, rendering the agreements more symbolic than transformative. While not entirely ineffective, international agreements often prioritise narrative performance over real structural change, allowing wealthy nations to avoid meaningful responsibility for emissions and ecological harm.

Climate Justice and Social Inequalities

Climate change is inseparable from social injustice. Marginalised communities—those affected by poverty, colonial histories, racial discrimination, or gender inequality—face the greatest risks from environmental disasters. These populations generally lack safe housing, and even when warned to evacuate, they have few resources or means to recover from disasters. General climate policies, which have been influcned by capitalist agendas, that focus solely on emissions reduction or “green” initiatives fail to address these deeper inequalities. True climate action must empower communities, redistribute wealth, and integrate social justice with environmental sustainability. Only by tackling the structural drivers of both inequality and ecological harm can we move toward genuine climate justice.

Conclusion

Cyclone Ditwah and other climate disasters are reminders that the effects of environmental degradation are unevenly distributed. The Global South pays a heavy price for the consumption patterns and industrial practices of the Global North. Market-based solutions, superficial sustainability initiatives, and weak international agreements are insufficient to address the systemic roots of climate change. Achieving climate justice requires a fundamental rethinking of economic priorities, social structures, and global responsibility—placing people and the planet above profit.

The author is a postdoctoral fellow at Harvard Divinity School.

by Anushka Kahandagamage ✍️

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Opinion

Ditwah wake-up call demands a national volunteer community service for rebuilding Sri Lanka

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Volunteers helping disaster victims. (Image courtesy BBC)

The Tsunami of 2004 struck our coasts, but the recent Cyclone Ditwah has delivered an unprecedented blow, devastating and traumatising the entire country. President Anura Kumara Dissanayake rightly called it the “largest and most challenging natural disaster” in Sri Lanka’s history.

The toll is staggering: Over 600 people were confirmed dead, with hundreds still missing. More than 2 million citizens – nearly one in ten people—have been affected. 41,000 to 86,000 houses are damaged or completely destroyed. The damage is widespread, with 22 of the island’s 25 districts declared disaster-affected areas. A provisional economic damage estimate reaching up to USD 7 billion—a figure that instantly consumes about 7% of our national GDP. This was not merely a natural disaster; it was a crisis amplified by systemic failure, culminating in a catastrophe that now demands a radical, long-term policy response.

Unlike the Tsunami, the destruction to our vital inland infrastructure—roads, bridges, railway lines, and power networks—has been colossal, crippling the nation’s ability to recover. Over 25,000 members of the tri-forces have been mobilised, and the nation rightly hails their courageous and relentless efforts in rescue and relief. They should now be graduated from ‘Rana Viruvo’ to RUN VIRUVO considering the efforts they are still putting into the relief operations in this unprecedented calamity. But the scale of the rebuilding effort requires a permanently sustained unified national mechanism, perhaps learning from their rich experiences.

Why did devastation reach this cataclysmic level?

Unlike a sudden earthquake/Tsunami, a cyclone’s path is largely traceable. Yet, the “post-mortem” on Ditwah reveals a horrifying truth: the storm’s devastation was amplified by our own institutional failures.

The India Meteorological Department (IMD) which runs the Regional Specialised Meteorological Centre (RMSC) monitors the oceans in this region and issues alerts for cyclones. It serves all the regional countries — Bangladesh, Maldives, Myanmar, Oman, Pakistan, Sri Lanka and Thailand. The RMSC first predicted the formation of a depression as early as November 13 and issued an alert over the possibility of a cyclone forming on November 20. From November 23 onwards, IMD/RMSC had been routinely sharing frequent weather updates with Sri Lanka.

Robust models from the India Meteorological Department and the RMSC provided ample warnings of the depression and subsequent cyclonic intensification. Some of these predictions by the RMC and even the BBC forecasted rainfall over 300- 400 mm which could go up to even half a meter per day. True to their forecasts, Matale tragically received unprecedented rainfall of around 520 mm, triggering fatal landslides. Ditwah’s impact was worsened by its unusually slow movement over the island which sustained heavy rainfall over several days.

The Governance Gap

The critical breakdown occurred between the scientific prediction and the state’s executive arm. Warnings, if not taken seriously or acted upon, become meaningless data points. The core issue is a fragmented disaster management system that lacks the “unified command structure” required for real-time data sharing and rapid deployment. As one analyst noted, the disaster delivered a hard lesson: we entered one of our worst natural disasters in decades without a functioning national strategy and with a severe deficit in “adaptive capacity.

Scientific forecasts were not translated into an appropriate, urgent disaster preparedness program by the Sri Lankan state apparatus. Public reports indicate that national preparedness was woefully short of what was needed. The warnings failed to translate into a coherent, proactive response into an appropriate disaster preparedness action program on the island. This failure points directly to long-standing institutional deficits.

The Strategic Imperative: Dedicated Workforce for a $7B Recovery

President Anura Kumara Dissanayake rightly emphasised that restoring public life requires a unified operational mechanism that goes beyond normal state administration. To tackle this immense task, the Government has established a ‘Rebuilding Sri Lanka Fund’ to finance the medium- and long-term recovery, including essential infrastructure and public health issues.

This newly established ‘Rebuilding Sri Lanka Fund’ addresses the financial cost, but it does not solve the fundamental manpower crisis which is a key bottleneck in retarding the progress of this formidable undertaking. Rebuilding 247 kilometers of impacted roads, restoring two-thirds of unusable railway lines, clearing hundreds of landslides, and repairing crucial irrigation systems demands a sustained, disciplined, and massive workforce that normal state administration simply cannot provide. Furthermore, with the changing climate, events of this nature and magnitude may be more frequent in the future.

As such, there is a moral call to a strategic imperative. The immediate, ad-hoc spontaneous public volunteerism is commendable, but the scale of the task ahead requires a permanent, non-partisan national investment in human resources. The time for piecemeal recovery programs is over. Ditwah has forced the issue of structural accountability and national capacity onto the policy agenda.

A Call for Mandatory National Service

One of the most responsible paths forward is to utilise this crisis to institutionalise a robust National Service System, transforming a generation of youth into a standing army for climate resilience and nation-building. To fail to do so would be to guarantee that the next storm will bring an even higher price.

Sri Lanka cannot afford to be unprepared again. The solution is to immediately mobilise and, for the long term, institutionalise the patriotic energy of our youth into a robust, structured National Service System. This service should be more than just disaster relief; it is a long-term investment that will:

i) Build the Nation: Provide a rapid-response labour force for future disasters, infrastructure projects, and conservation efforts.

ii) Forge Character: Instill essential skills like discipline, leadership, accountability, and responsibility in our youth, thereby contributing to lower rates of substance abuse and crime.

iii) Strengthen Unity: Promote social cohesion and reinforce national identity by having youth from all backgrounds work together for a common cause.

The legal framework for such a move already exists. The Mobilisation and Supplementary Forces Act, No. 40 of 1985, already gives the government the powers to issue a National Service Order to enlist people in a National Armed Reserve. This mechanism can be adapted to establish a non-military, civilian-focused service.

Sri Lanka already has a government supported National Volunteer Service affiliated to her Social Services Department. It coordinates volunteers, develops management systems, and works with partners like the UN volunteers. This service can be improved and upgraded to tackle challenges in natural and/or human induced disasters which are going to be more frequent with greater intensity, at times.

In the immediate term, the large number of existing volunteers dispersed all over the island need to be engaged as understudy groups, working directly alongside the armed forces and government departments in the recovery process which is already happening in a number of instances.

Ditwah is our wake-up call for longer-term strategic planning and policy reforms. Alongside reacting to catastrophes in a piecemeal manner in the short-term, we must systematically start building a resilient nation with a vision for the future. Investing in a structured, mandatory Civilian National Service is the only way to safeguard our future against the inevitable challenges of climate change and to truly rebuild Sri Lanka.

Globally over 60 countries have national service portfolios mostly of military nature. Both Germany and France have recently reintroduced their national services to meet their own specific needs. In the US, the National Community Service centers around the Corporation for National and Community Service (CNCS), a federal agency that runs programs like AmeriCorps and Senior Corps, mobilising millions of Americans in service to address needs in education, disaster relief, environment, and more, fostering civic duty and offering educational awards for service.

Incorporate National Service into Educational Reforms

We must mobilize our youthful energy into a national service portfolio unique to our own needs giving due recognition to our history, geography and culture. As a long-term investment, this should be initiated while children are still in school, preparing them mentally and physically to contribute to nation-building.

A well-designed National Volunteer Community Service would instill discipline and foster essential skills like leadership, responsibility, and mutual respect, while contributing at the same time to national development. We can tailor this service to tackle our unique challenges in public safety, disaster relief, and environment conservation.

Existing school programmes like scouting and cadeting can be innovatively transformed to lay a sound foundation for this life-changing National Service for all schoolchildren. According to the initial estimates of UNICEF, over 275,000 children are among the 1.4 million people affected both physically and mentally who need careful rehabilitation.

The current educational reforms are an ideal platform to impart crucial values in patriotism and introduce essential skills like time management, discipline, and accountability. This system could not only build successful individuals but also help decrease social issues like substance abuse and crime among youth.

In the immediate future, to meet the demands of the recovery effort now, currently available volunteers should be engaged as understudy groups, working alongside the armed forces and government departments involved in the rebuilding process. The long-term investment in a Mandatory National Service, on the other hand, will strengthen our national identity and contribute to the “unified operational mechanism” the President has called for.

The author can be contacted at nimsavg@gmail.com

by Emeritus Professor
Nimal Gunatilleke

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