By Rathiindra Kuruwita

The Sri Lankan government has neither attempted to enforce the agreements that doctors enter into before leaving for foreign training nor have they attempted to improve the conditions of doctors in the country and these are the reasons why a large number of health professionals are leaving the country, Sri Lanka Medical Association (SLMA) President Dr. Vinya Ariyaratne said.

The response from the recent governments to warnings and recommendations made by the SLMA has been negative as well, he said.

“There is a lot of impunity for those close to power and for the most part, fact based recommendations have been ignored. This is why I say, the crisis in the health sector is a crisis in governance”.

There are no elections in sight, and the politicians can do whatever they like, Dr. Ariyaratne added.

“People must put more pressure on the government. They must also take more precautions about their health”..

The Sri Lankan state health system, which was an equitable system for decades, is now facing a polycrisis, Dr. Ariyaratne mentioned.

“There were some deficiencies. There were some shortages of doctors and drugs but these were not systemic issues. The system as a whole was working. However, in the last couple of years, due to bad governance, things have fallen apart”.

SLMA said that there is rampant corruption in the state sector and that the Health Ministry is not an outlier. The economic crisis applied more pressure to a system that was already strained by corruption, he said.

“SLMA told Gotabaya, in late 2021, that in six months there will be a severe health crisis. And to streamline the process. We started informing doctors about optimizing available resources and minimizing waste. We did a lot of things to rationalize the system by educating doctors”.

The confidence in the Sri Lankan health sector was built over decades of hard work and has been dismantled in the matter of a few years, he said.

“Once people start losing faith, it’s hard to restore it. To be frank, we are on the verge of collapse. We have to do everything to prevent that from happening”.

Dr. Ariyaratne indicated that the government needs to address the drug shortages and ensure that quality drugs are purchased.

“There are processes and standards in place. This is easy to do if there is a will. We have to also do what we can to stop health staff from migrating. We have to look at pull and push factors. Furthermore, we can address the push factors. Some doctors can manage with what they get, but overall, our doctors need more facilities. Especially doctors who work in the periphery are making great sacrifices. The tax regime is really affecting younger doctors. We have to sympathetically look at what’s driving doctors away”.

The SLMA President said the government must also strictly enforce the bonds that medical professionals have signed when they have gone for overseas training and education. The government has done nothing to enforce these agreements.

“There is a code of ethics adhered to by all WHO member countries on health personnel migration. The recipient countries have to be conscious of the negative impacts on low-income countries where they are taking these doctors. The government is not doing anything to get the support of WHO. The previous government last year encouraged professionals to leave the country, so they would send more dollars. This was a bad decision”.

He said that donors and multilateral organizations are willing to help Sri Lanka and that there really are no resource constraints. The government just has to get its act together.

“Some hospitals are even closing down ICUs because there are no specialists. Even pediatric units are closing down, even at teaching hospitals. In a year or so, we will see avoidable deaths. The government must address these problems immediately”.

In 2022, around 700 doctors left the country, and no one knows how many doctors have left this year. The situation is worsening rapidly, the SLMA head said.