Features

Brain drain and future of medical education

Published

4 years ago

2022/11/22

By Ramya Kumar

Healthcare is in crisis. Medical doctors, and other health professionals, are leaving the country in droves. The WHO (2010), in its Global Code of Practice on the International Recruitment of Health Personnel, while discouraging the active recruitment of health workers from “developing countries” (p. 7), urges source countries to “address the geographical misdistribution of health workers and to support their retention in underserved areas” (p.8). What is the government doing to stem the health brain drain, in particular, the en masse migration of medical doctors? This article draws attention to several government policies, and proposals, that are likely to accelerate medical migration, and suggests that radically different measures may be needed.

Urban-rural inequalities

The Northern Province, which covers 13.3% of the land area and is home to about 5% of the country’s population, receives about 5% of specialists and medical officers in the state sector. Although the province receives what seems to be a fair allocation according to population size, the large land mass means that they are spread far and wide, with rural folk having to travel great distances to access healthcare. On the other hand, Colombo, where 11.2% of the country’s population resides, receives more than double its fair share, accounting for over a quarter of medical doctors, to cover just 1.08% of the land mass. While this misdistribution exists in other health worker categories (see table), the numbers show that the health brain drain will likely affect people living in rural districts more than others.

Percentage distribution of specialists and medical officers in the public sector – 2019

What have other countries done in times of crisis? Thailand has in place several policies to retain health workers in rural areas, including medical doctors. Government bonds, in place since the 1960s, require all graduating doctors to serve in rural areas for a stipulated period or pay the bond. In addition, the ministries of public health and education recruit rural students who score somewhat lower marks on national exams, to medical programmes, with specified rural service requirements to be fulfilled on graduation. The latter comprise over 30% of medical graduates in Thailand and tend to remain in public service beyond the mandated period. While similar programmes are in place to retain other health workers, health professional curricula are rurally-oriented, emphasising primary care and public health, with practical training in rural settings, with many offered in the Thai language. In addition, the Thai government offers hardship allowances, overtime payments, and numerous career advancement opportunities to incentivize rural work. The overarching goal of these policies is to improve rural access to healthcare, not constrain health workers. By contrast, in Sri Lanka, government policy seems to promote medical migration. Indeed, recent budget proposals, if implemented, may weaken existing policies that support rural retention of medical personnel.

Promoting medical brain drain

For one, no bonds are in place for medical graduates who have benefited from free education. This means that junior doctors do not need to think twice about migrating to greener pastures, with most planning to face exams to be eligible to work as doctors in other countries. Second, the Postgraduate Institute of Medicine (PGIM) sustaines a colonial policy that requires specialists to spend a stipulated period abroad to fulfill “foreign training” requirements in (mostly) high-income countries to be board certified. While the Ministry of Health forks out a (bonded) stipend for this training, it could just as well be obtained at state-of-the-art training centres in the South East Asian region that may cost less and are less likely to be destinations for medical migration.

Third, the Accreditation Unit of the Sri Lanka Medical Council (SLMC) is presently working toward securing recognition from the World Federation for Medical Education (WFME), as its local accreditation agency. According to the Unit’s website, benefits to be accrued include MBBS holders from WFME-recognized institutions being able to register in postgraduate medical courses that recognize WFME accreditation and also seek employment in such countries. However, harmonising medical programmes in line with international requirements may neglect local needs. For instance, the SLMC’s Minimum Standards of Medical Education, gazetted in 2018, do not include requirements to complete clinical training in rural stations, despite most doctors being posted to such areas in their first appointments.

Recruitment to the state sector has halted, presumably under directives of the International Monetary Fund (IMF). While it is uncertain to what extent this policy will affect the health sector, the government should ensure that public sector employment is guaranteed to health workers in the future. By guaranteeing employment and retaining postgraduate education in the state sector, the Ministry of Health has been able to ensure the availability of specialists and doctors in the public sector. Despite politicization, in particular the influence of the Government Medical Officers’ Association (GMOA) on transfer lists, and many other ills, this system allows the government to fill vacant rural stations with new cohorts of doctors. If public sector recruitment is halted/restricted, the uncertainties around employment may result in mass medical migration.

Privatisation and rural retention

In Sri Lanka, medical education remains under the state’s purview, delivered by 12 faculties of medicine, 11 under the University Grants Commission (UGC) and one with the Ministry of Defence. For decades, successive governments have attempted to privatize medical education. In South Asian settings especially, where most parents would like their children to follow a career in medicine, MBBS degree programmes present lucrative business opportunities. Even so, privatisation has been resisted in Sri Lanka with the SAITM debacle still fresh in our memories.

Yet, it is quite clear that the government is bent on establishing private medical schools.

Apart from the relentless attacks on student leaders, the SLMC’s Accreditation Unit welcomes applications for accreditation from all medical schools in the country; nowhere in the accreditation policy are state universities referenced. By placing accreditation in the hands of an “independent” unit, the government will be able to circumvent the UGC’s cumbersome administrative procedures, and invite foreign investment in medical education. These intentions are clear in the language used in the Minimum Standards of 2018:

“Every recognized university, or institution, within, or outside, Sri Lanka which grants or confers a medical qualification, alone or jointly with any Sri Lankan or foreign recognized university or institution under affiliation or under a twin medical programme shall ensure that the minimum standards set out in the Schedule hereto are adhere [sic] to and maintain [sic] by such recognized university or institution in the conduct of its medical education.”

Privatising medical education will shift the demographics of doctors in favour of the elite, who are far less likely to remain in the country. Contributing to these changes are the UGC’s renewed efforts to attract students with foreign qualifications, on a fee-levying basis, to local undergraduate programmes, including medicine. While a finite number of places are available at medical schools, increasing the number of students, with foreign qualifications, may see a parallel reduction in the number of local recruits within an already strained system. International medical students are even less likely to present a solution to the brain drain.

The Budget proposals for 2023 include plans to increase merit-based admissions from 40% to 50% in commerce, technology, science and mathematics A/L streams. This means that district quota based admissions to medicine from underserved districts, such as in the Vanni or Uva, will decline. While this move will deepen class-based inequalities in access to medical education, weakening the district quota system will mean that fewer rural students will enter medicine, although the latter are more likely to serve in their home districts.

Bleak future

Despite the crisis that faces the health sector, the government implements or is proposing to implement a number of short-sighted policies that are likely to accelerate medical brain drain. While the public healthcare system is in shambles, experiencing acute resource-constraints, massive changes are in the offing under World Bank-IMF pressures and what looks like a far right government. We must draw on lessons from other countries to demand the government to take measures to address the brain drain and support the retention of healthcare workers in underserved areas to avert a crisis in rural healthcare.

(Ramya Kumar is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna)

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Features

Proactive peacemaking becomes a paramount need

Published

21 hours ago

2026/06/4

Sahan Weerasooriya

Wasting wars: Some war-displaced people in Lebanon. BBC

It may be some time before the full impact of food inflation is felt in the West. Until such time the world would continue to keep itself in suspense over whether the Trump administration is in earnest when it seeks to convey the impression that it is backing a negotiated solution in West Asia.

As is usually the case, consumer stress would be one of the final determinants of political change. To the degree to which the average US consumer somehow ‘muddles through’ and puts the food on the table, to the same extent would the Republican sections of the US public in particular be tolerant of the Trump administration’s inconsistent handling of the West Asian war and the main issues stemming from it. That is, there would be no grave popular disaffection and a demand for political change in the short term.

However, the indications are that the Trump administration’s support base is suffering some erosion in the wake of the current economic crisis. While reports indicate that Democratic sections are firming-up their opposition to the political centre, Republican support for Trump is also showing signs of waning, we are given to understand.

The above developments are probably why Trump is on record as having given Israeli Prime Minister Benjamin Netanyahu a ‘dressing down’ recently on his seeming intransigence on the question of giving negotiations a chance in West Asia. The show of displeasure could be really aimed by Trump at containing the impatience of the American public.

However, the current ground situation in the Middle East, particularly the uncontained bloodshed, is likely to impress on the thinking sections of the world that more than temporary political change is needed in West Asia and the US.

A well thought out political solution that addresses all the contentious issues at the heart of the Middle East conflict is what enlightened opinion would demand, and very rightly. Right now, the ‘peace efforts’ initiated by the Trump administration give the impression of being piecemeal solutions at best.

There have been, of course, numerous initiatives in the past aimed at bringing permanent peace to the Middle East. These failed mainly because they did not address in full the root causes of the conflict.

At bottom the Middle East conflict is mainly about race and religious hate bred by socio-economic and material inequalities. For instance, if the Palestinian people were not displaced and deprived of land occupied by them at the time of the founding of the Israeli state, ethnic enmities would not have grown to the current unmanageable proportions.

When addressing the above questions, though, it must be remembered that the Israelis too were a displaced people who were entitled to land and a state of their own in the Middle East. Basically, out of these seemingly irreconcilable and conflicting demands have grown the Middle East imbroglio.

Middle East peace is considerably about reconciling these demands and arriving at a solution that would ensure the creation of two states that would opt for peaceful co-existence thereafter.

As long as the US does not see the need for a non-partisan solution that addresses the needs of both ethnicities and religions and goes all-out, as it were, to have it implemented, the Middle East would continue to bleed.

However, staunching the blood flow through the creation of two states would be only half the job done, though a very important part of it. More pernicious, pervasive and difficult to remedy are the inter-ethnic and inter-religious hatreds that have been unleashed over the decades.

However, if substantial, long-lasting peace is to be fostered in the region the latter ‘demons’ would need to be exorcised from the hearts and minds of the communities concerned. No doubt an uphill task but one that must be undertaken by those who wish the region well.

The UN would need to put its ‘best foot forward’ in such undertakings but it is time that it dawned on the international community and other caring quarters that Middle East peace, and all other such uphill challenges, require proactive peacemaking on the part of all civilized sections for their effective management. That is, public involvement in peacemaking too is a must.

Since hatreds are harboured in the human consciousness the enmities embedded in the latter need to be managed and defused judiciously alongside other undertakings in a peace process. In the case of West Asia, such enmities could be even spread globe-wide besides being multi-dimensional. For instance, it ought to be thought-provoking that Iran is insistent on a peace initiative that would also include Lebanon.

Besides security considerations it is also ethnic and religious affiliations that account for Iran making this demand. For instance, the Shias are a numerically important religious community in Lebanon and they provide a significant number of Hizbollah fighters, who are in a vital sense carrying out a ‘proxy war’ for Iran. It also needs to be factored in that Iran is a Shia-majority country.

Thus trans-border religious affiliations could add to the complexities and enormity of ethno-religious conflicts. However, the task of managing centuries-long enmities needs to be launched and prodded on with by peacemakers since a downing of arms alone would not guarantee substantive peace.

It is not realized sufficiently that the process of ending hatreds begins with mutual apologies by antagonists to a conflict for the harm inflicted on each other. This would be anathema in some ears but there is no getting away from the requirement. It is the vital first step to permanent peace anywhere.

In fact there could be no reconciliation worth speaking of without such mutual apologies. It is a point worth re-iterating in these times when even the government of Sri Lanka is voicing the need for national reconciliation. Well, without the words, ‘I am sorry’, there could be no permanent end to enmities – they would do well to remember.

The above requirements may not go down very well with governments, but they resonate in the hearts and minds of most people, since they are inheritors of religious traditions of some kind.

This is a principal reason why peacemaking works well when publics too are involved in them. The effectiveness of such campaigns increases several fold when they have a Mahatma Gandhi or a Jawaharlal Nehru at their helm. A strong proactive involvement by the public in peace could lead to the emergence of such leaders at some point in these campaigns.

Features

Dialog Brings Sri Lanka’s Largest Digital Vesak Experience to Matara

Published

21 hours ago

2026/06/4

Sahan Weerasooriya

From left to right: Hon. Saroja Savithri Paulraj, Hon. Sunil Handunnetti, and Lasantha Theverapperuma experience the Dialog 5G Ultra-powered VR tours.

Official Digital Partner of the 2026 ‘Dakshina Prabha’ National Vesak Zone

Dialog Axiata PLC, Sri Lanka’s #1 connectivity provider, collaborated with the Ministry of Buddha Sasana, Religious and Cultural Affairs to bring one of Sri Lanka’s largest and most technologically advanced Vesak experiences to the ‘Dakshina Prabha’ National Vesak Zone. The three-day celebration, in Matara attracted more than hundred thousand visitors, who engaged with a series of innovative digital activities powered by Dialog 5G Ultra, including Artificial Intelligence (AI) and Virtual Reality (VR) experiences, digital pandols and a Data Dansala. The opening ceremony was attended by Hon. Sunil Handunnetti, Minister of Industry and Entrepreneurship Development and Hon. Saroja Savithri Paulraj, Minister of Women and Child Affairs, along with distinguished guests and Dialog’s senior management.

One of the key attractions at the venue was the Dialog 5G Ultra-powered Virtual Reality (VR) experience, which attracted more than 35,000 participants. The activation enabled devotees to virtually visit and pay homage to sacred Buddhist sites, including the Jaya Sri Maha Bodhi in India and the Atamasthana in Anuradhapura, directly from the Vesak zone in Matara.

Visitors receive complimentary mobile data through Dialog’s QR-powered Data Dansala.

Dialog also conducted an AI Digital Vesak Greeting Card Competition from 21 May to 01 June 2026, attracting numerous entries from across the country. The shortlisted designs were showcased across 20 large LED screens throughout the venue and across Matara City, and were also made available for download via mobile devices. Further, through the use of AI, traditional Jathaka Katha were reimagined in a digital format, demonstrating how technology can be used to preserve and enhance cultural and religious heritage. Together, these initiatives blended traditional Vesak celebrations with emerging technologies, offering visitors a unique and immersive way to engage with Vesak traditions.

Extending the spirit of Vesak through connectivity, Dialog conducted a special Data Dansala powered by its QR Reload platform, enabling visitors to receive complimentary mobile data by scanning QR codes placed across the venue. In addition to the Matara National Vesak Zone, similar Data Dansala activations were also conducted at the Gangaramaya and Bauddhaloka Vesak zones in Colombo.Visitors also had the opportunity to create personalised Vesak-themed digital photos through an AI Photo Booth, generating AI-enhanced portraits using their own photographs and adding a contemporary digital element to the Vesak celebrations.

Visitors watch AI-generated Jathaka Katha

Commenting on the initiative, Hon. Sunil Handunnetti, Minister of Industry and Entrepreneurship Development, said, “The 2026 Dakshina Prabha Vesak Festival marked the first time AI-powered digital innovations were incorporated into a National Vesak Festival in Sri Lanka. Presenting Buddhist stories and teachings through technology created a new and engaging way for visitors to connect with these traditions. We thank Dialog for supporting this initiative and for working closely with us to bring our vision to life. Their contribution played an important role in making this first-of-its-kind event a reality.”

Lasantha Theverapperuma, Group Chief Marketing Officer of Dialog Axiata PLC said, “We thank the Government of Sri Lanka for the opportunity to support the 2026 Dakshina Prabha National Vesak Festival and for embracing technology as part of this year’s celebrations. As the Official Digital Partner, we were privileged to contribute through our Dialog 5G Ultra and AI capabilities, creating new ways for visitors to engage with Vesak traditions while preserving their cultural significance for future generations.”

Beyond supporting the National Vesak Zone in Matara, Dialog also enhanced the Gangaramaya and Bauddhaloka Vesak zones through a range of digital activations during the Vesak season. The company additionally continued its sustainability initiatives, including the Thirasara Aloka Poojawa, which illuminated rural places of worship through solar-powered lighting solutions.

Features

Beauty, elegance and talent…for women

Published

21 hours ago

2026/06/4

Sahan Weerasooriya

Universal Woman is an international pageant focused on “beauty, elegance, and talent” for women, positioning itself as a platform to shape global ambassadors. The 2026 edition will be held in Cambodia, and Sri Lanka will be there, as well.

According to reports coming my way, contestants, at the international event, will work with industry trailblazers, under international standards.

Sri Lankan supermodel, runway and pageant trainer Chulpadmendra Kumarapathirana, is the National Director for Universal Woman Sri Lanka 2026.

With over two decades in the industry, Chula was crowned Miss Sri Lanka 2006, and has since shaped the next generation of titleholders through her Colombo-based Chulpadmendra Catwalk Studio, widely regarded as one of the country’s leading modelling academies.

The team behind Universal Woman Sri Lanka 2026

A former host of Derana Miss Sri Lanka for Miss World 2008 and a judge for Miss Universe Sri Lanka 2025, Chula now serves as National Director for Universal Woman Sri Lanka 2026, leading the franchise’s search for Sri Lanka’s delegate to the international final in Cambodia.

Applications for Universal Woman Sri Lanka 2026 are being taken, via WhatsApp: 077 659 4994, says Chula.

The judging panel for Universal Woman Sri Lanka 2026 includes Senaka De Silva, Pageant Aesthetic Advisor & Chairperson of the Judging Panel, Angela Seneviratne, Caroline Jurie, Rozelle Plunkett, and Suraj Mapa.

Universal Woman Sri Lanka 2026 officially began its journey with a first round of auditions, held in Colombo, marking the start of an exciting new chapter in Sri Lanka’s pageant industry.

Launching the first round of auditions

The platform aims to empower women while selecting an intelligent, confident, and inspiring representative to compete at the Universal Woman International Pageant 2026 in Cambodia, this September.

Universal Woman Sri Lanka now moves forward with the vision of creating one of the country’s most prestigious and empowering pageants while preparing to crown a queen who will proudly represent Sri Lanka on the international stage.