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The silent crisis: A humanitarian plea for Sri Lankan healthcare

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As a clinician whose journey in medicine began from the lecture halls of the Colombo Medical Faculty, in 1965, and then matured through securing the coveted MBBS(Ceylon) degree in 1970, followed by a further kaleidoscopic journey down the specialist corridors, from 1978 onwards, I have witnessed the remarkable evolution of healthcare in Sri Lanka. I have seen the admirable resolve of a nation that managed to offer free healthcare, at the point of delivery, to all its citizens, and I have seen many a battle being fought to bring state-of-the-art treatments for the benefit of sick patients, even despite some of the initial scepticism on the part of some.

However, as we now try to navigate the turbulent waters of 2026, I find myself compelled to speak even impulsively. This is not a mission of fault-finding, or a manifestation of a desire to “ruffle feathers,” for the sake of fanning a fire. Rather, it is a reflection offered in good faith, born from the “Spirit of an Enthusiast” who has seen both the brickbats as well as the accolades bestowed on our profession. My goal is relatively simple: which is to bring to light the silent, sometimes extremely difficult, situations faced by patients, doctors, and relatives, and to urge for a compassionate and collective solution to a crisis that threatens the very foundation of the care we provide.

The Generic Gamble: The Lament of the Ward

The cornerstone of our health service has always been the provision of free medicine to all who come to our state medical facilities. For decades, the “generic-only” policy served as a vital safety net. But, today, that net is fraying, not just at the edges but virtually as a whole. In our hospital wards, the clinician’s heart sinks when a patient fails to respond to a standard course of treatment.

We are increasingly haunted by the fancy terminology, “Quality Failure”, as alerts on medicinal drugs. When an anti-infective medicine lacks the potency to clear an infection, or when a poor-quality generic drug fails to stabilise the circulation of a little gasping child who is fighting for his life, the treating doctor is left in a state of agonising clinical despair. It is a profound lament to realise that while the medicine is “available” on the shelf, its efficacy remains as a question mark. The “free health service” becomes tragically and obstinately expensive when it leads to prolonged hospital stays, complications, or, in the worst cases, even the loss of a life that could have been saved with a more reliable formulation of an essential medicine. We must acknowledge that a cheap drug that does not work is the most expensive drug of all. For the doctor, this turns every prescription into a calculated risk, a far cry from the “best possible care” we were trained to deliver. These situations are certainly not the whims of fancy of a wandering mind, but real-time occurrences in our health service.

The Vanishing Innovators and the Small Market Reality

In the private sector, the situation is equally dire, though the causes are different. We must face a hard truth: Sri Lanka is a comparatively small market in the global pharmaceutical landscape. For the world’s leading manufacturers of proven, branded medicines and vaccines, our island is often a small, rather peripheral, consideration.

When the National Medicines Regulatory Authority (NMRA) fixes prices at levels that do not even cover the “Cost, Insurance, and Freight” (CIF) value, let alone the massive research and development costs of these innovator drugs, these companies inevitably reach a breaking point. They do not “bail out” through a lack of compassion, but do so even reluctantly sometimes, because they simply cannot sustain their operations at a loss.

Over the last few years, we have watched in silence as reputable international companies have closed their shops and departed our shores. With them have gone some of the vaccines that provided a lifetime of immunity, and the so-called branded drugs that offered predictable, life-saving results. When these “Gold Standards” vanish, the void is often filled by products from regions with lower regulatory oversight, leaving the patient with no choice but to settle for what is available or just what is left.

The Shadow Economy of “Baggage Medicines”

Perhaps the most heartbreaking symptom of this broken system is the rise of the “baggage medicine” market. Walk into any major private hospital today, and you will hear the whispered conversations of relatives trying to source drugs from abroad, in a clandestine manner.

Reputed branded drugs are being brought into the country in the suitcases of international travellers. While these relatives are acting out of pure, desperate love, the medical risks are astronomical. These medicines sometimes bypass the essential “Cold Chain” requirements for temperature-sensitive products like insulin or specialised vaccines. There is no way to verify if the drug in the suitcase is genuinely effective, or if it has been rendered inert by the heat of a cargo hold of an aircraft.

As a physician, it is an agonising dilemma: do I administer a drug brought in a suitcase to save a life, knowing very well that I cannot certify its safety? We are forcing our citizens into a shadow economy of survival, stripped of the protections a modern regulatory body should provide.

The Unavoidable Storm: Geopolitical Shocks

Adding to this internal struggle is the current unrest in the Middle East. As of March 2026, the escalation of conflict has sent shockwaves through global supply chains. With major maritime routes, like the Strait of Hormuz effectively halted and air cargo capacity from Middle Eastern hubs, like Dubai, slashed by over 50%, the cost of transporting medicine has become a moving target.

* Skyrocketing Logistics: Freight surcharges and war-risk insurance premiums have added “unavoidable costs” that simply cannot be absorbed by local importers under a rigid price cap.

* Delayed Transport is delayed healing:

Shipments rerouted around the Cape of Good Hope add weeks to delivery times, leading to stockouts of even the most basic medical consumables.

These are global forces beyond our control, but our regulatory response must be agile enough to recognise them. If we ignore these external costs, we are not just controlling prices; we are ensuring that the medicine never arrives at all.

The Rights of Patients Seeking Private Healthcare

Whatever the reason for patients seeking private healthcare, all of us have an abiding duty to respect their wishes. It is their unquestionable right to have access to drugs and vaccines of proven high quality, if they decide to go into Private Fee-levying Healthcare. This is particularly relevant to the immunisation of children. Sometimes the child receives the first dose of a given vaccine in a Private Hospital, but when he or she is taken for the second dose, that particular vaccine is not available, and they are not able to tell the parents when it would be available as well.

Some of the abiding problems, associated with immunisation of children and adults in the Private Sector, were graphically outlined at the Annual General Meeting of the Vaccines and Infectious Diseases Forum of Sri Lanka, held on the 10th of March, 2026. This needs to be attended to as a significant proportion of vaccines are administered to patients, both children and adults, in the Private Sector.

In other cases, the drug or drugs of proven quality is or are not available in the Private Sector as the company, or importing authority, has wound up the operations in our country due to their inability to sustain the operations, resulting from factors entirely beyond their control. Let us face it, the current pharmaceutical industry is significantly profit-oriented, and they will continue to operate only in countries where their profit margins are quite lucrative.

A Humane Call to All Stakeholders

The current scenario is a shared burden, and it requires a shared, compassionate solution. We must look at this, not through the lens of policy or profit, but through the eyes of the patient waiting in the clinic or in the ward.

* To the Ministry of Health and the NMRA:

We recognise the extremely difficult task of balancing affordability with quality. However, we urge a “Middle Path.” We need a dynamic pricing mechanism that reflects the reality of global trade logistics and the unique challenges of a relatively smaller market. Let us prioritise the restoration of “Quality Assurance” as the primary mandate, ensuring that every generic drug in the state sector is as reliable as the branded ones we have lost. To be able to provide such an abiding certificate of good quality, we need a fully-equipped state-of-the-art laboratory.

* To the Private Sector and Importers:

We ask you to remain committed to the people of Sri Lanka. Your role is not just commercial; it is a vital part of the national health infrastructure. A transparent dialogue with the regulator is essential to prevent more companies from leaving.

* To our Patients and their Families:

We hear your lamentations. We see the struggle in your eyes when a drug is unavailable or when you are forced to seek alternatives from abroad. We respect your right to seek the best possible treatment, and we are advocating for a system that honours that choice legally and safely.

Finally, the Spirit of Care

In the twilight of my career, I look back at my work and the thousands of patients I have treated. The “Spirit of an Enthusiast” is certainly not one of resignation, but of persistent hope. We have the clinical talent and the commitment of our healthcare professionals, we have the history of a strong health service, and we have a populace that deserves the best. For us, in this beautiful land, hope springs eternal.

Let us stop the “baggage medicine” culture. Let us invite the innovators back to our shores by treating them as partners in health, not just as vendors. Let us also ensure that our state-sector generics are beyond reproach.

This is a mission to find a way forward. For the sake of the child in the ward, the elderly patient in the clinic, and the integrity of the medical profession. We desperately need to act now, together, hand in hand, and with a pulsating heart of concern, for the entire humanity we are committed to serve.

by Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin),
FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow,
Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.



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Features

The challenge of being positive about SAARC

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The RCSS forum addressed by SAARC Secretary General Ambassador Md. Golam Sarwar in progress. (Pic courtesy RCSS)

It was a few years back that a former President of Sri Lanka took it on himself to pronounce SAARC ‘dead’. Since then there have been other sections of Sri Lankan opinion that have joined the critics of SAARC and taken the solemn stance that SAARC has indeed died what may be called a natural death.

Their fatalism is understandable. SAARC has failed to meet at heads of government or state level for the past several years to take the SAARC process notably forward. Regional cooperation has more or less been only an appealing idea. No substantive concrete projects have taken off to make the idea a hard reality. ‘Inner paralysis’ seems to be SAARC’s lot. Hence the fatalism in these circles.

However, being one of the worst cash-strapped regions of the world and a teemingly populated one with people virtually left to their devices, what choices do the ‘SAARC Eight’ have other than to try their best to band together and continue with their cooperation efforts, however small they may be?

There is no escaping the mounting debt trap for many of these countries and bankrupt Sri Lanka is a glaring example, but ‘throwing in the towel’ and abandoning themselves entirely to the diktats of the strongest economies and their agencies will prove a ‘living death’ for many countries in the SAARC fold.

The gains may be meagre but giving-up on SAARC cooperation in full would prove self-defeating for the organization and South Asia. Right now, the collective intention ought to be to salvage what the region could from the tenuous cooperative efforts. Moreover, such initiatives could go some distance to generate a degree of goodwill among the Eight and help in sustaining a dialogue process.

Given this backdrop it proved ‘a stich in time’ for the Regional Centre for Strategic Studies (RCSS), Colombo, to recently host the SAARC Secretary General Ambassador Md. Golam Sarwar to a round table discussion on the unifying potential of SAARC and its future possibilities, besides other related issue areas.

Held on June 24th and moderated by RCSS Executive Director and former ambassador Ravinatha Aryasinha, the forum brought together a vibrant, wide ranging audience comprising academicians, diplomats, senior public servants, civil society activists and many others. Following the presentation by Ambassador Golam Sarwar titled, ‘Reigniting SAARC: Achievements, Challenges and the Way Ahead’, a lively Q&A followed.

The above forum could be described as an act of lighting the proverbial ‘candle’ rather than ‘cursing the darkness.’ It surely is a ‘darkness’ that could be seen as daunting considering that the region’s pivotal powers, India and Pakistan, are failing to act in a spirit of accord but are engaged in bitter finger-pointing on a number of questions of vital importance to SAARC.

On the other hand, what is the rest of the region doing to bring the above sides together? It is disappointing that to date the rest of SAARC has failed to launch a major diplomatic drive to bring peace between the feuding regional heavyweights. It needs to act without delay and establish its earnestness and this effort would need to prove SAARC’s staying power in the unfolding months and even years.

In assessing SAARC’s seeming failure local opinion in particular has failed to factor in what could be described as weak leadership. Since Sheikh Mujibur Rahman of Bangladesh, the founding father of SAARC, the region has failed to produce a visionary leader who could advance the SAARC cause with charisma and drive.

Among other reasons, weak leadership accounts considerably for the faltering and stuttering status, as it were, of SAARC. Badly needed are leaders who could go the extra mile, think less of narrow national interests and work diligently towards the collective well being of the region but SAARC’s millions of ordinary people have been made to wait in vain for leaders of such stature. Instead, they have been burdened with politicians who seem to be relishing the apparently moribund state of SAARC.

Looking back, it could be said that it was the dynamic leadership factor that led to the launching of the Non-Aligned Movement and for its sustenance for a few decades. True, it could be seen in some quarters that NAM is no more, but as in the case of SAARC, the former too has been unfortunate to be burdened over the years with politicians who lack the vision and drive to unflaggingly advance the fortunes of the South. NAM and SAARC lack the dynamism and vision of leaders of the stature of Jawaharlal Nehru, for example, to give them the required guidance and intellectual depth.

The reasons are complex for there not being among us currently political leaders with the vision and the steadfast commitment to advance the legitimate interests of the South. However, it could be stated with conviction that the majority of Southern leaders have too easily caved in to the demands of the global North and its financial agencies.

These leaders have failed to see, for instance, that the largely market economy oriented Northern governments would not view with favour a centrist economic model that attaches priority to the interests of the dis-empowered publics of the South. This realization ought to have dawned on the current government in Sri Lanka, for instance, some while ago but it has no choice but to abide by IMF dictates since economic survival at present is unthinkable without the latter’s succour.

Accordingly for SAARC this should be the time for some soul-searching. Priority needs to be attached to ending the feuding between India and Pakistan since at present the material fortunes of the region hinge largely on these regional giants giving peaceful relations among them a try. This is no easy challenge to meet but some daring, visionary diplomacy needs to take hold among the rest of SAARC.

There is some sense in SAARC bringing the peoples of the region together through programs that address their best collective interests. A meeting of minds among SAARC nations could enable SAARC and its agencies to build a region-wide people’s movement for progressive political and economic change that could in turn lead to the region’s political leaders sensitizing themselves more to the neglected needs of their publics.

However, the time is ‘now’ for the initiation of these progressive changes and the voice of SAARC well wishers would need to drown out those of their critics.

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OPA seminar examines Sri Lanka’s economic recovery, resilience and growth pathways

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(L to R) Dr Achinthya Koswatte, Anushan Kapilan, Dr Harsha Aturupane, Bhanu Wijeyaratne, Vice President, OPA and moderator of the discussion, and Eng Chamil Edirimuny, General Secretary, OPA, at the head table.

A seminar, “Sri Lanka’s Economic Crossroads: Navigating Recovery, Resilience and Growth” was recently held by the Organisation of Professional Associations of Sri Lanka (OPA) at the OPA Auditorium, bringing together economists, OPA members, and professionals from diverse fields for an insightful discussion on Sri Lanka’s economic recovery and future growth prospects.

The event was held under the patronage of Jayantha Gallehewa, President of the OPA, and was jointly organised by the National Issues Committee (NIC) and the Seminars, Workshops and Programmes Committee of the OPA. The event reaffirmed the organisation’s commitment to advancing professional excellence, fostering insightful intellectual engagement, facilitating interdisciplinary knowledge exchange and creating a constructive platform for informed dialogue on issues of national importance.

The panel of speakers comprised Dr. Harsha Aturupane, Lead Economist and Programme Leader for Human Development at the World Bank for Sri Lanka and the Maldives; Dr. Achinthya Koswatta, Senior Lecturer in Economics at the Open University of Sri Lanka, and Anushan Kapilan, Lead Economist at Verité Research.

In his welcome address, the President of the OPA emphasised that Sri Lanka was at a critical juncture in its economic recovery journey where sustained reforms, effective implementation, and collective national commitment are essential to achieving long-term stability, resilience and inclusive growth. He noted that the country had experienced one of the most severe economic crises in its history with the economy contracting by 7.8 percent in 2022 and a further 11.5 percent in 2023, resulting in significant economic and social challenges.

Delivering his introductory remarks Bhanu Wijeyaratne, Vice President of the OPA and Chairman of the National Issues Committee, underscored the need to move beyond short-term economic stabilisation towards a comprehensive agenda of structural transformation. He observed that the economic crisis had revealed deep-rooted weaknesses within the economy, including persistent fiscal pressures, rising public debt, foreign exchange limitations, and insufficient diversification of the export base. He stressed that addressing these challenges through strategic reforms, institutional strengthening and long-term economic planning would be essential to establishing a more resilient and competitive economy.

While acknowledging recent positive developments, including improved inflation management, tourism recovery and signs of economic stabilisation, Wijeyaratne stressed the need to advance reforms aimed at strengthening fiscal discipline, enhancing productivity, improving competitiveness, developing human capital and reinforcing governance and institutional effectiveness.

He further highlighted the important role of professionals, businesses, academia and other stakeholders in contributing to evidence-based dialogue and supporting Sri Lanka’s journey towards a resilient, inclusive and sustainable economic future.

Delivering the keynote presentation, Dr. Harsha Aturupane provided a comprehensive assessment of Sri Lanka’s economic prospects within the broader context of global economic transformation. He argued that Sri Lanka functioned as a small open economy whose performance is significantly influenced by developments in the global marketplace. External factors could not be controlled, and the country must strengthen its domestic capacity and resilience to respond effectively to international economic shifts, he noted.

Tracing the evolution of global economic systems, Dr. Aturupane highlighted the transition from ideological divisions between state-controlled and market-oriented economies towards increasingly pragmatic approaches focused on growth, competitiveness and development. He noted that Sri Lanka’s own economic journey reflects a similar evolution, with contemporary policy debates now centred on practical solutions for sustainable economic progress.

The presentation also examined the transformative impact of globalisation. Dr. Aturupane observed that global economic integration had enabled several East Asian economies, including South Korea, Singapore, Taiwan and Hong Kong, to achieve remarkable economic advancement through export-led growth strategies. Sri Lanka similarly benefited from this process through the expansion of its apparel industry and increased integration into global value chains.

Turning to Sri Lanka’s recovery programme, Dr. Aturupane emphasised that the ongoing stabilisation process should be viewed as a national programme supported by the International Monetary Fund rather than solely as an IMF initiative. He observed that strong worker remittances, improved tourism earnings, enhanced government revenue mobilisation and prudent import management have contributed significantly to economic stabilisation.

Despite this progress, he cautioned that rebuilding foreign exchange reserves and meeting future debt obligations remain major challenges. He underscored the need to strengthen export performance, attract investment and generate sustainable foreign exchange earnings to ensure long-term economic resilience.

The discussion also focused on monetary stability, inflation management and exchange-rate policy. Dr. Aturupane stressed that maintaining price stability was fundamental to sustainable growth and household welfare, while sound monetary policy remains essential for preserving economic confidence.

Looking beyond stabilisation, he argued that Sri Lanka must transition towards a broader economic transformation agenda. Sustainable growth, he noted, will depend on expanding productive capacity through investment, technological advancement, innovation, skills development and structural reforms.

Among the key constraints identified was the high cost of energy, which continues to affect competitiveness and investment attractiveness. Dr. Aturupane emphasised the importance of improving efficiency and affordability within the energy sector to enhance Sri Lanka’s business environment.

He further highlighted the social dimensions of the crisis, noting the rise in poverty and economic vulnerability among households. Strengthening social protection systems and ensuring inclusive growth, he argued, must remain central components of the national development agenda.

Another critical challenge identified was Sri Lanka’s demographic transition. With an ageing population, outward migration and evolving labour market dynamics, the country is increasingly confronting labour shortages in several sectors. Dr. Aturupane suggested that greater automation, increased labour-force participation and strategic workforce planning would be necessary to address these emerging realities.

Concluding his presentation, he emphasised the need to improve governance, strengthen institutions, enhance competitiveness and create an enabling environment for private sector investment. Sri Lanka’s future success, he noted, will depend on its ability to move decisively beyond crisis management towards a development model founded on resilience, innovation, productivity and inclusive growth.

Dr. Achinthya Koswatta reiterated the importance of policy consistency and predictability in fostering investment and industrial development. She observed that frequent policy changes create uncertainty and discourage long-term investment decisions, whereas stable and coherent policy frameworks build confidence and support sustainable economic transformation.

Meanwhile, Anushan Kapilan highlighted the substantial progress achieved in restoring macroeconomic stability following the recent crisis. He noted significant improvements in fiscal performance, including increased government revenue, reduced reliance on debt financing and a historically low fiscal deficit.

He further observed that public debt levels are declining faster than anticipated, economic growth has exceeded expectations and inflation has been brought under control more rapidly than forecast. Nevertheless, he cautioned that the recovery remains uneven, particularly within the industrial sector and that many households have yet to experience a meaningful improvement in living standards.

The seminar was expertly coordinated by Eng. Chamil Edirimuni, Vice President of the OPA and Chairman of the Seminars, Workshops and Programmes Committee, while the technical moderation and interactive discussion session were facilitated by Bhanu Wijeyaratne, Vice President of the OPA and Chairman of the National Issues Committee.

The event was attended by Tisara De Silva, President-Elect of the OPA, Eng. Ravi Rupasinghe, General Secretary, Past Presidents, members of the Executive Council, representatives of the General Forum and professionals representing a wide range of disciplines.

The seminar concluded with a vibrant exchange of ideas and perspectives, reaffirming the importance of evidence-based policy dialogue, institutional collaboration and collective national commitment in advancing Sri Lanka’s economic recovery, resilience and sustainable growth.

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Her roots run deep in Sri Lanka

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Samantha Kay: Now based in the UK Samantha’s biggest passion is helping people, especially women, build confidence and believe in themselves Today, her focus is on radio, podcasting and coaching women Whenever she visits Sri Lanka, she says she loves spending time on the beautiful south coast, especially Hikkaduwa and Mirissa She released a song with 90s music icon Angie Brown, which reached No. 9 in the UK Club Charts

Yes, for UK-based presenter and artiste Samantha Kay, home is where the heart – and the roots – are. And her roots run deep in Sri Lanka.

In an exclusive interview with The Island, Samantha says “I’m proud to be Sri Lankan. My mum is from Kandy and my dad is from Colombo, so Sri Lanka has always held a very special place in my heart.

“Whenever I visit Sri Lanka, I love spending time on the beautiful south coast, especially Hikkaduwa and Mirissa. It’s somewhere I always feel connected to my roots and completely at peace.”

Now living in Bournemouth, on the south coast of England, where, she says, she is lucky to be close to some of the UK’s most beautiful beaches, including the iconic Sandbanks, Samantha has built a career that refuses to fit into one box.

She is a radio presenter, podcast host, singer-songwriter, personal trainer and life coach.

“I genuinely love the variety because every role allows me to connect with people and, hopefully, make a positive difference in someone’s day.”

Of course, music has taken her far.

One of her proudest achievements, she says, was releasing a song with 90s music icon Angie Brown, which reached No. 9 in the UK Club Charts.

She also reached the final stages of The X Factor and performed at Wembley Stadium in front of thousands.

Beyond music, Samantha competed in bikini bodybuilding across the UK, winning several titles. “It taught me discipline, resilience and self-belief,” she recalls.

Today, her focus is on radio, podcasting and coaching women. Her podcast encourages people to live life on their own terms rather than feeling pressured to follow society’s expectations.

Says Samantha: “Whether someone is single, changing careers, travelling solo or simply trying to find their purpose, I want them to know that it’s never too late to create a life that feels authentic. If you’ve ever felt like you don’t fit into the box, maybe you were never meant to.”

Samantha Kay also spent a year in Dubai, performing at five-star hotels, including FIVE, and coaching at the iconic outdoor gym on Palm Jumeirah.

“I taught strength and conditioning classes, and hosted wellness retreats, combining my passion for music, health and inspiring others.”

However, with family matters calling her back to the UK, she made the choice to return. “Family comes first,” she says.

Looking ahead, Samantha plans to grow her radio and podcast work, release more music, and expand her wellness retreats.

“My biggest passion is helping people, especially women, build confidence and believe in themselves,” she says.

“Wherever my career takes me, I hope to continue inspiring others to live with courage, kindness and authenticity, while never forgetting my Sri Lankan roots.”

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