Free healthcare and education form the bedrock of social welfare in Sri Lanka. A majority of the population depend on these services. Healthcare in Sri Lanka reached several milestones over the years with achievements like eradicating malaria, leading preventive care in South Asia, and reducing maternal mortality rates. However, the healthcare sector took a shock during the Covid-19 pandemic, revealing several deficiencies in terms of facilities and number of staff. The medical staff who were overburdened by the pandemic were also affected by the economic crisis of 2022, leading to a widespread crisis in the sector. Amidst these crises, alleged corruption among government officials including the former Minister of Health, who is currently in custody, have arguably pushed the sector to a breaking point.
The Critical Issue of Low-Quality Medicine
In (2022), allegations were levelled at the subject minister Keheliya Rambukwella for importing cheaper quality drugs to be administered to patients. Some of these drugs have had fatal consequences including the death of a 23-year-old woman who passed due to an allergic reaction to low-quality medicine at the Colombo North Teaching Hospital in Ragama (Mudugamuwa, 2023). There have been several incidents of allergic reactions and infections due to these imported medicines. Several pharmaceutical items brought down to Sri Lanka from India under a recent Indian credit line have been withdrawn due to this issue (Mudugamuwa, 2023). Questions have been raised over the quality of the remaining imported drugs by the State Pharmaceuticals Corporation (SPC). Minister Rambukwella, before his arrest over this issue, appointed a seven-member committee to investigate the allegations. A committee member has revealed that the exact number of incidents of quality failure are still accumulating (Mudugamuwa, 2023).
The Ministry of Health (MoH) has assured that the investigations are underway but there has not been any transparency about how the investigations are proceeding. Public trust in healthcare is steadily dropping due to these fatalities and the apparent lack of transparency.
Multiple and Debilitating Issue Areas in Healthcare
In addition, there is also a continuing shortage of medicines (Bandara and Alwis, 2023), including the ones needed for treatment of cancer, animal bites, and for non-communicable illnesses like diabetes, hypertension and ischemic heart disease. Recent media reports highlighted the absence of meningococcal vaccines in the state sector for those travelling for Hajj pilgrim (Bandara and Alwis, 2023). Short-term shortages also disproportionately affect the poor, who are unable to purchase these items from private pharmacies.
The government has partnered with the World Bank to initiate an online logistics programme for medicine availability in hospitals. The lack of medicines and proper equipment in hospitals is a debilitating issue that is inhibiting proper care of patients, who sometimes have no other means to address their necessary and critical healthcare.
Lack of technical equipment such as scan machines and MRI scanners in hospitals is another debilitating issue (Mudugamuwa, 2023). Much of the technical equipment in hospitals are outdated. There is also a lack of wheelchairs and crutches in Primary Medical Care Units (PMCUs). PMCUs also do not have ambulances, and the 1990 Suwa Seriya service (although a significant milestone and improvement) does not always reach marginalised and rural populations due to capacity limitations.
Shortages of Staff
Affected by the strain of issues in the sector and the economic crisis, many medical professionals have opted to leave Sri Lanka in what has been viewed as an exodus. Among the foremost issues affecting medical professionals, especially the nurses and minor staff, is the strain of multiple crises on the healthcare sector with the added problem of the lack of enumeration to compensate for their service. In addition, the job satisfaction among healthcare workers has been affected by the influx of patients, toxic work environments, accommodation and transportation issues, problems in transfers, red tape and bureaucratic issues at the MoH, and administrative pressures (Alwis, 2023).
The shortage of staff is impacting healthcare services, medical education, and health equity in the country (Alwis, 2023). The lack of consultants is affecting the proper training of interns and medical officers who are still specialising in certain fields. Several PMCUs have been shut down due to the staff shortages and it is uncertain how many more will face the same fate soon. Medical professionals, including minor staff, are also discouraged by the lack of proper training opportunities and opportunities for salary increments.
The economic and political crisis have caused feelings of great uncertainty amongst Sri Lankans about their future in the country. Even though the economic strain has somewhat reduced for the middle classes subsequent to the economic policies of President Ranil Wickramasinghe, those belonging to the low income category are still fighting an uphill battle to gain a steady footing in the current economy. There needs to be more social security and welfare measures to address the lack of care for the vulnerable. There is also a looming uncertainty regarding the political and economic trajectory of the country in the future.
Inequalities and Discrimination
There are also allegations against the sector of discriminating against sexual minorities. Research shows that sexual minorities fear seeking help from psychiatrists or psychologists due to fear of violence (EconomyNext, 2023). There have also been cases where patients with HIV or hepatitis B had difficulty in obtaining medical care, especially from private institutions (EconomyNext, 2023). It is not surprising that sexual and reproductive illnesses are stigmatised in a country where comprehensive sexual education itself is not available. People, especially the youth, need more awareness about reproductive health as well as safe and consensual sex.
There is a lack of care and awareness about menstrual illnesses. Reproductive and menstrual health is very important, especially for adolescents. There are many reproductive and hormonal issues that affect youth, especially young women, such as Polycystic Ovary Syndrome (PCOS) and endometriosis and Uterine Fibroids. Such illnesses are easily remedied with the correct medical attention. However, the Sri Lankan medical sector and education are failing to create enough awareness regarding these issues.
Another critical issue area is the lack of care and awareness regarding menstrual hygiene. The country is in critical need of mechanisms to address period poverty among girls and women. Period poverty is a term used to describe the inaccessibility of disposable menstrual hygiene products to women due to their high cost. Majority of women resort to the use of clothes which has higher chance of leading to infections. Lack of menstrual hygiene has been found to cause infections like bacterial vaginosis (BV), urinary tract infections and cervical cancer (Arudpragasam, 2018). Many women are unaware of this and have no other safe alternatives.
Within the estate sector, there are reports of widespread discrimination against the Malaiyaha Tamil community, with Estate Medical Assistants (EMAs) prescribing wrong medicine. Due to structural issues including poverty, the Malaiyaha community does not have the ability to travel far to different hospitals or to buy the medicines that are not available in hospitals. A free transportation service to attend clinics in district or base hospitals would be very helpful to such marginalised communities.
There is a rampant lack of care for patients who are elderly and with disabilities. Many people who cannot afford treatment have to forgo care for disabilities. This includes hearing aids, spectacles, and cataract surgeries. There are also deficiencies in care for mental health. This is an issue that is related to society as a whole because mental illnesses are stigmatised. People tend to avoid seeking help they need. As a society that is postwar and attempting to rebuild from multiple concurrent shocks to the social and political fabric, we need much more proactive care and intervention in this area.
Recommendations
First and foremost, the government must be open and transparent about the current crisis regarding the quality of imported medicines. Investigations regarding this matter must make a full disclosure about how and why this happened, who is responsible and what has been done to resolve this issue as soon as possible. Transparency, accountability, better care and resources and equity are critical for the survival of the health sector in the coming years.
A country’s services are inherently tied to its economy and the Sri Lankan economy is still recovering from a devastating crisis. Addressing corruption among parliamentarians and higher officials in the government is crucial to providing safe, adequate and equitable services to the public. Sri Lanka’s resource allocation has always been lopsided, with critical sectors like healthcare and education receiving mere crumbs in terms of the budgetary allocations. The allocation of fiscal resources to these sectors are crucial reforms to improve the social capital and wellbeing of the citizens of the country. The government is currently focussing on tax hikes but has failed to recognise that social welfare programmes need to be hiked up at a similar level to garner public support and approval. Such reforms will also enhance the working conditions of medical professionals and reduce the exodus.
Resource allocation including medicines, equipment, transport, accommodations and other care must also be done in tandem with identifying gaps and imbalances in the current healthcare system including the rural and urban gap, deficiencies in certain fields like psychosocial care, and marginalisation of certain communities like the Malaiyaha Tamil Community, the LGBTQI+ persons and women. A remedy to discrimination of certain persons and communities by the staff is providing psychosocial support and sensitisation programmes to the medical staff. This would be effective in enabling them to provide better care. The recognition that Sri Lanka is a multi-ethnic and multi-religious country is important for government hospitals, as for any other government institution. Issues like making menstrual hygiene more affordable can be easily addressed by cutting down taxes on sanitary products and by providing subsidised and free products to low-income households.
References
Alwis, Inosha. 2023. “Sri Lanka’s exodus of healthcare workers”. Himal SouthAsian. Available at: https://www.himalmag.com/comment/sri-lanka-healthcare-governance-workers-migration-economic-crisis.
Arudpragasam, Amita. 2018. “Menstrual Hygiene, A Necessity Not A Luxury”. Colombo Telegraph. Available at:https://www.colombotelegraph.com/index.php/menstrual-hygiene-a-necessity-not-a-luxury/
Bandara, Shashika and Alwis, Inosha. 2023. “Health System Needs Urgent Support to Save Lives”. Groundviews. Available at: https://groundviews.org/2023/09/12/health-system-needs-urgent-support-to-save-lives/
EconomyNext. 2024. “Sri Lanka top doctor seeks equality in healthcare”. Op-ed/Special Reports. Echelon Media (PVT) Ltd. Available at: https://economynext.com/sri-lanka-top-doctor-seeks-equality-in-healthcare-148064/
Mudugamuwa, Maheesha. 2023. “Health sector: Waning public trust amidst critical issues”. Liberty Publishers (Pvt) Ltd. Available at: https://www.themorning.lk/articles/qvbVB1zV6XldMbbmfHaD
Mudugamuwa, Maheesha. 2023. “State health sector: Lack of service agreements affect broken CT scanners?”. Liberty Publishers (Pvt) Ltd. Available at: https://www.themorning.lk/articles/1Zf8Br3HbGuUIrRsjHyk
