Sri Lanka is one of the very few developing countries with a completely free Government healthcare service. Along with free education, it is one of the cornerstones of Government policy. This is indeed why some of our health indices such as the maternal mortality rate are almost on par with those of the developed world. This is an expensive exercise for a developing country, with an annual budgetary allocation exceeding Rs.200 billion. The general consensus is that this is money well spent, as a healthy country is essential for progress in all other fields.
The past three years have proved to be very challenging for the Government health sector, primarily due to the Covid-19 pandemic and the subsequent economic crisis. The pandemic stretched health resources to the limit, even though the vaccination campaign itself was a success. It also exposed some of the shortcomings in the sector – it was rather shocking to learn that Sri Lanka has only two ECMO (Extra Corporeal Membrane Oxygenation) machines, vital to save the lives of critically ill respiratory patients, such as those suffering from severe Covid.
If Covid exposed the vulnerabilities of the health sector, the economic crisis that engulfed the country for much of 2022 took it to the breaking point. At this stage, the country lacked dollars to import even basic medicinal drugs and other medical supplies, leaving the lives of many Non-Communicable Disease (NCD) patients at stake. The prices of medicines available at private pharmacies also shot up overnight, instantly making them out of reach for most patients. Some medicines disappeared from the shelves of private pharmacies as well, as the dollar shortage worsened. Unfortunately, despite the recent appreciation of the Sri Lanka Rupee against the US Dollar and the easing of the economic crisis, these prices have not come down by any significant margin.
Another consequence of the economic crisis was the large-scale migration of doctors in search of greener pastures abroad. It is estimated that more than 350 specialist doctors alone have left the country, along with hundreds of general physicians including some who had just become interns. Sri Lanka needs around 4,000 specialist doctors for its Government hospitals, but right now the number is 2,000. The imminent retirement of around 300 specialist doctors or consultants will not help matters either. There are suggestions to raise the doctors’ retirement age to 63 to ward off this shortage.
General and doctors’ trade unions are also to be blamed for this status quo, as they played a key role in abolishing the only private medical university that existed in the country (SAITM) and preventing the entry of others. If Sri Lanka had SAITM and a few other private medical universities, there would not have been a dearth of new doctors by now. Moreover, the strict employment requirements for those who had obtained medical degrees from foreign universities deter many such graduates from coming back to Sri Lanka. These rules need to be relaxed at a time when the health sector is facing an acute crisis. The Government must also explore the possibility of getting the services of Sri Lankan doctors domiciled abroad at least on a temporary basis.
From the point of view of patients, there is simply no excuse for not bringing down the prices of pharmaceuticals. According to newspaper reports, most patients are skipping their medications to save money for the next visit to the pharmacist, though this can even prove to be fatal. But they apparently have no choice due to the very high prices of many essential medicines including those required for heart ailments, diabetes and hypertension.
There is a precedent for the drastic reduction of pharmaceutical prices – when President Ranil Wickremesinghe was the Prime Minister of the Yahapalana Government, all importers and manufacturers were compelled to lower the prices of their products drastically – to give just one example, an imported antacid tablet that cost a staggering Rs.90 was sold at just Rs.7 after the reduction. This also covered equipment such as heart stents – brought down to Rs.100,000 from Rs.250,000. So it can be done.
The authorities must also probe the recent incidents caused by the import of low quality and/or expired drugs. Simply stopping the import of these drugs is not enough. Legal action must be taken against the local companies/agents and officials responsible for importing them. Moreover, the authorities must ensure the availability of adequate stocks of essential medicines and ramp up the local manufacture of generic drugs with import substitution in mind.
There are also reports that CT Scanners and other diagnostic equipment at many State hospitals are not functioning, with patients given the option of getting these scans and tests done at private hospitals and labs. However, only a very few patients who patronise State hospitals can afford to do so, as private hospitals charge exorbitant sums for such services. In fact, the whole health sector, private hospitals included, must be revamped to give a better service and a better choice to the public.