No quick fix for ailing healthcare system

Government nursing staff members shouting slogans in police presence during a protest, demanding an increase in incentives to relieve soaring living costs in Colombo. — AP

ONCE considered one of the best in the region, Sri Lanka’s healthcare system is ailing, laid low by the exodus of hundreds of doctors and, with patients left languishing, experts are calling on the government to act to stop the loss of talent.

More than 1,700 medical officers – an umbrella term for doctors and other healthcare professionals – have left Sri Lanka over the past two years, according to the Government Medical Officers’ Association trade union.

This compares to the departure of around 200 doctors and other health workers in 2021. The latest exodus has dealt a heavy blow to the island nation’s much-praised universal health system, on which most of its 22 million people depend.

“It is very sad to see the lack of doctors. The little support we had is slipping away,” said Srimal Nalaka, 47, who had been waiting for six hours for his monthly diabetes checkup at a state-run hospital south of the capital Colombo.“The economic crisis has hit us all. But for those of us with health issues the impact is even more severe,” said Nalaka, who has a diabetic ulcer on his right leg.The worst may be yet to come.

A health ministry report showed that 4,284 doctors obtained “Good Standing” certificates – considered mandatory to verify an individual’s professional status to foreign regulators – from the medical council between June 2022 and July 2023, indicating that they, too, are thinking about leaving.The same report also revealed that more than 5,000 doctors had acquired medical licences from Britain, Australia and countries in the Middle East.

A similar number had reserved slots for foreign licensing exams this year and in 2025.More than two million Sri Lankans have left the country to work or study abroad since 2022, when the country defaulted on its debt and sank into its worst financial crisis in more than seven decades.

And while the economy is clawing its way back towards recovery, the healthcare system is still doing poorly, with ever-longer waiting lists and a lack of access to quality treatment and medicines in a country with 1.2 doctors per 1,000 people, according to World Bank data from 2021.

Chamil Wijesinghe, a GMOA spokesman, said hospitals were already severely strained before the financial crisis.

“We are urging the president and the government to take greater responsibility for the lives of innocent citizens.

“Urgent measures and policies are needed to retain the existing doctors,” said Wijesinghe.

“But the government is comatose.”

The health ministry did not respond to requests for comment on the concerns raised by GMOA.

President Ranil Wickremesinghe has already put forward the idea of seeking compensation from the countries that recruit Sri Lankan doctors.

Last August, he asked the government to raise the issue with the World Health Organisation.

When asked about progress on the president’s request, Palitha Mahipala, the secretary to the health ministry, said the issue had to be handled with careful consideration and diplomacy.Last year, Wickremesinghe also reversed an earlier order that reduced the retirement age of public employees, including doctors, from 65 to 60 to ease staff shortages. And in January, the cabinet approved his proposal to double the Disturbance, Availability & Transport allowance for doctors.This, however, triggered a strike in February after trade unions unsuccessfully lobbied for the allowance to be extended to other healthcare workers as well.

The challenge of keeping talented, expensively trained medical professionals at home is not unique to Sri Lanka.

In many African countries, notably Nigeria and Zimbabwe, poor pay and difficult working conditions have driven doctors and nurses to seek employment abroad.Zimbabwe Vice-President Constantino Chiwenga even announced plans to criminalise the foreign recruitment of health staff, saying it is wrong that Zimbabwe spends vast sums training health workers only for them to be poached by richer countries.In Sri Lanka, where medical studies are publicly funded, it takes seven years to become a medical officer and up to 15 years to train as a specialist doctor.

Wijesinghe of the GMOA said the authorities have to make it more attractive for doctors to stay. The GMOA presented an eight-point proposal to the president last October, with the key focus on improving salaries, benefits, incentives, and facilities for doctors.

In the meantime, low-income households are suffering most because they cannot afford private care or increasingly expensive medicines.

For RS Siva, a 72-year-old retired engineer, the lack of specialist doctors at a government hospital meant he had to dip into his savings to pay for private care to have an operation on a small bowel obstruction.

“If I had no savings for a medical emergency like this, I wouldn’t be alive today,” he said.

“The daily rate for the private room was 100,000 rupees. The doctor charged 500,000 rupees for the surgery alone,” he said as he recovered at home.For many Sri Lankans, these costs are prohibitive, leaving them dependent on the public sector, which provides nearly 95% of inpatient care and about 50% of outpatient care.

Aside from the immediate effects on staffing at hospitals, the brain drain will also hit education.

Medical experts warn that with more skilled healthcare workers flying out, there will be significant gaps in mentoring and training medical students.

A health ministry panel, which compiled the report on those leaving, found that fewer doctors were taking part in selection examinations for postgraduate training, meaning there would be fewer consultants in the future.

It added that a “considerable number” of doctors, who had initially enrolled in post-graduate training programmes, had dropped out of their courses.

Sirimal Abeyratne, head of the economics department at the University of Colombo, said there is no quick fix to the brain drain and its disproportionate effects on the poorest.

“No overnight policy changes can solve this issue.

“In Sri Lanka, the exit door is open but our entrance is closed. Our labour market is not open to foreign talent,” he said.Nalaka, who runs a small grocery store, said doctors should give their country a second chance.“I have to choose between putting food on the table and buying insulin,” he said.

“We need solutions that keep our doctors here, caring for us at home.” — Reuters

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