Opposition grows to government attacks on public health in Sri Lanka

By Ajitha Gunarathna
13 November 1999

Sri Lankan medical students, their parents, teachers and government doctors have launched a joint campaign to oppose the drive by the Peoples Alliance (PA) government to dismantle the country's public health service. The attacks on public health have been intensified over the past years in line with the dictates of the International Monetary Fund and World Bank.

A series of recent demonstrations, pickets and rallies have attracted growing support. The most recent protest at the beginning of September saw 5,000 medical students and their supporters march about four kilometres across Colombo to the Health Ministry where they held a rally. Students in Jaffna Medical Faculty, situated in the war-torn Northern Province, sent messages of solidarity to the rally.

The students are opposed to the recent decision by the government to discontinue the long-time practice of recruiting medical interns as preliminary grade medical officers after their internship. Over the past months some 600 doctors who completed internship were not recruited.

Yet there is a chronic shortage of government doctors in the country. The ratio of doctors to people now stands at 1 to every 4,347, well behind India nd Pakistan that have 1 to 2,083 and 1 to 1,923 respectively.

In 1997 the Colombo district only had 78.7 medical officers and 166.1 nurses for every 100,000 people. In the rural areas the situation is much worse. For example, the Monaragala District had only 9.4 medical officers and 36.5 nurses per 100,000, and in the Killinochchi and Mullaitivu districts—both in the northern war zone—there were only two medical officers.

The lack of medical specialist is even more drastic. The ratio of specialists is 0.3 to every 1,000 people, ten times less than the world average and almost half of that in the South Asian region. There are only 576 specialists available in Sri Lanka to staff 25 curative services.

This shortage has caused a breakdown of many preventive and curative programs, leading to an increase in cases of cholera, malaria, Dengue heomoragic fever (DHF), hepatitis-A and diarrhea, resulting in an increased mortality rate. In 1963 there were only 17 cases of malaria reported, whereas in 1997 there were 163,000.

The students and medical academics are also concerned about a plan being implemented through the government's Board of Investment to encourage the establishment of private medical colleges by offering lucrative tax concessions to investors. To date the Board has granted permission for three private medical colleges to be set up.

At the same time, faculties at public colleges are being run down. Students and staff complain that there is an acute shortage of lecturers, non-academic staff and an overall lack of facilities.

Students and parents at the recent demonstration spoke to WSWS. Ausha de Silva, a student at the Colombo Medical Faculty, said: “We don't have enough library facilities and also we don't have enough new books. Only half of the students have access to government hostels. The others have to spend thousands of rupees for accommodation.

The mother of a student Pathma Dinapala said: "This is a tragic situation. We are trying our level best to educate our children. We have to spend a lot of money for their education. They also have made sacrifices dedicating a lot of their life and time to their studies. If they are not provided with jobs, it is likely they will be pushed into the street. Everybody knows that there aren't enough doctors in Sri Lanka. People need the services of qualified doctors. So why is the government not recruiting new doctors? This is a real indication that the government is in a process of privatising the public health system."

P. N. Perera, whose son is studying at the Colombo Medical Faculty, said: “We have gone without even our day-to-day needs for his studies. If the government keeps them unemployed it is unjust, not only for the students, but also for their parents. Everybody knows how patients suffer without doctors. What the government should do is to recruit more doctors and take the necessary steps in expanding the health service."

The assault on student conditions is only part of a raft of government measures to undermine public health in preparation for widespread privatisation. The PA government has set up a Presidential Task Force to oversee what it terms “health reform”. Already free trade zone tax concessions are being offered to transnational companies looking to invest in the health industry. There are presently over 118 private hospitals with 2,467 beds throughout the island. Over the last months Appalo Hospitals—a well-known Indian conglomerate—has been given permission to establish a 350-bed hospital in Colombo.

The PA government is deepening the systematic cuts to public healthcare begun under the former United National Party (UNP). While the government claims that public health expenditure has increased over the last two decades it has not increased as a percentage of either national expenditure or gross national product (GDP). According to the Annual Health Bulletin (AHB), health spending as a percentage of national expenditure has gradually decreased from 6.5 percent in 1989 to 4.7 percent in 1997. As a percentage of GDP it fell from 2.3 percent in 1989 to 1.6 percent in 1997, yet the growing population is in greater need of services.

Also, capital expenditure as a percentage of total government allocation for health has been eroded dramatically over this period meaning that the expansion of health care infrastructure, such as hospitals and modern medical equipment, has been curtailed. In 1965 there were 3.2 hospitals beds for every thousand people. This had plunged to 2.9 per thousand by 1997. Over the same period annual hospital admissions increased from 150.4 per 1,000 to 184.5.

Most of the country's 548 government hospitals suffer from a chronic shortage of nursing staff. In an effort to cut costs the PA government failed to enroll students in the Nurses Training Schools and Paramedical Training Schools in 1994 and 1996. Both categories now lack trained health personnel. For example Colombo National Hospital—the major hospital in Sri Lanka—has only 1,300 nurses, well below the 1,950 needed to maintain services.

The already strained public hospital and medical facilities have been placed under even greater pressure by the twenty-year long civil war being conducted in the country's north by the Colombo regime. War casualties, in particular wounded soldiers, are given priority at the already overcrowded public hospitals. At the same time health facilities in both the North and East have been either deserted or occupied by both the Sri Lankan army or the Liberation Tigers of Tamil Eelam (LTTE)—the Tamil separatist movement.

Both UNP and PA governments have slashed the conditions of hospital and health workers. Thousands have been forced to quit their jobs under the so-called “voluntary redundancy” schemes that were first introduced by the UNP regime in 1990. Those who are left are made to shoulder increased workloads with no increase in wages.

Specialty attendants, auxiliary workers, sanitary laborers and watchers, receive wages that are as low as 5,000 rupees a month (about US$72). In March this year thousands of these workers began a campaign to oppose the deterioration of their working conditions.

The health unions have played a crucial role in assisting the government implement its attack on public health. They have worked to isolate struggles and to keep health workers divided. Now the majority of the health unions have formed a federation, lead by the Government Medical Officers Association (GMOA), supposedly to fight against the government's privatisation plans.

However, while the federation leaders have not joined the Presidential Task Force (PTF) they have agreed to cooperate with the PTF by submitting their own proposals for the “reform” of the public health system. Their only criticism of the PTF is that it does not contain enough doctors and other medical experts.

The union bureaucracy has also acted to ruthlessly suppress any opposition to their collaborationist policies. This took its sharpest form when union officials on several occasion physically assaulted members of the Socialist Equality Party, and its predecessor Revolutionary Communist League, when they tried to campaign among health workers for a socialist program to fight the governments attacks.