Sri Lankan health services “heading for total breakdown”

Last Thursday, the Sri Lankan Medical Association (SLMA), the peak body for all medical practitioners, held a press conference to warn that the country’s health sector is heading towards as “total breakdown.”

Addressing the media, leading medical experts said that the island confronts a serious emergency with shortages of around 300 essential medicines, including a complete lack of 160 specific items at the medical supplies division, the national distributor of drugs to public hospitals. These medicines include antibiotics, anesthetics and other surgery-related drugs, as well as prenatal, neonatal, pediatric and cancer-treatment medicines.

Doctors and other health workers demonstrating over shortages and higher taxes outside Apecsha cancer hospital, Mharagama, a Colombo suburb [Photo by Health workers]

The Sri Lankan government is implementing the savage budget cuts demanded by the International Monetary Fund (IMF), including slashing funding to the public health service. As part of this year’s budget President Ranil Wickremesinghe, who is also the finance minister, will establish “paying wards” in state hospitals as part of its moves to dismantle what remains of the country’s free health service.

SLMA president Dr Vinya Ariyaratne told the press conference that “the health sector is facing a severe crisis due to the shortage of medicines, surgical equipment and chemicals used in labs.” The costs of these items, he said, “have gone up tremendously,” adversely impacting on the entire health sector.

College of Anesthesiologists and Intensivists president, Dr. Anoma Perera, said the crisis was nationwide, not just affecting rural hospitals, the National Hospital of Sri Lanka or private hospitals. “It impacts you and me, and if we ignore it anymore, there is a looming critical situation,” she said.

“Whether it’s a patient in the Intensive Care Unit, someone who has undergone surgery, an expectant mother who has had a Caesarian section or a victim of an accident, a shortage or lack of medicines impacts on them all,” she continued.

Ongoing shortages and the lack of anesthetics and pain management medicines has limited options for doctors, Perera warned. “In the next few months, the health sector might be compelled to maintain only the most emergency services,” she said.

National Institute of Infectious Diseases consultant Dr. Ananda Wijewickrama pointed out that most hospitals do not even have the facilities to conduct basic blood tests. “Some hospitals can’t even print x-rays. They ask patients to bring a CD so they can burn the images into it,” he said.

The health ministry has responded to this dire situation as a promoter of death, not life. Health Minister Keheliya Rambukwella told the Daily Mirror last weekend, that the ministry has advised hospitals to delay “non-urgent” surgeries and give priority to urgent surgeries.

Health workers across the country—from doctors to junior staff—have been demonstrating outside hospitals for months over shortages of medicinal supplies and demanding improved facilities and working conditions.

Dr. Sanduni Perera protesting high income taxes and lack of medicine outside Apecsha cancer hospital in Mharagama, a Colombo suburb. [Photo by Health workers]

Dr. Sanduni Perera from Apeksha, Sri Lanka’s dedicated cancer hospital, spoke with the media last week during one of these demonstrations. “There is no point patients coming to hospitals if we don’t have facilities to do a surgery and cannot provide them with medicine. We have been demanding the government resolve these issues since last year, but the government has other priorities and the health sector is neglected,” she said.

A Chilaw provincial hospital doctor told the World Socialist Web Site (WSWS): “There are no medicines for patients who come to clinics with diabetes and hypertension. Some of the essential medicines needed for the labor room were obtained through friendly doctors in Australia. We’ve been working with utmost dedication to save the lives of our patients since the height of COVID-19 but there’s a limit to the aid we can obtain from outside.”

A nurse from the same hospital explained that much of the equipment and medicines, including for childbirth, is now being purchased by patients.

The WSWS also spoke to a nurse from the Jaffna Base Hospital. “All hospitals lack medicines, including in the North. We are all facing a dangerous situation,” she said. “We also lack staff, including doctors, nurses, and others, in our hospitals, but the government is not concerned,” she added. She also explained that ambulance services had almost ground to halt in the area because there were no funds to service the vehicles.

A Kandy National Hospital psychiatric ward doctor who spoke with the WSWS said: “We face a dire situation because we do not even have drugs to control the violent and suicidal behavior of aggressive, mentally ill patients.”

A schoolteacher explained that one of her students had been treated at Kandy National Hospital over complications with her kidney transplant. She was treated because she was young, the teacher said, but lots of older patients were still on surgery waiting lists.

Doctors and health workers protest outside Kandy hospital on 20 January 2023.

The teacher, who is a cancer patient, could not afford to buy the prescribed medicine she needed because it was too expensive. “I had to purchase some cheap alternative,” she said.

The catastrophic situation now facing the health system is a direct result of ongoing and intensifying budget cuts by successive Sri Lankan governments in line with IMF directives.

The run-down state of the health system drastically worsened following the outbreak of the coronavirus pandemic in 2020, which saw hospitals overwhelmed with patients. This catastrophic situation, however, has further deteriorated with cuts to the health budget in response to the country’s debt crisis, inflation and the economic impact of the US-NATO war against Russia in Ukraine.

This year’s allocation for the health sector is just 322 billion rupees ($US880 million) compared to 539 billion rupees for defence and the police. The government’s allocation for health, however, is only on paper. Successive Colombo governments have consistently provided only 1 to 2 percent of the country’s gross domestic product for the health service.

The Wickremesinghe government is currently collecting massively increased funds via its 15 percent value added tax on essentials, including food items, fuel and telecommunications. All monthly wages above 100,000 rupees are now subjected to a 6 to 36 percent pay as you earn tax and imports of all essential items, including medical supplies, have been slashed to minimum.

These increased taxes, however, are not to provide the life and death necessities for the masses but to pay back loans to global creditors organised by successive Colombo governments.

The health sector trade unions continue to make futile appeals to the government to resolve the health disaster while promoting the deadly illusion that the government can be pressured to change course.

The capitalist opposition parties, including the Samagi Jana Balavegaya and Janatha Vimukthi Peramuna, are likewise attempting to exploit rising mass opposition against the government to come to power. Notwithstanding their denunciations of the Wickremesinghe government, these organisations have no fundamental differences with the austerity measures and would impose the same budget cuts if they won office.

Billions of rupees are immediately needed to prevent the collapse of the public health service and to provide free, high-quality health services to the masses. The health service must be urgently provided with the necessary medicines and infrastructure, along with more health workers at all facilities.

The working class must fight for this program by taking matters into its own hands. This requires the building of action committees, independent of the trade unions and all the capitalist parties. Following the initiative of Socialist Equality Party (SEP), doctors, nurses and other health workers have established a Health Workers Action Committee. This must be expanded to all hospitals and other health institutions.

The funds necessary to save and develop a high-quality free public health service can be found by repudiating all foreign debts, seizing the wealth of the billionaires, and nationalising the big companies, banks, plantations and major economic centres under democratic workers’ control. This is inseparably connected to the fight for a workers’ and peasants’ government as part of struggle for international socialism.