Sri Lankan government approves paying wards in state hospitals

The Wickremesinghe government has formally approved the establishment of paying wards in state-funded hospitals. It is yet another major move towards the scrapping of free public health care on which the overwhelming majority of Sri Lankan workers and the poor depend.

Part of a health workers protest march in Colombo on July 7, 2022

Announcing the decision last month, cabinet spokesman Bandula Gunawardena declared: “The paying ward system will be established in parallel with the free health care system… These wards will be available at a reasonable payment scheme and whoever wants to have those facilities can go to a state hospital.”

President Ranil Wickremesinghe first proposed paying wards last November, in his 2023 budget. This attack on the public health is in line with International Monetary Fund’s (IMF) austerity demands and part of a massive privatisation program being implemented by the government.

While successive Sri Lankan governments have slashed health funding, the recent collapse of the economy, under the impact of the global economic crisis, has battered the free health service. Reduced funding, along with shortages of essential drugs and medical equipment has drastically affected public health care and pushed it to the brink of collapse.

Addressing the media this week, Sri Lanka Medical Association President Dr. Vinya Ariyaratne said: “There is an acute shortage of certain drugs at government hospitals.” Doctors, particularly in clinics, “are writing prescriptions for patients to buy medicines from outside. In addition, some patients are not taking the proper dosages due to the exorbitant prices of drugs available at private pharmacies. This is a major issue, which needs to be addressed soon.”

Ariyaratne said that while the shortage of medicines “has been prevalent for the last one and half years, the government, however, seems to have taken the seriousness of the matter for granted.”

Limited supplies of basic medicines have meant that essential surgeries have become impossible. Laboratory testing services in public hospitals and at the country’s state-owned Medical Research Institute have been crippled.

Patients waiting in a clinic at Kandy National Hospital in May 2023.

The recent imposition of exorbitant pay as you earn (PAYE) tax rates on wages has seen hundreds of doctors, nurses and other health professionals take overseas jobs, further aggravating the health crisis. Specialised clinical services in public hospitals across Sri Lanka have reportedly been stopped due to the shortage of doctors.

In 2020, there was an average of 1.3 doctors for every 1,000 Sri Lankans, half the ratio in most industrialised countries. According to one senior government health official, 1,000 medical specialists out of 3,700 previously working in Sri Lanka have left the country in the past two years.

Other reports indicate that there is a shortage of more than 10,000 nurses in public hospitals. This is because the government has drastically reduced the number of students attending nursing schools and stopped hiring qualified nurses.

Sri Lanka’s main base hospitals and other provincial hospitals, as well as the island’s exclusive cancer hospital, the Apeksha Hospital in Maharagama, and the Lady Ridgeway Hospital, a famous children’s facility in Colombo, have been severely impacted by staff shortages and funding cuts.

The introduction of paying wards, to convert the free public health system to a paid service, is occurring amid this deliberate rundown of the free public health system and the network of the government hospitals.

Patients are already being forced to spend money on essential medical services, including tests, scans and also emergency treatments, even as COVID-19 continues to run rampant and the mosquito-borne dengue disease is again threatening to become an epidemic.

This devastating assault on public health care has been covered up by the bourgeois opposition parties, the trade unions and various pseudo-left formations, who are committed to the IMF austerity program and the defence of Sri Lankan capitalism. Not one of the trade unions, including the health workers’ organisations, have opposed the government paying-wards decision.

Several health workers and patients recently spoke to the World Socialist Web Site (WSWS) reporters, voicing their opposition to the government’s decision and the threat to the public health system.

An attendant at Colombo National Hospital said workers were disappointed over the reluctance of the trade union leaders to organise a public awareness campaign and a fight against the paying wards. “Some trade unions connected to the government are spreading the lie that privatisation is good because our salaries will be raised. This is false. Patients who cannot even afford the present situation will be left to die and when privatisation comes, our overtime payments and leave will be curtailed, and jobs will be in danger,” the attendant said.

A doctor at Sirimavo Bandaranaike Children’s Hospital in Peradeniya near Kandy said: “I think that the government is going to put paying wards in the government hospital in order to break the free health service. They will expand the paid service little by little, thereby destroying free health care. Already my ward does not even have simple medicines. We should definitely oppose allocating paid beds in our hospitals.”

Anushka, a nurse at Gampola Hospital in Kandy district, commented: “Innocent poor people will be in danger by creating these paid wards. The wealthy will go and get treatment in countries like Singapore and those who can afford it will go to private hospitals. This measure will drastically affect poor people. Health care is a right that everyone deserves equally but this is not possible if paid beds are put in public hospitals.”

Paheerathan, a nurse from Jaffna Hospital, agreed with WSWS reporters that paying wards are detrimental to Sri Lanka’s free health service and threatened health workers’ jobs. “Poor people are already buying medicine and paying for tests. They will be further affected from this paying ward system. I oppose this,” he said.

An attendant from Karapitiya Hospital in southern Sri Lanka, angrily denounced the introduction of paying wards: “If the privatisation process goes forward big corporates will take over the hospitals and reduce the work force. Our jobs will be in danger,” he said.

Patients lying in the passage of a ward due to overcrowding at Kandy National Hospital in March 2023.

A nurse from Karapitiya Hospital said: “My basic monthly salary is 24,500 rupees ($US84.90). With overtime and allowances, it becomes 46,000 rupees but when payment on my loans are deducted I get only 20,000 rupees. I cannot cope with paying my expenses from that.

“Conditions in this hospital are very serious—there’s no medicine for serious diseases and cancer patients don’t have essential drugs. Some medicines have to be acquired from pharmacies as emergency purchases. I’m totally against privatising hospitals. If the situation in hospitals is already like this, free health care will disappear forever when it becomes a paid service.

“The trade unions in this hospital have not opened their mouths about this [privatising]. During the last election, various groups were formed loyal to the JVP [Janatha Vimukthi Peramuna] at our hospital, but for me, there’s no difference between the JVP and the present government. They all say let’s take this program forward.

“I’d like to form an independent health action committee here. I’m sick of these betrayals [by the unions]. Even under these very harsh conditions there’s no protest. I think work on these [action committees] needs to be taken further.”

One hospital patient said: “I was receiving treatment at Galle Karapitiya Hospital but had to get all the tests done from private laboratories on several occasions which cost me over 1,100 rupees for tests. Medicine also had to be purchased from outside.

“I was supposed to have an MRI scan and the hospital has only one MRI machine for the whole of the southern region. Even seriously ill patients had to wait in the queue. I had to starve for three days before I had the scan. The scan was taken on the fourth day but it was not successful and so it was postponed for 14 days. The cost of MRI scan in a private hospital costs over 12,000 rupees.

“I heard one doctor saying to a patient ‘Mother, I cannot do anything. We don’t have even cotton to treat a wound.’ I’ve also seen lots of patients being sent away without having any treatment and being told that their diseases are incurable.

“Health workers are facing immense difficulties due to this situation. Patients who cannot afford to pay for tests and medicine or go to private facilities, either die or go home without treatment,” the patient told WSWS reporters.

Governments everywhere have responded to the deepening economic crisis of capitalism by stepping up their assaults on public health care and ruthlessly imposing privatised health care. This has produced an eruption of strikes, demonstrations and rallies by health workers in a host of countries.

Sri Lankan health workers should turn to their international class brothers and sisters to fight these attacks and demand funds be allocated to establish free and properly equipped and staffed public health services, and the fundamental right of all to good health. This requires the fight for a workers’ and peasants’ government and socialist policies, including the nationalisation of the large corporations, repudiation of foreign loans and the seizure of the wealth of billionaires, placing these resources under the democratic control of the working masses.

That is why workers need to establish action committees in hospitals and other health facilities, independent of the unions. The SEP has already taken the initiative to establish a health workers’ action committee (HWAC) and calls on health workers across Sri Lanka to join this committee and take up the struggle against establishing paying wards and privatisation.

The HWAC’s phone and WhatsApp number is +94773562327. We urge you to contact the HWAC and take up this fight.