• Patients forced to wait for more than 7 months for an angiogram 
• Gap in facilities leaves many patients waiting for treatment 

As details emerge of thousands of patients waiting for cardiology treatment in Sri Lanka’s public healthcare system, concerns are growing about systemic weaknesses that have caused the crisis to escalate.

Speaking in Parliament during the committee stage debate on the expenditure head of the Ministry of Health, Minister Nalinda Jayatissa shared that the waiting list for bypass surgeries and angiogram tests had grown exponentially, coming against the backdrop of a majority of the deaths in Sri Lanka – about 80% – being caused by non-communicable diseases, with about 34% being related to heart diseases.

According to the data shared by the Minister, the waiting list at the National Hospital of Sri Lanka (NHSL) for bypass surgeries stands at about 9,600, with some patients forced to wait for about five years for treatment. For angiogram tests, there is a waiting list of about 5,000, requiring a patient to wait for about 7–11 months for a test.

“Currently, the NHSL can do 700-900 bypass surgeries annually, and around 50–60 angiogram tests per day. This is not sufficient,” the Minister noted.

Behind the backlog

According to Government Medical Officers’ Association (GMOA) Assistant Secretary Dr. Thenuwan Wickremasinghe, the reason for this widening gap is the growing numbers of patients while facilities remain static.

“The daily disease burden and number of patients who have been referred for cardiac care are growing, but our facilities and surgical capacity have remained static for the last few years, causing patient numbers to rise and the waiting time to increase,” he said.

The situation has been further exacerbated by the Covid-19 crisis and the economic constraints, which the healthcare system continues to recover from.

Dr. Wickremasinghe pointed out that cardiac surgeries required the fulfilment of certain extreme conditions. 

“We need certain facilities to perform cardiac surgeries and angiograms. When there are limitations, we need to restrict the number of surgeries; when the equipment, consumables, essential medicines, and diagnostic facilities are unavailable, surgeries have to be limited accordingly. Moreover, the post-surgical care that we can provide is also limited because of the available number of Intensive Care Unit (ICU) beds, medicines, etc.”

While this crisis is not unique to the NHSL, it is most visible there due to the large volume of patients being referred from peripheral hospitals, especially when they lack the required facilities to handle cardiac cases, according to Dr. Wickremasinghe, who nevertheless stressed that the problem persisted everywhere.

At the semi-Government Sri Jayewardenepura General Hospital, where patients must pay part of the cost, around 700 cardiac surgeries are performed per year.

Yet with affordability being a concern, with each surgery costing around Rs. 1.5–2 million, Dr. Wickremasinghe said that while fewer patients came to the hospital compared to other Government hospitals, they still had to wait around three to four months for cardiac surgery.

Across the hospital system, numbers remain difficult to estimate given the dynamic nature of the situation. As Dr. Wickremasinghe noted, these numbers change daily as patients are added or removed depending on urgency and cancellations due to various reasons. “The numbers are dynamic, but the waiting list persists,” he said.

Patient risks

These prolonged delays come with significant risks for patients. Nevertheless, most patients have no option but to wait until a date for surgery becomes available.

“While some patients can manage their conditions with medications and wait for some time for  surgeries, some patients require urgent surgical intervention according to their angiogram results and cardiac condition. The problem is that we can’t attend to urgent patients because of existing limitations,” Dr. Wickremasinghe said.

However, he cautioned against attributing all patients’ deaths directly to waiting times, noting that while there were deaths on the waiting list, it was difficult to say these occurred solely due to the delay. He pointed out that patients often succumbed due to multiple comorbidities, may choose alternative treatments, may opt out of surgery, or lack the financial means to proceed. 

Against this backdrop, Minister Jayatissa’s statement in Parliament reveals Government plans to take several immediate measures in this regard, with provisions made in the Budget.

Among these initiatives are a budgetary allocation to build Sri Lanka’s first heart centre associated with the NHSL. Rs. 200 million has been set aside to commence preliminary work for this 16-storey complex. 

Noting that there were only 15 cath lab machines in Sri Lanka’s hospital system at present, with about three being non-functional, the Minister pledged that 11 new machines would be procured by 2026, along with the addition of five new angiogram machines by 2026, all of which were intended to reduce waiting times and improve cardiac care delivery.

Resource bottlenecks

Meanwhile, human resource shortages remain a pressing concern. “Even if we improve facilities and infrastructure, we don’t have the necessary staff to manage them,” Dr. Wickremasinghe said, pointing to a lack of cardiac surgeons and skilled staff who could handle ICUs, etc. 

“It takes about 7–10 years to train a cardiac surgeon and 2–3 years to train an ICU doctor,” he explained, noting that the same extensive training applied for nurses and other support staff.

“Immediate measures must be taken to stop the brain drain and attract those who are remaining abroad without returning to Sri Lanka,” he stressed.

Moreover, limitations in equipment, facilities, and operating theatres are also playing a role in extending waiting times. A long-term concern is the need to expand existing facilities, such as ICU, post-surgical care, and theatre facilities.

Noting that certain facilities needed to be fulfilled for a cath lab, Dr. Wickremasinghe said: “There should be a cardiologist and trained staff to perform angiogram tests and post-angiogram care. Although we have 7–8 cath labs around the country in Government hospitals, and the Government is planning to invest in cath lab machines and such facilities, the problem persists: how will we operate these machines and facilities if we don’t have trained staff?”

Charges of administrative neglect

Meanwhile, NHSL Deputy Director Dr. Rukshan Bellana placed the responsibility squarely on the incumbent Health Ministry administration, noting that the hospital had operated without a director for eight months and charging that administrative mismanagement was responsible for the present situation.

“This has nothing to do with the specialists; they are innocent. It is the administration that is to be blamed,” he said, expressing criticism of the ministry administration and its delays in taking action. 

Dr. Bellana stressed that the NHSL was lacking everything necessary to address the situation, noting: “We don’t have enough staff, medicines, or equipment.”

Addressing the shortcomings at the hospital, he said that four out of five angiogram machines were out of order, while four out of five MRI machines were also out of order. Moreover, most CT scanners are under repair rather than in working condition.

He stressed that the hospital’s Cardiology Department was under immense stress, noting: “Patients are increasing while the deficiencies and difficulties are growing. We are not in a position to meet the demands of people.” 

Attempts by The Sunday Morning to contact Deputy Minister of Health Dr. Hansaka Wijemuni and Health Ministry Secretary Dr. Anil Jasinghe proved futile.