• 1,000 new Arogya Centres planned
• Govt. moves towards referral-based healthcare
• Family doctor and medical team proposed for every 10,000 people; rollout planned over 3 years
• Existing workforce sufficient, but rerouting and fresh recruitment will be required: Health Ministry 
• Doctors back family care concept but warn reforms must be gradual and adapted to SL realities
• Rural access, meds shortages, transport difficulties emerge as key concerns
• Opposition alleges President’s hospital-access remarks contradict his position while in Opposition
• NPP rejects criticism, says President’s remarks were misinterpreted and reforms target gaps in preventive care

President Anura Kumara Dissanayake has said that the Government intends to overhaul Sri Lanka’s healthcare service by introducing a family doctor system, under which patients would require a referral before being able to access major hospitals, a proposal that has drawn a mixed public response and criticism from the Opposition.

The planned health reforms programme is expected to be rolled out within three years, it is learnt. Some medical professionals have supported the concept but warned that its implementation will need to be undertaken with awareness-building and in a streamlined manner over a period of time.

Speaking at a rally in Beruwala last Sunday (6), the President said: “We are going to change the healthcare service. We will change the culture of people going to hospitals whenever they feel like it. We will establish centres where every family will have a doctor. You will not be able to go to a major hospital without a recommendation from that doctor.”

He said the current pattern of hospital use had become unsustainable. “Now, even if people come to the market, they go to the hospital; even if they go to the junction, they go to the hospital. That cannot continue. You must have a recommendation from your doctor to go to a major hospital,” he said.

Citing utilisation figures, the President said that around 80 million outpatient visits were recorded annually across the State and private healthcare sectors against a population of 22 million. “This means one person goes seven or eight times. Why? There is no proper system, there is no referral, and it is the patient who decides where they should go,” he claimed, adding that a doctor, rather than the patient, should determine which specialist a patient needed to consult.

The President said that the Government planned to establish 1,000 Arogya Centres next year as part of the initiative, with a primary care doctor assigned to make the initial assessment.

“There will be a primary care doctor and only with that doctor’s recommendation can the patient move on to a higher level of care,” he said, adding that patients often did not complete prescribed courses of medicine. “If the doctor tells you to take some coriander and get some rest, then go home and rest instead of going and getting all these medicines. Even when you get them, you don’t take all of them, do you? You take them once, even though they are prescribed for three days, right?” the President observed, claiming that such practices were a waste.

Public reaction divided

The statement generated extensive discussion on social media, with reactions divided between support and criticism. 

Some commentators noted that comparable referral-based systems operated in countries such as the United Kingdom and Germany, while cautioning that replicating them would require substantial investment and would carry their own shortcomings. Others pointed out the shortcomings of such systems which were used overseas, like the well-documented long waiting lists to see a specialist, which had plagued the British National Health Service (NHS) for decades.

One user recalled facing long waiting times for a doctor’s appointment after moving to the UK and said that Sri Lanka’s system, despite its limitations, delivered timely care with minimal resources. Another pointed to Germany, where medicines for minor ailments such as fevers, allergies, and stomach upsets were sold in supermarkets, suggesting that Sri Lankans would use similar facilities if they were available locally.

Other users argued that the existing system should be strengthened rather than replaced with a model imported from elsewhere, noting that Sri Lanka’s healthcare indicators had been sustained over decades through the work of healthcare staff independent of political change. 

Some said they did not have sufficient information to comment and called on the Government to conduct public awareness activities before implementing the programme. Some called for the much praised public health system of Sri Lanka to be strengthened before the Government tried to experiment with policies which may impact people’s health.

A doctor working at a leading hospital in Colombo, commenting on social media, said that patients travelling to tertiary hospitals for minor requirements such as deworming medicine placed unnecessary strain on resources, while acknowledging that any solution modelled on systems used in the UK or Australia could not simply be transplanted into Sri Lanka without modification.

A consultant resident physician based in Kandy, also writing on social media, said that patients in remote areas sometimes collected medication from three different hospitals over three days for what turned out to be a viral fever requiring only paracetamol, largely because those on daily wages could not afford to lose a day’s income to illness.

The physician said that limited stocks of basic medicines in Government hospitals, difficult transport links in rural areas, and the prevalence of tropical illnesses such as dengue and leptospirosis were among the practical constraints that would need to be addressed in any redesign of the system, and cautioned that “a solution designed for Colombo 7 will not necessarily be a solution for the entire country”.

Roots in the 2024 manifesto

President Dissanayake’s remarks reflect commitments made in his 2024 Presidential Election manifesto, ‘A Thriving Nation, A Beautiful Life’. Under the Primary Care subsection of the chapter titled ‘A Vigorous Life – Healthy People,’ the manifesto states that a family doctor and healthcare staff will be provided for populations of between 5,000 and 10,000 people. 

It notes that basic hospitals, general hospitals, and teaching hospitals will be clustered as primary, secondary, and tertiary care institutions, respectively, to ensure continuity of care. The manifesto also refers to satellite clinics, including visiting specialist consultants, as well as psychological, speech, audiological, occupational, and community physiotherapy services.

Health Ministry outlines rollout, staffing, funding

The Government plans to establish 1,000 new Arogya Health and Wellness Centres over the next three years as part of a broader restructuring of Sri Lanka’s primary healthcare system, introducing a family doctor-based model aimed at reducing pressure on major hospitals.

Consultant Medical Administrator and Health Ministry Director of Primary Care Services Dr. Sarathchandra Kumarawansa told The Sunday Morning that the Government’s health policy envisaged assigning a medical team, including a family doctor, to every 10,000 people. 

“The idea is to provide a family doctor and a medical team for every 10,000 people. Patients will first receive care at the primary healthcare level. If they need specialist care, they will be referred to a secondary-level hospital, and if they require further specialised treatment, they will be referred to a tertiary-level hospital,” he said. 

He added that the referral system was intended to reduce congestion at outpatient departments by ensuring patients received appropriate treatment at the primary level.

Dr. Kumarawansa said that at least 2,000 primary healthcare institutions would be required to provide the proposed coverage nationally, of which around 1,000 already existed. “The additional 1,000 institutions are what we call Arogya Health and Wellness Centres,” he said. 

He noted that around 80% of the new centres would be developed using existing clinical centres staffed by family health service officers, with the remaining 20% requiring new construction at a cost of up to Rs. 50 million per unit, along with basic medical equipment and information technology facilities. 

He stressed that the programme was not confined to the 1,000 new centres and that all 2,000 primary healthcare institutions would need to be developed and strengthened. The new centres are expected to be established in phases over three years, with 300 planned for the first year, 400 for the second, and 300 for the third.

On staffing, Dr. Kumarawansa said that the number of healthcare personnel currently within Sri Lanka’s system was sufficient for the programme, referred to internally as Project Aarogya, though re-routing and recruitment would be required. 

“For the initial phase, we will recruit primarily from outside, such as hiring 10 doctors and 10 staff members while redistributing existing junior staff internally. For subsequent phases, we expect to rely on existing personnel without needing additional outside recruits,” he said. 

On financing, he stated that Rs. 15,500 million had been allocated in the current year’s budget, with continuous Government budget allocations secured for the next three years, and that a further $ 150 million from the World Bank’s Primary Health Care System Strengthening Project would also be deployed for the programme.

Dr. Kumarawansa said that a pilot project based on the Arogya concept had begun in 2026 and was being evaluated on a monthly and quarterly basis, with positive results so far. He added that Health Minister Dr. Nalinda Jayatissa had requested an independent evaluation by the World Health Organization (WHO), which involved five consultant specialists from Japan, the UK, Thailand, India, and Australia.

“The WHO has recommended the Arogya model as a suitable model for our country. It has also made several recommendations,” he said, adding that the Health Ministry’s own evaluation had identified shortcomings that would be addressed as the programme expanded.

According to Dr. Kumarawansa, a central component of the proposed system would be the prevention and early detection of Non-Communicable Diseases (NCDs), particularly diabetes and hypertension. 

Under the plan, everyone over the age of 30 would undergo annual screening for diabetes and hypertension, with the frequency eventually increased to twice a year, while screening for oral, breast, and cervical cancers would also be included.

People over 60 would undergo annual screening for 10 common health conditions and the primary healthcare package would additionally cover palliative care, rehabilitation, primary mental healthcare, eye care, and oral healthcare services.

While acknowledging that structural change would be necessary, Dr. Kumarawansa stated that Sri Lanka’s existing healthcare achievements should not be overlooked. “We should not forget that although Sri Lanka is a lower-income, developing country, for more than 100 years we have maintained health indicators comparable to those of developed countries. One of the main reasons for that is the strength of our human resources,” he said. 

He added that the Government bore primary responsibility for building public understanding of the changes before restricting direct access to hospitals. “At the same time, we cannot simply stop patients who currently come directly to hospitals. An attitudinal change needs to be created among patients as well, covering the entire system from primary to secondary and tertiary care,” he said.

Doctors’ association calls for gradual introduction

Meanwhile, Medical and Civil Rights Professional Association of Doctors President Dr. Chamal Sanjeewa said that the family doctor concept should be introduced gradually, primarily as a mechanism to regulate patient referrals and reduce overcrowding at major hospitals’ outpatient departments.

He stated that successive governments had been reluctant to pursue the concept in the past, partly because it was not politically attractive and partly due to resistance from health sector trade unions, noting that initial groundwork undertaken by the Government that came to power in 2015 had not developed into a functioning system.

While describing the present Government’s effort to revive the concept as commendable, Dr. Sanjeewa said that attention needed to be paid to the efficiency of the existing healthcare system before a new model was introduced, including how budgetary allocations and donor funding were utilised, the duplication of projects, bureaucratic delays, and procurement and tender procedures. 

He added that reforms could not consider the State sector in isolation, given the close relationship between public and private healthcare, while calling for stronger national policy frameworks covering medicines and antimicrobial drugs, regional healthcare delivery, human resource management, salaries and recruitment, and the training of healthcare professionals.

Opposition alleges contradiction

The President’s statement was criticised in Parliament by Opposition Leader Sajith Premadasa, who stated that there was a contradiction between the President’s current position and statements he had made while in Opposition.

“When the President was in the Opposition, he said that health was a fundamental right and that this fundamental right should be strengthened. He said that if you went to a hospital and it failed to provide you with a bed, you should be able to take legal action against the Government,” Premadasa stressed, adding that the Government was now saying people could not go to hospitals whenever they wanted.

He attributed the policy shift to “the serious deterioration of the healthcare system, the severe shortage of medicines in the country, and the shortage of equipment in hospitals,” saying that the Government’s responsibility was to implement, while in office, what it had advocated while in Opposition.

Remarks were misinterpreted: NPP MP 

In response to the criticisms of the Opposition, National People’s Power (NPP) MP Dr. Najith Indika told The Sunday Morning that the President’s statement had been misinterpreted by the Opposition. 

The Opposition had alleged that the President had advised diabetic patients to stay at home and drink coriander water (koththamalli) rather than seek treatment. Indika claimed that the President had instead been addressing systemic informality within the healthcare model rather than criticising medical staff or patients.

“The challenge in this era is not getting people to access health services. Our people do come to hospitals, but the issue is whether the system is organised to deliver what is actually necessary,” he argued.

Indika said that patients under the current structure frequently visited hospitals four times a year to collect routine prescriptions without receiving basic diagnostic screening such as blood glucose or cholesterol tests, with many only diagnosed after complications such as kidney failure requiring dialysis, strokes, or heart attacks. 

He cited Health Ministry and WHO figures showing that while 10.7% of the adult population, or approximately 1.6 million people, were officially diagnosed with diabetes, WHO data estimated actual prevalence at 13.7%, meaning roughly 22% of diabetic individuals remained undiagnosed until advanced complications occurred. He said that hypertension affected 34.8% of adults, more than a third of the adult population, with 19% of these cases remaining uncontrolled.

Indika further noted that Sri Lanka’s historical healthcare model had successfully reduced maternal and child mortality by deploying trained midwives to rural maternity centres from the 1950s, but had not developed equivalent preventive mechanisms for NCDs. 

He said that the Arogya Wellness Centres were intended to address this gap by deploying public health nurses into communities to conduct screenings, monitor NCDs, and manage family health profiles, in a role comparable to that of the earlier midwife programme.

Indika confirmed that 39 Arogya Wellness Centres were already operational, alongside continuing expansion of tertiary infrastructure such as catheterisation laboratories and dialysis units. He described the primary care reforms as the largest long-term investment in Sri Lankan health history.

“This is a long-term solution and an investment. In 10 years, as a result of these steps, our national health budget will inevitably decrease,” he said, calling on parliamentarians to support structural formalisation across the health, transport, and education sectors.