• 705 doctors breach bonds, leaving over a billion unpaid
• 116 officers avoid file submission, Rs. 119 m pending
• 2,837 specialist posts approved, only 2,740 recorded
• 972 specialist shortages across 35 fields; surplus of 113 in 12 others
• 141 specialists deployed to unapproved medical fields
• 71 fully-funded study leave doctors fail to return

In a new report, the National Audit Office (NAO) has exposed staggering financial mismanagement, bureaucratic negligence, and a collapse of internal control at the Ministry of Health that has cost the State over Rs. 1.27 billion.

The NAO’s latest audit has revealed that hundreds of medical officers have quit the public service – many for foreign employment or postgraduate study – leaving behind a trail of unpaid bond money, fines, and salary overpayments. 

The ministry, despite having legal provisions and agreements in place, has failed to recover these dues for years, it is revealed.  

According to the audit, there has been a surge in medical officers abandoning their posts, often to pursue higher education abroad or lucrative overseas jobs. 

In many cases, these doctors have simply walked away from their obligations, ignoring the security deposits and fines owed to the Government.

The Establishments Code and the Procedural Rules of the Public Service Commission (PSC) – first implemented in 2009 and updated in 2023 – have clearly stipulated how overseas travel and related matters must be handled. 

Yet, the NAO has stated that the Health Ministry has consistently ignored these frameworks. 

Weak internal controls and administrative inertia have left billions in public money uncollected, with recoveries delayed so long that some may now be irretrievable.

As at 31 October 2024, a total of Rs. 1,156,562,119 was outstanding from 705 medical officers who had breached their agreements. Another Rs. 119,404,239 was due from 116 medical officers who had not even submitted their personal files for audit inspection. 

On top of that, Rs. 1,041,215 – paid out as salaries, allowances, and loan balances – has remained unrecovered from five doctors who had left the service without any contractual bonds.

The audit team had found that responsible officers had failed to act “efficiently and responsibly” to recover the money. Files had been missing, correspondence incomplete, and follow-ups minimal or nonexistent. 

In some cases, auditors have discovered that Provincial Council hospitals and health institutions had exercised powers beyond their legal authority, even overriding the PSC – the only body constitutionally empowered to appoint and discipline medical officers.

The report has noted that specialist medical officers have not been placed in positions relevant to their expertise, personal files have not been updated, and no formal verification system exists to ensure that Government assets and dues have been recovered from officers who vacated posts.

The NAO has recommended that the ministry maintain proper records and appendices in line with procedural rules, establish a centralised database of all medical officers from appointment to resignation, and recover Government dues without delay. 

It has also urged disciplinary action against officials who either neglected or deliberately failed to perform their duties and demanded a strengthened internal control mechanism to prevent recurrence.

The audit has also uncovered that 116 medical officers who had left the service without submitting their personal files were collectively liable for Rs. 119.4 million in unpaid bonds and fines. 

During the course of the audit, information has surfaced about 33 additional doctors who had left the service by 29 November 2024, but the ministry is yet to calculate or take action to recover what they owe.

The NAO has also revealed that the ministry has mishandled specialist medical officer appointments. Data from the Tertiary Care Division has shown that although 2,837 specialist posts across 58 specialist fields have been approved by the Cabinet of Ministers, the ministry has recorded only 2,740 across 50 fields. No appointments have been made for 66 approved posts in eight fields.

As of November 2023, there was a shortage of 972 specialists across 35 fields, and a surplus of 113 in 12 others. Even more disturbingly, 141 specialists had been deployed to 12 medical fields that have never been formally approved, in a clear breach of Cabinet authorisation.

Staff data as of 30 June 2023 has also revealed that Central Government hospitals and other institutions showed a shortage of 226 specialist doctors in 50 hospitals, while 23 hospitals had a surplus of 123 specialists.

The audit has also traced the roots of this mismatch to a Cabinet memorandum that once sought approval to raise the number of specialists from 971 to 2,837 by 2015. Instead of adhering to the approved structure, it is revealed that the ministry had treated the figure as a blanket authorisation, deploying doctors arbitrarily, with no regard for field of expertise or institutional need.

The NAO has further exposed that out of the medical officers who went abroad on fully paid study leave to obtain board certification, 71 had failed to complete their training and return to duty. 

According to the Postgraduate Institute of Medicine (PGIM), 68 of them never completed their degrees, rendering the entire cost of their training – a full Government expenditure – a complete waste. In another instance, the ministry had failed to inform the PGIM of the resignation of 12 medical officers, further reflecting its lack of coordination and diligence.

The NAO has estimated that a total of Rs. 1,277,007,573 – covering bonds, fines, overpaid salaries, allowances, and loan balances – must be recovered from medical officers who breached their agreements as of 31 October 2024.

Further, the NAO has recommended the creation of a real-time database of all medical officers, stricter control over paid and unpaid leave as per Chapters XII and XV of the Establishments Code, and disciplinary action against those granting leave in violation of circulars.

It has also recommended ensuring that bonds and surety statements are correctly completed to enable legal recovery, and has called for prompt action by the Legal Division, which auditors found to be ineffective and disorganised.

In addition, the NAO has urged the ministry to issue a comprehensive circular covering recruitment, promotions, disciplinary action, foreign leave, resignations, and bond enforcement to all officers, including provincial governors. 

It has also recommended a fair and transparent transfer policy, proper deployment of redundant specialists to areas with shortages, and the creation of incentive programmes to retain doctors in Sri Lanka.

The audit has suggested the ministry explore a collaborative mechanism with the Sri Lanka Medical Council (SLMC) to recover funds from doctors who violate bonds but later register to practice locally.

Attempts by The Sunday Morning to contact Health Ministry Secretary Dr. Anil Jasinghe, Director General of Health Services Dr. Asela Gunawardena, Deputy Minister of Health Dr. Hansaka Wijemuni, and Health Minister Dr. Nalinda Jayatissa were futile.