This week, letters of appointment were handed to new directors at five major hospitals: the teaching hospitals in Kalubowila, Ragama, Batticaloa and Peradeniya, and the Lady Ridgeway Hospital for Children. The news deserves a welcome. However, it also invites a question that those in authority have yet to answer convincingly. Why did it take so long?

These are not minor postings. Lady Ridgeway is the national referral centre for sick children, while Kalubowila and Ragama carry much of the burden of the Western Province. Batticaloa serves the East, and Peradeniya the hill country. Each is a large, complex institution, and each needs a permanent head who can plan beyond the next few weeks and answer for the results.

Moreover, these appointments are part of a wider pattern. Earlier this year, nine Deputy Director General posts were filled, including those that head the National Hospitals in Colombo, Kandy and Galle. Several had been vacant for seven or eight years. Within days, seventeen more directorships followed. The progress is welcome, yet the sheer size of the backlog tells its own story of neglect spanning more than one Government.

What, then, happens when a hospital has no director? On paper, very little, because an acting officer steps in. In practice, a great deal. An acting head is, by definition, a caretaker, and caretakers understandably hesitate over long-term plans, major purchases or difficult disciplinary decisions, since they may not be around to answer for them. At one stage, a single officer was overseeing both the National Hospital in Colombo and the Lady Ridgeway Hospital, dividing his day between two of the most demanding institutions in the country. Meanwhile, vital meetings, including those at which medicines are evaluated, were reportedly not held for months. No individual deserves blame for that; it is simply what happens when a system expects one person to do two jobs.

This matters far more here than in many other countries. The state sector provides nearly 95 per cent of all inpatient care in Sri Lanka, so for most families there is no private alternative when a public hospital falters. A director's desk is where medicine supplies, equipment repairs, staff rosters, budgets and patient complaints finally land. When nobody owns those decisions, the consequences eventually reach the wards as longer queues, idle machines and frustrated staff. Furthermore, at a time when doctors are leaving the country in large numbers, an institution without clear leadership is hardly an incentive to stay.

Nor can the delays be pinned on a single cause. For years, the service rules deciding who is qualified to run a hospital have been disputed, with trade unions and trained medical administrators pulling in different directions and the courts drawn in more than once. Approvals through the Public Service Commission have often been slow, and uncertainty over doctors' retirement age, settled less than two years ago, added to the confusion. Above all, there has been a familiar habit of leaving difficult matters for another day. Each of these factors may explain a delay of a few months. None excuses a vacancy of seven or eight years.

Consequently, the lesson must be learnt now, while the appointments are fresh. Most vacancies at this level are entirely predictable, since retirement dates are known years in advance and promotions are planned. Interviews and approvals should therefore begin well before a post falls vacant, not long after. Acting arrangements should carry a firm time limit, perhaps six months, beyond which the Ministry must explain publicly why no permanent appointment has been made. The qualification criteria should be settled once and for all and applied transparently on merit. In addition, the Ministry should publish a list of every hospital still run by an acting head, so the public can see how much remains to be done.

The Minister of Health has promised the new director’s greater authority than their predecessors enjoyed, along with freedom from political interference. That pledge is welcome and should be honoured. Nevertheless, authority means little while the chair stands empty, and independence counts for nothing if appointments drift for years.

A hospital can cope with a shortage of beds for a while. It cannot function well for long without someone in charge, and neither can a national health service. Filling these posts promptly is not an administrative nicety; it is part of the promise of free healthcare that this country has made, and must keep, to its people.