For decades, Sri Lanka’s public health system has been widely regarded as one of the best in the region for a nation of our economic standing. However, poor governance, economic hardship, the Covid-19 pandemic, and bureaucratic lethargy have left the public health system battered and bruised. The ongoing depletion of baseline medications, ranging from critical anaesthetics to essential cardiac medications and oncology treatments, has laid bare a grim reality: a nation cannot boast a sovereign healthcare system if it remains permanently dependent on the charity of its neighbours.
There is a serious shortage of medicines in the public health system and even in the private medical establishment, with some medical specialists observing a reduction in the quality of medicines which are now imported. While issues with the quality of the medication available have yet to draw serious complaints and be proven through independent investigations, the allegations remain unchallenged.
As with building resilience and capacity for energy security, which this Government has begun, Sri Lanka needs to repair its damaged pharmaceutical supply chain to ensure a robust supply and sovereign capacity.
Thus far, Sri Lanka has relied largely on emergency credit lines from India, international bailouts such as those from the World Health Organization (WHO) and the World Bank, and foreign donations, which have temporarily averted an absolute medical catastrophe. They have also served as a convenient distraction, especially as building resilience may be a painful affair. Relying indefinitely on emergency foreign aid for lifesaving, baseline medicines is not a sustainable remedy; it clearly reflects chronic, systemic failures in local procurement, budgeting, and medical governance. Multiple administrations, including the one currently in power, have painted this situation as a product of a foreign currency crisis. But it is not, in the broader context of the issue.
Some State administrators have tried to lay the blame for pharmaceutical shortages solely at the feet of macroeconomics and the evaporation of foreign currency reserves. However, market analysts and seasoned industry specialists think otherwise. A recent Pharmaceutical Supply Chain Assessment for Sri Lanka by an international donor agency highlights that despite the State operating massive bulk warehouses and regional infrastructure, critical operational gaps and a total absence of robust inventory controls actively fuel sudden stockouts and massive pharmaceutical wastage.
The primary failure is administrative paralysis. Bureaucracy within the Ministry of Health routinely moves slower than medicine manufacturing. Delays in procurement decisions have crippled subsequent supply cycles. For instance, despite the critical need for forward planning, tenders for hundreds of imported medicines are frequently delayed by months, forcing public hospitals into a state of perpetual triage. A modern healthcare system cannot function when a standard procurement cycle takes up to nine months of convoluted red tape just to move a medicine from an initial tender to a patient’s bedside. Meanwhile, payments for some of the pharmaceuticals delivered have not been carried out in a regular manner, industry insiders charge, explaining that such issues make importers hesitant to take on tenders.
Furthermore, registration backlogs at the National Medicines Regulatory Authority (NMRA) leave qualified international suppliers stranded in administrative limbo, exacerbating supply crunches. When legitimate, high-quality suppliers step away due to rigid pricing controls or bureaucratic delays, it leaves the State vulnerable to capacity issues from low-tier distributors – or worse, predatory elements looking to exploit the system.
This structural inefficiency does not just cause logistical delays; it fosters active corruption. When routine procurement breaks down, governance lapses force the state into ‘emergency purchases’. Historically, these emergency spot buys have bypassed the strict quality assurance protocols of the NMRA, sacrificing patient safety for speed.
The consequences have been fatal. High-profile procurement scandals involving falsified, substandard human immunoglobulin and rituximab injections – discovered to contain little more than saltwater – offered a chilling look into the dangers of deregulated emergency health procurement. Billions of rupees are squandered annually on emergency purchases, failed tenders, and unusable, poor-quality medicines that must ultimately be withdrawn from circulation. These issues also erode public trust in the system.
As such, Sri Lanka cannot continue to rely on the generosity of regional neighbours or the stopgap funding of multilateral lenders to secure basic paracetamol, antibiotics, and anaesthetic agents. Neighbourly assistance is a welcome bridge, but it is a poor foundation for national health security.
There is a need for a proper reform programme to address the issue. One area where improvement can be made is by fully integrating the supply chain through a unified data platform. Real-time consumption tracking from peripheral hospitals to the central ministry would eliminate manual forecasting errors. The procurement system also needs streamlining: the separation of roles between demand estimation, price evaluation, and contract management must be cleanly defined to reduce integrity risks. Grounded in recent collaborative efforts with international bodies like the WHO, the NMRA and the Ministry of Health must institutionalise strict, transparent corruption risk assessments across all tender stages.
Sri Lanka’s universal healthcare system was designed to ensure no citizen would suffer because of the financial cost of illness. However, if the State fails to fix the deep-seated rot in its medical procurement and governance networks, the promise of free healthcare will remain an empty shell, leaving patients to pay the ultimate price.