- Outdated CT scanners in need of replacement; MRI scanners facing maintenance issues
- 40 CT scanners operational, but half of them require urgent replacement: Karunathilake
Sri Lanka’s healthcare system faces a pressing crisis in diagnostic imaging, with a significant portion of the nation’s CT scan machines being outdated and in dire need of replacement. This issue, highlighted by the Division of Biomedical Engineering Services (BMES) of the Ministry of Health (MOH), reveals systemic challenges impacting the efficiency and accessibility of vital medical scans across the country.
According to BMES Deputy Director General Eng. S.A.J. Karunathilake, approximately 40 CT scan machines are operational in Sri Lankan hospitals, with nearly half requiring urgent replacement. “The primary issue lies with the X-ray tubes of these machines, which need replacement. Each tube costs between Rs. 15 million and Rs. 20 million,” Karunathilake disclosed.
The ageing equipment has led to frequent breakdowns, undermining the reliability of diagnostic services.
The situation is not isolated to CT scans. Sri Lanka also has around 12 MRI machines distributed across its hospitals. Despite the majority being operational, significant concerns exist regarding their maintenance and functionality. For example, at the National Hospital of Sri Lanka (NHSL), only two out of four MRI machines are currently operational.
Mishandling has led to issues such as foreign objects blocking the machines, including an unusual case where baby diapers had been found obstructing one MRI scanner. Additionally, a machine donated by Japan has a factory fault and is expected to be replaced by the donors.
Increased frequency of failures
The chronic underperformance and breakdowns of diagnostic machines have not gone unnoticed. Health sector unions, including the All Ceylon Nurses’ Union (ACNU), have voiced strong concerns about the increasing frequency of equipment failures.
ACNU President S.B. Mediwatta revealed that patients were often forced to seek scans from private facilities or transfer to other hospitals due to the unavailability of functional machines. “At the NHSL alone, around 200 scans are conducted daily,” Mediwatta noted.
In contrast to these observations, Karunathilake argues that the number of scans performed daily is significantly lower, ranging between 15 and 20. He attributes this discrepancy to the need to utilise existing machines more. “Hospitals are not performing scans at their full capacity,” he explained. “Many machines are underutilised, which is why we are not seeing the high volume of scans that some reports suggest.”
The disparity between these machines’ perceived and actual usage highlights deeper issues within the healthcare system. The ACNU has raised alarm about the mounting bills at the MOH, which they claim are causing delays in necessary repairs and contributing to a shortage of functional diagnostic equipment. Mediwatta criticised the ministry for failing to address these problems effectively, resulting in extended wait times for critical tests and overheating issues due to overuse.
Payment and service agreement delays
Adding to the complexity of the situation, a senior medical official at the MOH, speaking on condition of anonymity, accused the ministry of mismanagement, claiming that delays in payments and renewal of service agreements had compounded the crisis.
Allegedly inflated costs due to middlemen in the procurement process further exacerbate the problem. According to the official, about half of the CT scan machines in State hospitals are non-functional, with 15 out of 25 machines currently out of service.
The official emphasised a stark contrast between international standards and Sri Lanka’s limited number of CT and MRI scanners. They suggested that better management by BMES could have prevented excessive spending on third-party service contracts and mitigated the current crisis.
The official’s comments underscore the need for a strategic overhaul in the management and procurement processes within the MOH.
In response to concerns regarding pending payments, Karunathilake assured that bills had been settled and that there were no significant arrears. He acknowledged the economic constraints affecting larger equipment purchases but emphasised that procurement processes were underway.
“We have floated a tender for new machines. Although the initial quotes from local agents were exorbitant, we managed to secure a more reasonable rate through an open tender. We are currently awaiting approvals from the National Medicines Regulatory Authority (NMRA) to finalise the procurement,” he explained.
High costs
According to the ministry’s Performance and Progress Report for 2023, Sri Lanka has utilised Rs. 256.14 million of the allocated Rs. 2,600 million budget for the procurement of medical equipment.
Additionally, Rs. 1,036.15 million has been spent in the past year on service and maintenance agreements as well as the procurement of spare parts from an allocated Rs. 4,000 million.
At the Sri Jayewardenepura General Hospital, the costs for diagnostic imaging services are as follows: an MRI scan for the brain is priced at Rs. 16,450, an MRI scan for the spine/lumbar spine/thoracic spine is Rs. 15,700, a CT scan for the brain is Rs. 7,500, and a CT scan for the abdomen is Rs. 14,250.
In comparison, patients seeking these services from private hospitals often face significantly higher rates.
Given the disparity in costs, patients from lower-income backgrounds who rely on State hospitals may find it challenging to afford these essential diagnostic procedures should they be required to seek them elsewhere.