Concerns have recently been raised over the annual transfers of medical officers, as the Government Medical Officers’ Association (GMOA) criticises the Government officials involved in the process for not following instructions issued by Health Minister Dr. Nalinda Jayatissa.
Early last week, the GMOA warned of trade union action, which was later suspended with an agreement to discuss the matter further. However, it was reiterated at a mid-week press conference by the GMOA that if officials failed to provide a proper solution, doctors may proceed with strike action.
These concerns arise amid a large exodus of medical officers, particularly consultants and experienced doctors, who migrate in search of better living conditions, often citing the Government’s failure to develop necessary infrastructure. Yet, over 20,000 medical officers remain in Sri Lanka, facing largely the same obstacles cited by those who have left.
GMOA complaints
Against such a backdrop, doctors demanding a fair transfer scheme, as highlighted by the GMOA, argue that the current delay constitutes a clear violation of Ministry of Health rules regarding doctor transfers, stressing the importance of Establishments Code guidelines in creating these lists.
“This is a matter involving 23,000 doctors; 10,000 doctors already have their transfer orders, but they have not been implemented. This means they have to stay in places they are not supposed to be. Nearly 1,000 post-intern doctors are in trouble as the procedure was incorrect and there were a lot of errors in the list,” said GMOA Spokesman Dr. Chamil Wijesinghe.
According to Dr. Wijesinghe, the lists included vacancies in hospitals that lacked the capacity for such units, putting doctors at a disadvantage.
He added that the reduction in the Difficult Station Transfer List had created a shortage of doctors, putting nearly 200 hospitals at risk of closure and affecting services in others.
“We need urgent action for the Post-Intern Vacancy List as well as the Difficult Station Transfer List and the Annual Transfer List 2025. We need a comprehensive plan – a strategic approach to implement those 10,000 annual transfers,” Dr. Wijesinghe stressed.
“We hope it will end positively because we do not need to undertake this strike, but it is clear that ministry officials want to bring us to a strike. To bring us to a strike is to collapse the health system.”
The GMOA has accused the Ministry of Health of failing to implement agreements reached with the Health Minister to address irregularities in the doctors’ transfer process. According to the association, recent months have seen shortcomings in preparing transfer lists, issuing transfer orders, and filling hospital vacancies.
These issues have prompted the association to consider trade union action, although such measures were temporarily suspended following verbal assurances from the Minister.
However, the GMOA expressed dissatisfaction over the ministry’s continued inaction and the failure of senior officials to act on the Minister’s commitments. The association has formally raised the matter with the Health Minister and its Executive Committee, warning that if the Transfer Board does not implement transfer orders transparently – or if delays persist – it will pursue firm measures, including complaints to the Public Service Commission (PSC).
Transfer process
In Sri Lanka, the annual transfers of medical officers are governed by the Establishments Code and PSC regulations, with implementation overseen by the Ministry of Health and, in provincial settings, relevant provincial authorities.
The process typically begins with a call for transfer applications, which are categorised – often prioritising those who have served five or more years in the same post – before being reviewed by a transfer board. Transfer orders are then issued, with officers given the opportunity to appeal through a formal appeal board.
Although regulations require transfer lists to be published before 1 November each year, delays are common, sometimes stretching several months or even over a year, as highlighted by the GMOA.
Different categories of medical officers, such as Grade Medical Officers, specialists, and dental surgeons, have their own vacancy lists and cycles, but all follow the same basic application-review-appeal structure.
As reliably learnt by The Sunday Morning, in recent years, computerised systems like the Human Resource Management Information System (HRMIS) have been introduced to improve efficiency and reduce delays, although administrative bottlenecks between the Ministry of Health and the PSC continue to slow the process.
Inequality in distribution of doctors
These inefficiencies contribute to a larger problem of serious inequality in the distribution of medical officers across the country.
Speaking to The Sunday Morning, a senior medical officer attached to one of the leading hospitals in the Central Province, who wished to remain anonymous, said: “As a doctor who has worked in remote areas for almost two decades, the delays and weaknesses in the transfers result in an unequal distribution of doctors in Sri Lanka, especially when it’s not handled using systematic, needs-based criteria.”
As the senior medical officer went on to explain, the official purpose of these transfers is to ensure a fair allocation of medical officers across the country, but in reality, the process is plagued by delays, ad hoc decisions, political pressure, and personal requests rather than service requirements.
“This means that urban, well-equipped hospitals in cities like Colombo, Kandy, and Galle end up with more doctors than they need, while rural and remote areas, particularly in the north, east, and plantation sectors, struggle with persistent shortages,” the senior medical officer stressed.
When transfers are delayed for months or even years, doctors remain in preferred postings far longer than intended, leaving peripheral hospitals understaffed, according to the medical officer, who further claimed: “Without a transparent, data-driven system to match doctors to the areas that need them most, the process becomes reactive instead of strategic.
“This is why many of us support the calls for scientific transfers – where decisions are based on clear criteria like service duration, hardship allowances, patient load, and healthcare access, rather than on influence or convenience. If done right, annual transfers could fix distribution imbalances, but as it stands, they often make the problem worse.”
As highlighted by D. De Silva in an article titled ‘Shifting Paradigms – The Changing Landscape of Sri Lanka’s Medical Workforce,’ published this year in the Sri Lanka Journal of Medicine, the country has 1,126 healthcare institutions, yet access to quality care remains uneven.
Major cities like Colombo host world-class hospitals, while rural areas rely on underfunded divisional hospitals, according to the study. The healthcare workforce consists of roughly 150,000 personnel, but specialists are concentrated in urban centres.
Sri Lanka has a doctor-to-population ratio of 104 Government doctors per 100,000 people, although distribution is uneven; the Western Province has over 160 doctors per 100,000 people, while the Uva Province has fewer than 70 doctors.
Considering all sectors, the ratio rises to 127 doctors per 100,000 people; with dual practice, it reaches 163 doctors per 100,000 people – favourable compared to many developing nations. This imbalance leads to burnout among rural healthcare workers and affects service quality, as highlighted in the study.
The study also notes that medical specialists are concentrated in Colombo and other major cities, resulting in long waiting times and unnecessary referrals, forcing patients from rural areas to travel to urban centres and increasing their financial and emotional burdens.
Strain on healthcare system
The study further notes that the Sri Lanka Medical Association (SLMA) has reported that roughly 2,500 doctors have migrated over the past decade.
Moreover, according to Ministry of Health data, in 2023/2024, 210 specialists – about 10% of ministry specialists – and 700 doctors – less than 3% of total medical doctors – left Sri Lanka for employment abroad. This ‘brain drain’ has created shortages in key specialities and delayed patient care.
Government-trained doctors leaving the country essentially subsidises foreign healthcare systems, raising concerns about the return on investment in medical education and highlighting the need for retention policies.
According to the Ministry of Health, healthcare facilities in Sri Lanka aim to provide accessible, quality care. The public sector delivers nearly 95% of inpatient care and around 50% of outpatient care. The ministry oversees policy formulation, health legislation, programme monitoring, technical oversight, management of health technologies, human resources, and tertiary hospitals. Primary and secondary care, along with preventive services, operate under nine provincial ministries.
By mid-2022, Sri Lanka had over 1,500 healthcare institutes, including 588 hospitals, 517 primary care facilities, and 335 Medical Officer of Health (MOH) offices. The country has 555 Government hospitals providing primary health care and curative, preventive, and rehabilitation services.
Citizens and residents are registered at local health centres and referred to secondary institutions as needed. Nursing, pharmacy, laboratory, radiology, and medical records coordinators form integrated teams delivering these services.
Retaining experienced doctors
As reliably learnt by The Sunday Morning, many peripheral hospitals lack qualified, experienced doctors, often being staffed with trainees. Most experienced doctors and consultants are located in Colombo, Kandy, Galle, or Matara.
Despite having adequate facilities in some hospitals, retaining experienced medical officers remains challenging, with some leaving the country without notifying the Ministry of Health.
In this context, PSC Health Service Committee Member Dr. Ananda Hapugoda refuted allegations against officials, noting that the PSC only observed and did not make decisions. He declined to comment further, citing ethical grounds.
When contacted, Health Ministry Director of Medical Services Dr. Ayanthi Karunarathne declined to comment, directing the newspaper to contact Director General of Health Services Dr. Asela Gunawardena.