• Suwa Seriya provided special provisions in fuel quota; follows procedures streamlined during pandemic
• Midwives, PHIs struggle to deliver services, handicapped by fuel rationing; critique ministry’s reluctance to engage on crisis management

As Sri Lanka readjusts to the reintroduction of fuel rationing under a QR-based distribution system, essential public services like healthcare are facing concerns about sustaining operations with restricted mobility.

Since 15 March, a weekly fuel quota has been imposed islandwide based on vehicle types: motorcycles are limited to 5 litres, cars and three-wheelers to 15 litres, vans and special purpose vehicles to 40 litres, lorries to 200 litres, and buses to 60 litres.

While intended to manage limited fuel stocks, the requirements of the health sector – including emergency medical services and public health workers – mean that such rationing will complicate the execution of essential and life-saving services that depend on mobility and rapid response.

Emergency medical services

Many public service health care providers depend heavily on field work and direct contact with patients, making mobility essential for service delivery. 

Against this backdrop, the Ceylon Petroleum Corporation (CPC) has said that all ambulances will be issued fuel under a special priority category, allowing them to obtain fuel from CPC depots and filling stations during the rollout of the new QR-based distribution system.

At the frontline of emergency response, the 1990 Suwa Seriya ambulance service has, for now, been assured of uninterrupted operations.

Speaking to The Sunday Morning, 1990 Suwa Seriya Foundation Director Shervin Arsakularatne said that ambulances had been granted unrestricted access to fuel. 

“We can go with the QR code and fill up the whole tank, without restrictions and without waiting in queues. This is similar to the arrangement we had during the Covid-19 period,” he explained.

He noted that the special arrangements made for emergency transport during the Covid-19 period were once again being considered. “During Covid, we were assigned certain petrol sheds for fuel. The same thing can apply.”

Thus far, Suwa Seriya has not reported any delays in emergency response times due to fuel limitations: “We always try to keep tanks full,” he said, warning that emergency services could not afford to wait in queues or run low on fuel.

He also highlighted the geographic disparities in demand, noting that urban centres faced a heavy workload. 

“For example, we undertake about 12–15 cases per day in areas like Maradana and Nugegoda, while outstation areas may handle only one or two cases per day. Regardless of the location, we want to have full tanks, because the demand for our service is unpredictable; we never know when the next call will come.”

Midwives

Sri Lanka’s Public Health Midwives (PHMs), who are primarily field-based workers, are similarly grappling with the impacts of fuel rationing, with Government Midwifery Services Association (GMSA) President Devika Kodithuwakku noting that the fuel allocation was inadequate.

“Most PHMs do field work and use motorcycles for home visits, and the weekly quota is insufficient. The responsibilities of midwives are related to maternal and child health, so we cannot reduce home visits.

“Sri Lanka’s low maternal and infant mortality rate is being maintained with the greatest dedication by PHMs. At present, with the fuel issue, we are unable to discharge our duties. Should this situation create issues for maternal or children’s health, it will be a tragedy. Therefore, before such a situation emerges, the Government must provide the necessary support to PHMs, allowing them to provide their services continuously.”

Kodithuwakku further warned that logistical challenges were already emerging. 

“With Wednesday being declared a public holiday, there will inevitably be restrictions on public transport. However, PHMs are required to carry out their duties regardless. Our concern is what facilities are being provided by the Government to enable this. The fuel quota is insufficient for our needs; we expect the authorities to give this matter special attention and ensure that PHMs are able to access adequate fuel,” she said.

She stressed that without timely Government intervention in this regard, maternal and child health services could collapse. 

Motorbikes are essential for PHMs, particularly in rural areas where public transport is scarce. In areas like Polonnaruwa, Hambantota, and Anuradhapura, PHMs travel long distances between households, sometimes through isolated areas, including those with elephant-inhabited forests.

Kodithuwakku also pointed to potential access issues for patients themselves. While village clinics provide a point of access for rural women, she noted that difficulties were likely to arise for mothers trying to reach these clinics due to the fuel situation. She added that they were likely to witness a drop in attendance within the coming week, warning that should this happen and vaccinations be delayed, it would create a public health risk.

The GMSA President further criticised the lack of engagement from the authorities, charging that the incumbent ministry officials had not engaged in discussions regarding the matter. 

“We consistently try to engage with the Health Ministry when issues arise. However, at present, ministry authorities have not come to the table for discussions.”

PHIs

A similar crisis is unfolding among Public Health Inspectors (PHIs), whose responsibilities span  controlling communicable diseases, establishing a safe and healthy food culture, and ensuring the well-being of schoolchildren, among other duties.

PHIs’ Union Secretary M.A.A.D.S Muthukuda described a situation in which field work had effectively ground to a halt. While a request had been submitted to authorities seeking an increased fuel quota for PHIs, he noted that no response had been received yet.

“PHIs are officers whose duties are entirely field-based. At present, there is no dedicated fuel allocation for field work. We receive the same 5-litre quota as the general public, but our weekly requirement is at least 15–20 litres. Without adequate fuel, our field work has come to a standstill.”

He explained that these transport constraints had created challenges in responding to public health risks. He further noted that investigations into infectious disease outbreaks, food safety inspections, school health inspections – all responsibilities that require PHIs to be on the ground – had been suspended since they could not be carried out without transport.

Moreover, Muthukuda pointed out that the issue was not limited to the quota alone. He noted that accessibility was also an issue, as spending hours in queues was impractical for PHIs since it took time away from their essential duties. According to him, what is needed is both an increased quota and a mechanism that allows PHIs to access fuel without delays.

He also raised concerns about the timing of the disruption, pointing out that a reduction in PHI inspections ahead of the Sinhala and Tamil New Year season could pose a public health risk. Noting that this was a critical period where inspections were usually intensified, he said that PHIs were unable to conduct such operations islandwide at present. 

“Plans were in place to carry out inspections and raids on shops across the island from last week. However, due to the fuel crisis, all this has now been suspended.”

According to Muthukuda, during the New Year season, some traders try to clear out unsold stock accumulated throughout the year. Without continuous raids and inspections by PHIs, he warned that public food safety could be at risk.  

Hospitals and critical care

The situation remains stable at tertiary care institutions for now. At the National Cancer Institute (NCI), Maharagama, operations are yet to be disrupted.

NCI Deputy Director Dr. Buddhika Kurukulasuriya told The Sunday Morning: “No quota has been imposed on us; ambulances continue to receive unlimited fuel. At present, there is no immediate issue. Our registered suppliers are still able to provide fuel. We would only face difficulties if those suppliers were affected.”

However, the hospital had observed a drop in patient attendance since fuel rationing began, he said: “While I would need to review the data to provide precise figures, at a glance, there appear to be fewer vehicles and patients coming in, likely due to the fuel situation.”

Given the risks of treatment interruptions for cancer patients, Dr. Kurukulasuriya said that several rounds of discussions had been held with the Director General of Health Services to explore alternative options to support patients in the event travel became difficult. 

Despite the situation, access to the hospital has not been significantly impacted. He noted that long-distance patients from areas such as Anuradhapura, Kurunegala, and Matale continued to reach the hospital using public transport, with buses arriving at the Maharagama depot still operating and bringing patients as usual.

Attempts by The Sunday Morning to contact the Minister of Health, Deputy Minister of Health, and the Secretary to the Ministry of Health regarding the Government’s response to the challenges faced by healthcare workers were unsuccessful.