The National People’s Power (NPP) Government came into office with a mandate for a system change; that is a fact. 

However, increasingly, some of the proposed changes and reforms which it plans to enact have cast a long shadow over what is really behind such action.

With his Government turning two years in power, President Anura Kumara Dissanayake took to the stage at a public gathering in Beruwala, where his comments about how citizens use the public health system failed to resonate well with many. The NPP’s swing support base of youth and middle-aged demographics, who express themselves mostly on social media platforms, is showing their displeasure about the statements regarding access to health, a most basic right we all enjoy. It must not be forgotten that the island is also facing an ageing population crisis.

For an observer who listens to the President speak about the use of the public health system, it becomes clear that the message between the lines is essentially that less expenditure for the health sector is on the horizon. While some may consider the reference to ‘take kothathamalli’ for a fever or flu in a humorous light, the broader signalling behind the statement involves State expenditure cuts. Perhaps all is not as well as we are told on the economic recovery front.

The language the President used to describe the average citizen misusing the health system is deeply troubling. It sounded a lot like the rhetoric used during the NPP’s and Janatha Vimukthi Peramuna’s (JVP) rise to paint a ‘category’ of people as part of the problem. 

Sri Lankans would tell you that few, if any, wish to visit hospitals for the ‘slightest issue’. 

An overwhelming majority of Sri Lankans will only go to a hospital to seek medical assistance once they have exhausted home remedies, or after they have tried what a pharmacist or a traditional ayurvedic medical practitioner has advised them to do. Dissanayake’s snipe at the vulnerable community he himself comes from, alleging that people will use a hospital while en route to the markets or a village junction, is belittling the struggles of the average citizen, who, after weathering the Covid-19 pandemic, economic crisis, and Cyclone Ditwah, is barely getting by. 

The President’s message, said in a condescending tone, is the smokescreen covering the advance of a larger problem, one which the Government is finding it difficult to acknowledge. The average Sri Lankan, unless they are caring for an infant or a seriously ill person, will try a range of home remedies: the old faithful ‘koththamalli’ (coriander) and over-the-counter medicines to weather poor health before making the reluctant journey to a hospital.

Most use the public health system since that is all they can afford, and despite some hiccoughs, Sri Lanka’s State health services are held in high regard. 

Nevertheless, it is hard to find many who would wish to travel to a hospital on a whim and endure the sparsely resourced facilities and the colourful conduct of some of its junior staff. 

For an overwhelming majority of the citizenry, the visit to a hospital is a last resort or one to preempt a problem. Some in vulnerable communities seek care from multiple hospitals in order to obtain the full prescription of medicine they are recommended. Let’s not forget that there was and continues to be a shortage of medicines in Sri Lanka, especially in State hospitals and clinics. Given the cost incurred to access a hospital OPD and the need to shop around from private pharmacies for a prescription, as State facilities have run out of many medications, it is debatable that patients ‘collect’ medications and do not use the full course. 

Expanding the health service with new primary care clinics where patients will have access to what will likely be a general practitioner is a welcome move. However, should one’s choice of who to get treatment from and the appropriate medical approach to ailments be decided only by a general practitioner, who, according to what the President said, will be the gatekeeper of higher treatment or analysis? 

Will this move restrict a patient’s rights to seek the kind of treatment they want for their bodies? Should we not be able to debate this in public and seek broad consultation before it is arbitrarily pushed through by the Government? Where is the transparency and accountability in such a situation? 

Individual rights should not be so easily constrained or given away simply because a government deems it necessary; there should be consultation and a right of choice. Will this not make the right to choose treatment only available to those whose purse is big enough for private practice?

With Sri Lanka’s prevailing deficit, the island’s economic growth still not firing on all cylinders, and a global market in turmoil due to trade wars, disrupted supply lines, and conflict, the writing is on the wall that we, like many other nations, will need to endure hardships for longer than we all anticipated. 

If the Government is concerned about State expenditure and wishes to cut down, it should start with the dozen or so State-owned enterprises which it is hanging on to due to ideological reasons. 

Reduction of expenditure in the health sector is a choice which a state must exercise cautiously and with broad consultation, including with the people who use the system. Going by the President’s statement, however, it seems like we will see none of that before changes are made.