Although Sri Lanka’s free health system is regarded as one of the country’s most important social pillars, the sector has been facing a range of challenges in recent times. The country’s medical service, renowned around the world, has suffered a major setback owing to the current economic crises and a lack of adequate infrastructure. In this context, the forthcoming Budget for next year (2027) is seen as a crucial factor in safeguarding the country’s health service as a whole and taking it forward effectively.
As things stand on the ground, shortages of medicines in State hospitals, a lack of modern medical equipment and the poor state of hospital infrastructure in underdeveloped areas are severely affecting the public. More importantly still, the continued exodus of the human resource (HR) who have sustained the country’s health sector for many years, including specialist doctors, senior doctors and nurses, has cast a doubt on the very future of the sector.
Even amid these economic challenges, the Government was compelled to spend more than Rs 30 billion in additional funds to restart and complete over 17 health projects that had been suspended in the past. Meanwhile, under the Appropriation Bill for 2027, about Rs 590.5 billion (about six per cent of the total Government expenditure) has been allocated to the Health Ministry. Although it has been decided for the first time in history to purchase all of the country’s immunisation vaccines entirely with Government funds, solutions to the fundamental problems in the health sector have yet to be fully achieved.
Proposals forwarded for 12 November Budget
Against this backdrop, the Government Medical Officers’ Association (GMOA) has put forward proposals for the health sector for the 2027 Budget, due to be presented on the 12 November.
In fact, the proposals we have put forward are aimed not merely at strengthening doctors’ finances, but at strengthening a health system that serves the whole country. Rather, it is a set of comprehensive solutions to the ongoing crisis among doctors and the entire health system. Our proposals are based on five main pillars.
The first of these is the HR stability. Doctors are in great demand abroad. As a result, most doctors, after completing their internship, pass the qualifying examinations required to work overseas and leave the country. This brain drain is having a major impact, especially on the health sector. The Government, which spends heavily to produce doctors, has failed to retain them in the country.
We are now in the unfortunate situation where the country cannot obtain service from the doctors that it produces. With the aim of resolving this problem, we have put forward a proposal to retain both junior and experienced senior doctors in the country. Since the last Budget (this year [2026]), only two-thirds of the extra duty (overtime) allowance and the holiday allowance due to doctors have been paid. The Government assured that the balance will be paid when the economic constraint is relieved. We have therefore also asked that the outstanding one-third be paid.
Even though such restrictions have been placed on doctors’ allowances, doctors do not limit their work accordingly. They continue to serve the public as far as they can. We therefore urge that our extra duty allowance, which is capped at 120 hours, be added to our salary as a fixed allowance. Similarly, only less than 30% of the Disturbance, Availability and Transport allowance, which is paid specifically to medical professionals, is being paid.
The amount approved in 2018 is 120,000, and the revised value for 2022 as per the approved formula is Rs 260,000, but today, we are paid only Rs 70,000 of it. We request that this amount be increased to a realistic level. Not only doctors but other health sector staff, too, often work in high-risk conditions. Although allowances are paid for this in other countries, no such allowance is paid in our country.
Furthermore, we have long been calling for the medical profession to be established as a separate service, the ‘Sri Lankan Medical Service’. This would make it possible to bring all categories in the medical field under one service and meet their needs. Rather than resorting to practices that push the health service into unnecessary crises, we call for it to be declared a public service under the name ‘Sri Lankan Medical Service’.
Besides these problems, the accommodation available to doctors serving in very remote areas is extremely poor in many places. The Government must pay attention to this as well. Beyond this, the Government must adopt a fair tax policy. We pay two months’ salary a year in income tax. The Government should therefore take this into account and grant fair tax relief, at least in this Budget. This relief should apply not only to doctors but to all professionals. To this end, we request that the current annual tax-free income threshold of Rs 1.8 million be raised to Rs 2.4 million.
Challenges faced by past budgets
As a special point, we have requested that the medical sector be developed as a major source of foreign exchange for the country. This can be described as ‘medical tourism’. Specialist doctors in the country should be allowed to go abroad and provide medical services for short periods. In addition, we have laid down category-specific proposals targeting the Specialist, Grade Medical Officers and Medical AdministratoRs Although we have repeatedly requested an appointment with President Anura Kumara Dissanayake, in his capacity as the Finance Minister, to discuss these matters, we have not yet been given one. If the Government ignores our proposals, the GMOA will move to the next course of action, in line with the decision of its General Committee and the Executive Committee.
Past Budgets faced many challenges in improving health sector infrastructure and restarting suspended projects. For example, according to information released by Health Minister Dr. Walakada Appuhamilage Nalinda Wajiramal Jayatissa, the Government had to pay more than Rs 30 billion over and above the planned cost just to complete 17 health sector projects that had earlier been suspended or slowed down. This clearly exposes the weaknesses in financial management and the planning delays of the past.
Under the published Appropriation Bill for 2027, about Rs 500 billion is reported to have been allocated to the Ministry. The announcement that for the first time in the history of Sri Lanka’s health sector all the immunisation vaccines required in 2027 will be purchased entirely with Government funds is seen as an important step. Even so, the Government must take steps to ease the discontent among doctors and health workers caused by the continuing economic crises and the tax burden.
The writer is the Assistant Editor of the GMOA
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The views and opinions expressed in this column are those of the writer, and do not necessarily reflect those of this publication