Sri Lanka’s public health system is once again caught in the crossfire of a familiar confrontation. The Government Medical Officers’ Association (GMOA) has intensified its trade union action, restricting prescriptions, laboratory referrals and specialist services, citing the Government’s failure to honour commitments made to doctors. The Government, in turn, has condemned the action as unreasonable and harmful, insisting that dialogue remains open and recent concessions have already been granted.
Both sides claim the moral high ground. Neither emerges unscathed.
At the heart of this dispute lies a deeper and long-standing failure of governance. Successive governments have relied on Sri Lanka’s public health system as a political success story while chronically underfunding it, overworking its professionals and delaying structural reforms. Agreements on allowances, staffing norms and service frameworks have been signed, postponed, renegotiated and quietly shelved. It is this pattern of delay and broken assurances that has eroded trust and driven doctors to repeated trade union action.
On this fundamental point, the Government bears responsibility. When agreements are reached with professional bodies and not implemented within reasonable timeframes, escalation is inevitable. Calling such action unjust after months of inaction does little to rebuild confidence. Nor does invoking fiscal constraints without presenting transparent timelines or credible alternatives.
However, legitimacy of grievance does not automatically justify every method of protest.
The current phase of GMOA action is designed to apply pressure where it hurts most. That pressure is not felt in Cabinet rooms or budget meetings. It is felt in outpatient queues, crowded clinics and by families who depend entirely on the State health system. When external prescriptions are withheld or referrals delayed, it is not policymakers who scramble for alternatives. It is patients with chronic illnesses, the elderly and the working poor.
The GMOA has repeatedly assured the public that emergency services will continue. That assurance, while important, is insufficient. Public healthcare does not consist only of emergencies. Delayed diagnostics, interrupted follow-ups and restricted specialist access can ultimately become emergencies themselves. The ethical discomfort arises not from doctors protesting, but from patients becoming the bargaining tool.
This is where public sentiment has begun to turn. Sri Lankans generally understand that doctors work under difficult conditions and deserve fair compensation. Many acknowledge that the health sector is strained and that professionals feel unheard. Yet sympathy frays when daily suffering becomes collateral damage. The prevailing public mood is less hostile than weary. There is frustration with the Government’s inertia, but also growing resentment towards a union seen as powerful enough to disrupt, yet unwilling to protect those with no alternative.
There is also a political undercurrent that cannot be ignored. The GMOA’s history of forceful activism has made it an influential actor well beyond hospital corridors. That influence brings responsibility. Each escalation risks reinforcing perceptions that the union is quick to strike and slow to compromise, even when the human cost is visible.
The Government, meanwhile, cannot continue to rely on moral appeals to patient welfare while failing to fix the underlying system. Repeatedly urging doctors to return to work without addressing structural grievances is not leadership. Nor is framing the issue as ingratitude after salary increases, when the dispute is as much about working conditions, staffing safety and service organisation as it is about pay.
What is missing on both sides is urgency to protect the public interest.
Doctors are right to demand accountability from the State. The State is right to insist that essential services must not be weaponised. These positions are not mutually exclusive, but they require maturity and restraint that have so far been absent.
If this dispute continues along its current path, everyone loses. Patients lose timely care. Doctors lose public trust. The Government loses credibility. And, more critically, the healthcare system, already fragile, absorbs another blow.
The way forward requires more than statements and ultimatums. The Government must publish clear timelines and binding mechanisms for implementing agreed reforms. The GMOA must recalibrate its action to apply pressure upward, not outward. Protest should inconvenience power, not punish the vulnerable.
A health system cannot be sustained on brinkmanship. When healers and the State lock horns, it is the public that bleeds in between.