• Nurses working extra shifts at same salary: Mediwatta 
• Govt. urged to address issues, more doctors migrating 

Sri Lanka’s healthcare system is facing one of its most challenging periods in recent memory, as the newly appointed Government contends with a mounting crisis in the sector. The mass emigration of doctors and nurses, coupled with severe staffing shortages in rural hospitals, is pushing the healthcare system toward breaking point. 

The issue, long flagged by health sector unions, has remained unresolved despite proposals and reports submitted months ago. With healthcare workers increasingly voicing their dissatisfaction, the new administration is under pressure to provide immediate and sustainable solutions to prevent further decline.

Nurses overworked, underpaid

All Ceylon Nurses’ Union (ACNU) President S.B. Mediwatta has raised alarm over the dire situation facing nurses across the country. 

According to Mediwatta, many hospitals are merging wards to cope with a shortage of staff, a move that places immense strain on already overworked nurses. The problem is particularly acute in rural hospitals, where the lack of resources and personnel has led to nurses working extra shifts without any increase in pay.

“The situation is unsustainable,” Mediwatta said, noting that many nurses were working long hours with minimal rest, which he warned could compromise patient care. “We have 2,595 qualified nurses who are awaiting appointments, but the Government has only committed to employing 1,000 of them. Meanwhile, hospitals are struggling to maintain adequate staffing levels.”

The shortage has left nurses at a breaking point, with many expressing frustration over the Government’s inability to fill all vacant positions. Mediwatta pointed out that while the national requirement for nurses was 42,157, the country currently had only 41,000 active nurses, leaving a critical gap. 

The ACNU is urging the authorities to prioritise filling these positions to relieve the burden on the nursing community and ensure the healthcare system can meet the growing demand for services.

GMOA’s unheeded proposals

The staffing crisis extends beyond the nursing sector, with the Government Medical Officers’ Association (GMOA) warning of a potential mass exodus of doctors unless urgent measures are taken. 

Several months ago, the GMOA submitted an eight-fold proposal to the Ministry of Health aimed at addressing the root causes of the crisis, including inadequate compensation and poor working conditions. The proposals included the introduction of a performance-based salary structure, increased allowances for doctors, and significant improvements to living and working conditions, particularly in peripheral hospitals.

In September 2023, a Technical Committee within the Ministry of Health finalised a report with recommendations to mitigate the effects of the brain drain on the healthcare delivery system. Yet, 10 months after the report’s submission, no permanent decisions or comprehensive solutions have been implemented.

“The Government cannot afford to delay any longer,” a senior medical officer who wished to remain anonymous said. “We are losing doctors at an alarming rate. The longer we wait to address these issues, the more talent we lose, and that is a loss the country cannot afford.”

The GMOA’s proposals are wide-ranging and include reforms to tax policies to ease the financial burden on medical professionals, particularly those working in challenging locations. 

Additionally, the GMOA is calling for a revised transport allowance for doctors working in remote areas and the establishment of proper schooling arrangements for families of doctors who are transferred to peripheral hospitals. These proposals are seen as critical steps toward retaining medical talent and preventing further emigration.

Rural hospitals struggle

The impact of these shortages is being felt most acutely in rural areas, where hospitals are already operating with limited resources. 

The departure of even a small number of doctors or nurses can have a severe impact on the ability of these hospitals to provide care. In many cases, patients are forced to travel long distances to access medical services, a journey that can exacerbate their health conditions and impose significant financial strain.

“Rural hospitals are barely holding on,” a healthcare worker from a district hospital said. “The staff are exhausted and we don’t have the personnel to provide the level of care that patients need. Every day feels like a crisis.”

The situation in these regions is further compounded by the fact that doctors and nurses working in rural hospitals are often required to stay on duty for extended periods without proper accommodations or transport facilities. 

According to the GMOA, improving living conditions for healthcare workers in these areas, including upgrading substandard quarters and providing better transport allowances, would go a long way toward retaining staff in peripheral hospitals.

Political will 

With a new Government now in place, there is renewed hope that these long-standing issues will finally be addressed. However, healthcare professionals remain cautious, noting that previous governments have made similar promises without delivering lasting solutions.

For Mediwatta and the ACNU, the immediate priority is ensuring that all vacant nursing positions are filled. “We need action, not promises,” he said. “Nurses are working around the clock with no additional pay and the situation is becoming untenable. We cannot continue like this.”

Similarly, the GMOA is urging the Government to take swift action on its eight-fold proposal, which it argues is a comprehensive roadmap for stabilising the healthcare sector. “The solutions are already on the table,” GMOA Spokesperson Dr. Chamil Wijesinghe said. “What we need now is the political will to implement them.”

One of the key areas where the Government is expected to act is on the issue of compensation. Doctors and nurses alike have long complained that their salaries do not reflect the work they are doing, particularly in light of the long hours and difficult conditions many of them face. The GMOA’s proposal for a performance-based salary structure, which would align doctors’ pay with their market value and performance, is seen as a critical step toward addressing this issue.

The cost of inaction

The stakes are high for the new Government. If the current trends of emigration and staff shortages continue, the country’s healthcare system could be left in a state of near collapse. 

Medical experts have warned that the loss of experienced doctors and nurses could lead to longer waiting times for patients, reduced access to specialised care, and increased pressure on the remaining healthcare workers.

For rural areas, the consequences could be even more severe. With many hospitals already operating with minimal staff, the departure of even a few medical officers can leave entire regions without adequate medical care. This, in turn, forces patients to seek treatment in urban areas, leading to overcrowding in larger hospitals and further straining the system.

“The time for action is now,” the senior medical officer said. “The longer we wait, the more difficult it will be to fix this. We need to retain our doctors and nurses, improve their working conditions, and ensure that the healthcare system can meet the needs of the population.”