• Nearly 5,000 more doctors have applied for foreign employment; over 2,000 have already left 
• Rural hospitals worst affected by shortages; GMOA makes 8 proposals to address issues 

Sri Lanka is on the brink of a healthcare crisis as nearly 400 State hospitals and medical centres face the imminent threat of closure. This alarming situation stems from the potential mass exodus of consultants and medical officers, which experts warn could unfold within the next few months unless the Government takes decisive action.

Since the beginning of 2022, more than 2,000 medical officers, including consultants, have left Sri Lanka.

According to the latest available statistics, nearly 5,000 more doctors have applied for foreign employment. This troubling trend, which had temporarily slowed, has resurged due to ongoing economic pressures, political instability, and unmet expectations regarding the resolution of grievances.

Grievances of medical professionals

As explained by medical experts, the potential mass exodus of medical professionals will destabilise the healthcare system and compromise the quality of care for millions of citizens and the Government’s response to this crisis will determine the future of healthcare in the country.

It is imperative to act now, addressing the grievances of medical professionals and ensuring that hospitals remain operational and capable of providing essential services to the population, they warn.

“The number of letters received by the Health Ministry from medical officers indicating their intention to leave the country is gradually rising,” Government Medical Officers’ Association (GMOA) Spokesman Dr. Chamil Wijesinghe said.

“Doctors’ confidence in systemic change and a better future for themselves and their families is fading. While there are several progressive areas, the process must be expedited to prevent a large-scale departure of medical professionals,” he told The Sunday Morning.

The GMOA has been vocal about the need for immediate action, having proposed an eightfold plan to address the issues plaguing the healthcare system. However, there has been a delay in implementing these proposals, despite the pressing need for resolution.

“The current issue cannot be addressed by merely opening new medical schools. We must address the grievances of existing medical professionals,” Dr. Wijesinghe emphasised.

“Hospitals are currently managing despite shortages, but the migration of consultants is particularly concerning. Without consultants, specific units must close. Although we are managing for now, we must take necessary steps promptly,” he said.

The doctor shortage was discussed at a recent meeting chaired by Health Secretary Dr. Palitha Mahipala. “Even after meeting with the President, who gave necessary instructions, progress has been slow due to the lethargic approach of several officers,” Dr. Wijesinghe noted.

One of the primary concerns for doctors is securing proper schooling for their children.

“Not all doctors are asking for leading schools in Colombo. The Education Ministry has prepared a plan, which is a progressive development, but it is yet to be implemented. Many doctors who have left would return if their minimum expectations were met, and those considering leaving may stay,” Dr. Wijesinghe explained.

When contacted, Health Ministry Additional Secretary – Administration I G.C. Karunarathne stated that matters concerning doctors should be referred to the Director General of Health Services, as she was not familiar with the issue. Attempts to reach Health Minister Dr. Ramesh Pathirana, Health Secretary Dr. Palitha Mahipala, and Director General of Health Services Dr. Asela Gunawardena were unsuccessful.

Public healthcare sector 

In Sri Lanka, the public sector provides nearly 95% of inpatient care and around 50% of outpatient care. As of mid-2022, Sri Lanka had over 1,500 healthcare institutions, including 588 hospitals and 517 primary care institutes, along with 335 Medical Officer of Health (MOH) offices. 

Among these, 555 Government hospitals provide primary healthcare, offering curative, preventive, and rehabilitation services to the entire population. All citizens and residents are registered for treatment at their local health centre and can be referred to secondary care institutions if necessary. An integrated medical team, comprising nursing, pharmacy, laboratory, radiology, and medical records coordinators, provides these services.

The Ministry of Health is responsible for key functions such as policy formulation, health legislation, programme monitoring, technical oversight, management of health technologies, human resources, and tertiary and other selected hospitals.

The primary and secondary levels of curative care and preventive services are managed by the nine provincial ministries.

GMOA’s eightfold proposal

Several months ago, the GMOA circulated its eightfold proposal to relevant authorities.

At the GMOA’s request, the Minister of Health appointed a Technical Committee within the Ministry of Health to provide recommendations on mitigating the effects of the brain drain of doctors on the healthcare delivery system.

The committee finalised its report, which was officially handed over to the Minister of Health on 4 September 2023. However, 10 months after the report’s submission, there has been no permanent decision or comprehensive addressing of the issue.

The GMOA’s demands to address the urgent crisis in the healthcare sector caused by the emigration of doctors include several critical measures. 

Firstly, it proposes introducing a dedicated salary structure based on performance and market value, along with increased internship allowances, to address insufficient compensation. There is also a pressing need to upgrade substandard quarters for doctors, particularly in peripheral hospitals, with a focus on challenging locations. 

Additionally, improvements to transportation facilities are recommended, including adjustments to the Disturbance, Availability, and Transport (DAT) allowance, and inclusion in transport policies for Government officials. 

It is also recommended to establish a proper schooling scheme prioritising peripheral areas, to support doctors on compulsory transfers and those returning from foreign training.

The GMOA also suggests providing additional incentives for doctors in challenging peripheral hospitals, revising tax policies to alleviate financial burdens on medical professionals, and implementing initiatives for ongoing professional development to retain skilled professionals.

The impact of this potential exodus goes beyond statistics and policies. As medical experts warn, the healthcare crisis has profound implications for patients and communities relying on State hospitals and medical centres. Therefore, the loss of experienced consultants and medical officers could lead to longer waiting times, reduced access to specialised care, and increased pressure on remaining staff.

For instance, rural areas, already struggling with limited medical resources, will be hit hardest. Hospitals in these regions often operate with minimal staff and the departure of even a few medical officers can severely disrupt services. Patients may have to travel long distances to access care, exacerbating their health conditions and financial burdens.

Therefore, as medical experts note, the situation calls for urgent, coordinated action from the Government. The proposed solutions by the GMOA are not mere demands but essential steps to stabilise the healthcare system and ensure its sustainability. Addressing compensation, improving living and working conditions, and providing educational support for doctors’ families are critical components of this strategy.

Speaking to The Sunday Morning, a senior medical officer attached to a leading State hospital in Kandy who wished to remain anonymous stressed that the Government must recognise the gravity of the situation and act swiftly to implement the proposed measures. Delays in addressing these issues could lead to an irreversible crisis, with long-term consequences for the country’s healthcare infrastructure and public health.

The medical officer stressed that the GMOA’s eightfold proposals offered a comprehensive roadmap for addressing the current challenges. By implementing these measures, the Government can retain its medical talent, ensure better working conditions, and ultimately secure a healthier future for Sri Lanka.

“The time for action is now, and the cost of inaction is too high to contemplate,” the medical officer warned.

Issues of nurses 

Meanwhile, All Ceylon Nurses’ Union (ACNU) President S.B. Mediwatta raised serious concerns about the merging of wards in many hospitals to cope with patient numbers due to a shortage of doctors and nurses, with rural hospitals bearing the brunt of this crisis. He pointed out that nurses were increasingly working extra shifts without any corresponding increase in their salaries, putting their health at risk and potentially compromising the quality of patient care.

Mediwatta emphasised that rural hospitals were particularly hard-hit by these shortages. “Many nurses are now working extra shifts, yet their salaries remain unchanged. The situation is dire, with nurses working tirelessly around the clock without adequate rest. This ongoing issue threatens to impact the quality of patient care,” he warned.

He also revealed that there were currently 2,595 qualified nurses awaiting appointments, but the Government’s commitment covered only about 1,000 of these positions, leading to dissatisfaction among the nursing community. This disparity not only raises concerns about seniority but also leaves many highly qualified nurses unemployed. Nurses are calling for the urgent filling of all vacant positions to meet the growing demands of the healthcare system.

Mediwatta further noted that while the national requirement for nurses was estimated at 42,157, the current number of active nurses stood at approximately 41,000, highlighting a critical shortfall that needed immediate attention.