Which the current economic crisis has had a disastrous impact on the health sector, the conditions that will be imposed as part of a possible IMF deal could bring about long-term structural challenges
People’s Dispatch | April 30, 2022
In a stalemate between the people of Sri Lanka and the government, the health sector stands on the threshold of collapse as the country runs out of essential medicines.
The health crisis in Sri Lanka reached alarming levels this month due to an acute shortage of medicines and medical equipment in hospitals. Hospitals, doctors and unions have been putting out calls for donations on social media requesting help for essential medicines, without which several health services have already come to a halt.
Due to a shortage of anesthetic drugs, the Director-General of Health Services, Dr. Asela Gunawardena announced that all except emergency surgeries have been suspended. As of mid-April, nearly 124 medical items were out of stock, reported The Sunday Morning.
The shortage of medicines has led to hospitals being forced to re-use equipment or substitute drugs. Concerned doctors, medical officers and unions have been holding protests to demand action from the government.
At present, hospitals in Sri Lanka lack access to imported emergency drugs and medical equipment due to the forex crisis. The situation has compelled health authorities to curtail the operations in hospitals for emergencies as well as chronic patients.
For more than three months now, Sri Lanka has been experiencing an all-out economic crisis which has spun out of control resulting in acute fuel, food and medicine shortages across the country. Desperate citizens took to the roads on April 9 to demand the current President Gotabaya Rajapaksa and his government’s resignation over its failure to control the ongoing socio-economic crisis.
Protests have continued for more than weeks, while the government dodges the people’s demands that it step down.
The health sector crisis caught the attention of international media after the Government Medical Officers Association (GMOA) declared a “public health emergency” on April 4, triggering a request by international agencies for donations of medicines and equipment.
So far, the World Bank (WB) has agreed to provide a total of $10 million for the health sector. A total of $14 million is expected from the Asian Development Bank (ADB). However, officials have warned that it may take up to six months to receive these funds. The Singapore Red Cross (SRC) has also pledged support and launched a public fundraising appeal.
Sri Lanka is in urgent need of securing nearly $60 million to import essential medicines for the next three months in addition to the $12 million required immediately by the State Pharmaceutical Corporation (SPC).
The Sri Lanka Medical Association (SLMA) issued a statement recently expressing concern over the current situation of drug shortage, “which could result in an unprecedented humanitarian crisis in the country.”
“A huge gap has been created between private healthcare and public healthcare”
Sri Lanka follows the universal healthcare system, divided into preventive, curative and rehabilitative healthcare, which has been free of charge at the point of delivery for over 80 years. It is made up of a unique institution of community medicine: a ‘health unit’. A health unit emphasizes the provision of primary health services at the community level, delivered by a medical officer and a team of field health workers.
Peoples Dispatch spoke to Dr. Manuj C. Weerasinghe, professor at Department of Community Medicine in University of Colombo about the current situation in Sri Lankan healthcare.
“We have seen out-of-pocket costs rise in an increasing trajectory, if one is to compare private health expenditure with total health expenditure of a citizen. The health sector in Sri Lanka is almost completely publicly funded. All expenditure by the citizens is covered under the general insurance scheme. At present, due to a lack of private healthcare insurance mechanisms, a huge gap has been created between private healthcare and public healthcare, which is being funded by the citizen’s pockets.”
In the last five to ten years, rapid privatization of the health sector has taken place, with several private practices sprawling in urban centers such as Colombo, Kandy and Jaffna.
Since the 1970s, medical officers from the health sector in Sri Lanka are legally allowed to work as consultants in privately-run health services facilities after normal work hours. This has led to increasing pressure on public hospitals and frequent drug shortages.
“Almost 80 percent of the employees at public hospitals in Sri Lanka work as consultants after-hours or after retirement thus providing the human infrastructure of an ever-increasing private sector while retaining their government jobs.” Weerasinghe added, arguing that private hospitals may still find it hard to compete with the state hospitals. But for how long?
With IMF’s arrival, public healthcare under threat of privatization
After credit lines and currency swap agreements failed to provide sustainable funding mechanisms and protests escalated this month, Rajapaksa’s government has finally approached the IMF. Talks held on April 23 on the sidelines of the IMF and World Bank Spring Meeting, between Managing Director Kristalina Georgieva and Sri Lankan Finance Minister Ali Sabry have reportedly concluded after “fruitful technical discussions” on the latter’s request for an IMF-support program.
The threat of IMF restructuring means two things for Sri Lanka’s health sector: a rolling back of the state-owned initiatives and an aggressive push to privatize the health unit system. Introducing IMF’s austerity measures at a time of food and fuel shortage for the working-class citizen will result in a “catastrophic situation for the state-citizen relationship”, said Weerasinghe, “as health and education are the two sectors which account for the maximum government expenditure.”