After a year of severe economic collapse in Sri Lanka, the nation’s public health institutions are in ruins, suffering from a lack of drugs, postponed procedures, and a flight of medical specialists.
“Our hospital system is in a shambles,” said Peter Almeida, deputy general secretary of the Ceylon Mercantile, Industrial and General Workers’ Union.
At least 1,000 medical professionals are said to have recently fled the country, based upon recent reports.
According to the World Health Organisation, supplies of 150 vital pharmaceuticals, including anaesthetics, blood thinners, antibiotics, vaccinations, and cancer chemotherapeutic therapies, have periodically run out over the last year. Several public hospitals have also been forced to stop laboratory testing due to slow machine maintenance, a staffing shortage, or a scarcity of chemical reagents.
“Accessibility of healthcare is a problem,” said Dr Mahesh Gunasekara, director-general of the Sri Lanka Red Cross Society. “Then, once you access healthcare, you can’t get medicine because the availability of medicine is not there and the availability of services has been compromised… this has clearly affected the people.”
While there may not yet be proof that the mounting issues are directly contributing to patient deaths, Gunasekara believes it’s undeniable that patients are suffering. “I don’t have hard evidence to say people have been dying, but suffering is there because of the lack of medicines and [due to] routine surgeries being postponed.”
Almeida shared the story of one colleague who has been waiting for more than six months for surgery, despite the fact that his death could me imminent because of a 90% blockage in his heart. “He went to the clinic, and he was [prescribed] eight drugs, none of which are available in the government hospital. How on Earth is he going to pay and get the drugs?”
Even if the meds were available, Almeida’s coworker may not be able to purchase them due to Sri Lanka’s financial constraints. The percentage of Sri Lankans living in poverty as of 2022 was up to 25.6 per cent, almost twice as high as the 13.1 per cent figure in 2019.
Sri Lanka made its first international loan default in May 2022 amid a decrease in currency reserves. The government no longer had the funds to import certain necessities, such as gasoline and food, as seen by the empty grocery shelves and long lines at petrol stations.
According to a Save the Children survey, between June and December of last year, average household spending increased by 18 per cent, and households unable to meet most or all of their basic needs increased by 23 per cent. As a result, half of all families were forced to reduce the amount of food they fed their children.
In addition to food, one of the categories most impacted is medication, of which 80 per cent is imported.
“There are a large number of all different types of medicines out of stock or in short supply,” said Gunasekara. Additionally, the cost of those medications that are still imported could be up to four times higher than before, which has an effect on the efficiency of both public and private hospitals.
The “Huge Brain Drain“
Colombo has resorted to asking New Delhi to acquire Indian-made medication on credit to alleviate the pharmaceutical shortages. However, after difficulties occurring in several Sri Lankan patients, the quality of Indian medicines is being scrutinised.
A WHO study into a supply of contaminated cough syrups produced in India that caused infant fatalities in other countries has raised more concerns about the usage of medications imported from India.
“People have to get it done from the private laboratories, so the out-of-pocket expenditure for laboratories has gone up,” explained Dr Manoj Fernando, a doctor and senior lecturer in health promotion at Rajarata University, when commenting on the lack of laboratory services at public hospitals which is causing patients to seek out private institutions and pay for services that would have been covered by insurance.
Many individuals, including highly qualified professionals, are emigrating in pursuit of better-paying jobs and more inexpensive living circumstances abroad in the face of economic hardship and shortages of basic necessities.
Nurses, physicians, lab technicians, and chemists were among the 1.1 million individuals who departed Sri Lanka in 2022, according to the Central Bank of Sri Lanka.
“There’s a huge brain drain at the moment… from Sri Lanka to other developed countries,” Fernando said.
What are the impacts?
With no healthcare staff, there can be no healthcare.
Due to a lack of staff, the paediatric ward at the main hospital in the northern city of Anuradhapura was forced to close temporarily in March. In April, emergency care and surgeries had to be suspended at a hospital in the southern Ratnapura district due to a shortage of anaesthetists.
What can be done?
In an effort to support the struggling healthcare system, the government has begun taking some action.
In addition to installing various economic recovery programmes with a focus on assisting lower-income families, it has raised the number of medical students it generally accepts to its courses to address the shortage of medical professionals, according to Fernando.
According to the WHO, $8 million is needed to assist the nation in purchasing raw ingredients so that the State Pharmaceutical Manufacturing Corporation may domestically create necessary medications.
Although things are improving, there are still shortages, especially in rural regions.
“We have to help communities to look after themselves to a certain degree, and the government ministries need to take action, especially to look after the vulnerable people,” agreed Fernando.