Need urgent measures to save the health of citizens

The prevailing economic situation in the country has resulted in many adverse effects on health
of the Sri Lankans. A vast majority of people are unable to afford for health expenditure at
personal levels while the health system is at the verge of collapse due to unavailability of many
essential medications and surgical instruments on one hand and the frustrated health care staff
on the other side.

Health is defined as a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity and it is a fundamental human right which means that
everyone has the right to enjoy the highest attainable standards of physical and mental health.
There are many determinants of health such as education, living condition, working
environment, agriculture and food production, water and health care system. Although the health
of the people cannot be ascertained by the health system alone, in an economic disaster of this
kind, the government should take immediate measures at least to maintain health system at an
acceptable functional level.

Failure to respond to this economic turmoil has resulted in near collapse of the health care
delivery in the country with deleterious outcomes. Many essential items and medications are not
available and surgeries are also postponed even in cancer patients resulting in poor outcomes.
Still, many drugs including antibiotics are withdrawn after being reported as they were quality
failed. We have no idea of loss of lives or incapacity due to poor quality or unavailability of
essential and lifesaving medications. Many patients followed up in clinics have poorly controlled
non communicable diseases such as diabetes and hypertension due to intermittent unavailability
of medications like insulin leading to complications such as chronic kidney disease and cardiac
diseases ultimately further rising the health care demand.

Poverty has multifaceted grave effect on health. People do not seek medical attention and did not
concern their chronic diseases such as diabetes until they get late complications as they are
unable to afford. Instead of a balanced healthy diet, majority tends to rely on mainly
carbohydrate rich unhealthy diet increasing the risk of diabetes, hypertension obesity and so on
and, poorly controlled medical conditions for those who have got them already.

Productive workforce is a vital need for an economic stability. The workforce is the engine that
drives the economy and supports the financial underpinnings of the health care system too.
Therefore, an appropriate approach is to view health as a social investment to be leveraged rather
than a cost to be justified. According to the Special Committee on Health, Productivity, and
Disability Management of American College of Occupational and Environmental Medicine,
improving the health of workers can reduce total costs (health-related productivity loss plus
disability benefit costs plus medical/ pharmacy costs). Many researches by experts in
occupational medicine have shown that a focus only on medical/pharmacy costs, as done by
many nations, obscures the full benefits of truly improving the health of citizens of a country.
 First of all, the Sri Lankan government should understand the gravity of consequences of this
economic doom and gloom. Sri Lanka should immediately focus on short term scientific rational
methods to identify national issues, health challenges and should encompass a holistic approach
to educate the general public so that unnecessary or avoidable health problems such as accidents
and dengue like communicable diseases can be minimized. Then, the government should take
immediate steps to prioritize the essential services and government functions such as health, food
security, stable echo system and education while changing the fiscal policy.

Sri Lanka’s total health care expenditure is 3.8% of GDP while the government spends only less
than a half (1.54%) of it. Government spending on the health sector in Sri Lanka is mostly
financed through domestic resources; that means in in rupees. In the 2021 central-level approved
budget, the domestic to foreign resources ratio in the health sector stands at 95% to 5%. If so,
why cannot the health care be improved to a some degree by increasing domestic resources when
the country in a crisis of dollars? That means, we need urgent attention to minimize
mismanagement of local income! Thereby, Sri Lanka should be able to reduce the out-of pocket
expenditure (nearly around 50%) which should be lower for a better health system.

We have significant shortage of essential items and lifesaving medications. But, there are plenty
of imported unnecessary medications, me-too drugs, and counterfeit medications in the market
spending dollars accounted in the national health budget. As Prof. Senaka Bibile suggested in his
national drug policy, we should adhere to an updated essential drug list and make sure that they
are available to save the life of citizens. At the same time, centralization of the purchase of
rational drug list and shopping around the world and accepting low price-bid as bulks rather than
finished products can save lot of money.

Finally, the government should address the prerequisites of health and determinants of health for
a healthy nation. There should be a national plan to protect patients from economic hardships
due to their chronic ill health too. According to the World Food Programme, 6.3 million people,
or over 30 percent of Sri Lanka's population, are "food insecure" and require humanitarian
assistance. Of these, around 5.3 million people are either reducing meals or skipping meals, and
at least 65,600 people are severely food insecure. This situation is likely to worsen as the crisis
unfolds in the island nation due to higher inflation, rising electricity bills and so on. Therefore,
there should be an urgent national plan to improve food production, reduce food wastage and
proper distribution of agricultural products and secure safe food and healthy meals as a nation.

Dr. K. Ajith Kumara

Consultant Physician

President, All Ceylon Medical Officers Association