A dearth of doctors, nurses and other essential medical personnel coupled with bureaucratic bungling and political favouritism has plunged the state health service into the doldrums, forcing poor patients out into the cold, the Sunday Times learns.
According to the Government Medical Officers Association (GMOA) and the All Ceylon Medical Government Medical Officers Association another 27,000 doctors, 20,000 plus nurses, a 1000 Public Health Inspectors (PHIs) Public Health Monitors (PHMs) and Medical Officers of Health (MOHs) just to name a few are needed to fill urgent vacancies throughout the country, but little is forthcoming from the Government towards this end.
|Patients at the National Hospital OPD
The GMOA places the blame on the Health Ministry, saying it is behaving in an arrogant manner without trying to work out solutions.
“To begin with, what is urgently needed is a National Health Policy (NHP) that could provide the mechanism for the smooth functioning of the public health services, while at the same time stamp out irregularities such as corruption, waste, political interference,” GMOA spokesperson Dr. Upul Gunasekera said.
“Perhaps this is one of the few countries in the world without a NHP, and this could be the chief reason behind the current state of affairs,” he said.
A proposal for the setting up of a NHP which was drawn up by professionals was handed over to the Health Ministry some three years ago, but it continues to gather dust and no one in authority seems to be bothered, he said.
“The ministry is unable to solve even simple issues and now it appears that the chief executive must intervene like in this week’s case regarding the transfer of interns at the IDP centres in Vavuniya. The GMOA was forced to take trade union action owing to the stubborn position taken by the ministry and in the end the President was forced to intervene and bring about a solution”, Dr. Gunasekera said.
“There are 606 state-run hospitals, some 500 plus dispensaries and more than 250 MoH divisions in the country and all these are operating without proper supervision,” Dr Gunasekera alleged.
Another confusing component is the free flow of drugs into the market and hospitals, the bulk of them sub standard and imported mainly from India without proper supervision or guidelines as required by international standards, says Dr. Jayantha Bandara from the All Ceylon Medical Government Medical Officers Association.
“This would not have been the case if the authorities had over the past years stuck to the Drug Control Policy brought in by Professor Senaka Bibile in 1971 which sought among other things to streamline the manufacture of medicinal drugs and its distribution to the market,” he said.
| Dr. Upul Gunasekera
He explained that at present it was a free for all in the pharmaceutical trade with nearly 8,000 brands already having made its way in to the country, and more still to come with the state cheering on the importers. “For example there is nearly a hundred different types of amoxycillin in the market while in the developed UK there are just 10 or even less.
“The task at hand is to encourage the State Pharmaceuticals Manufacturing Company (SPMC) to increase its output and drastically cut down on imports. At present the SPMC turns out some 50 different drugs, but the output is totally dwarfed by the imports ,” Dr. Bandara said.
During shortages resulting in emergency situations state hospitals are even allowed to make direct drug purchases from private traders shunning all the standard procedures such as tenders and so on. “So one could come to an easy conclusion that officials at the highest levels are on the take,” he further alleged.
“All this is taking place because there is no proper drug control policy in place thereby leaving room for various irregularities, from corruption to waste and bribery and at the end of the day it is the poor taxpayer and the patients who are forced to suffer ,” he said.
He said the purchase of large stocks of drugs with short expiry dates have also led to mass scale wastage with much of it being thrown away.
“This should never be the case. Purchases should be made according to the immediate need and not in excess. But it is just the reverse. Large stocks of drugs are purchased in bulk and have to be later discarded as they have already expired.
“Earlier this year the authorities were forced to destroy some 350,000 vials of the pain killer-methadone since it had expired, but no one was held accountable,” he said.
An acute shortage of nurses and other support staff is further worsening the situation in government hospital wards and for the past decade or more that situation has not changed, says Saman Ratnapriya-Convenor for the All Ceylon Health Workers Union. “The sector is experiencing a shortage of nurses cadre but and in some instances attendants dress wounds and even give saline to patients, a frightening development,” Mr. Ratnapriya said.
“This is a common practice in nearly 95 per cent of government-operated hospitals and other related institutes in rural areas which come under the purview of the respective Provincial Council administrations. The reason is the lack of nurses while the patients are placed at terrible risk.
“This practice has been taken for granted and has now even spread to the larger hospitals controlled by the central government There are also cases of deserving staff members being politically victimized and therefore they willfully ignore their duties out of frustration. At the end it is the patient who suffers under a wrong system,” he charged.
“Another pressing problem faced by nurses is the lack of facilities such as quarters, non-payment of salaries etc, and the worst affected are those in the north and east. For example a batch of 150 nurses were sent for service in the east at the start of this year and already 35 of this number have returned owing to such problems,” he said.
“While the authorities are to be blamed for much of the current mess, an important sector of the medical staff, mainly doctors are also responsible leading to a flourishing private practice termed as the ‘medical mafia’.
It is well known that many doctors and specialists create artificial shortages in drugs and laboratory tests citing various reasons, and instruct unsuspecting patients to seek medical treatment from private institutions in which they have vested interests,” Mr. Ratnapriya said.
He added that this racket appears to be growing by the day and it was time that responsible organizations, trade unions and others connected with the profession take action and arrest this trend to save the good name of the practice and the patients as well.
“Sometimes patients needing simple lab tests are advised by the ward doctor to obtain it from outside saying the tests taken at the hospital are not reliable. This should never be the case because the staff in the hospital labs are trained personnel and know their job. It is demoralizing to say the least.
Eventually the patient is directed to a private institute linked to the respective doctor. In most cases the doctors are also known to connive with other junior staff but very few cases are brought to light or even documented since everything is kept under a shroud of secrecy,” Mr. Ratnapriya charged.
At the end of the day it is a sad case of sick hospitals and frightened patients.
Patients suffer as docs and Ministry disagree
A multi-million rupee renal facility set up in Maligawatte has been on hold owing to a row between health authorities and the doctors.
The GMOA is adamant that the institute be run by the Health Ministry while the government wants to handover a section of it to the Medical Faculty for research and other tests.
The GMOA fears if this is allowed, the place would become semi-private like the Jayewardenepura Hospital in Kotte. They argue that it is the responsibility of the government to bear the costs and open the facility to patients.
And while all this is happening, an estimated 25,000 renal patients, about half that figure from the North Central Province (NCP) continue to languish without propper treatment.
At present there are renal treatment centres at government hospitals in Karapitiya, Colombo, Kandy, Anuradhapura and Jaffna but it is wholly inadequate when comparing with the number of patients in need of urgent treatment.
‘Our public health service the best in South Asia’
The Director General of Health Services Dr. Ajith Mendis said the National Health and Drug Policy could not be implemented owing to the presence of too many stake holders.We have had discussions with the GMOA and other organizations but unfortunately, a consensus could never be reached and as a result the proposals could not be drafted and remains in cold storage.
“The Ministry will shortly make public, through the media, the developments including the agreements made by these stakeholders who later went back on their commitments. It will be up to the public to decide,” Dr. Mendis said.
“On the part of the Ministry we have nothing to hide,” he added.
In regard to the new renal unit institute at Maligawatte he said that the trade unions had at first agreed to allow the University Grants Commission (UGC) to use one third of the facility for research and related purposes.
“But later for reasons known only to the GMOA, they decided against it and called on the ministry to take full charge,”, he alleged. Dr. Mendis also dismissed estimates put out by the trade unions regarding the number of vacancies in the hospitals, adding that there was adequate staff at present in the National Health Service. “There are absolutely no shortages in that respect,” he stressed.
“These unions and other interested parties are known to come out with these bloated figures and therefore we do not take them seriously. In fact our public health service is about the best in the whole of South Asia,” Dr. Mendis added.