There has been a lot of recent discussion related to the trade pact CEPA with India, and many Sri Lankan economic pundits have had their say, but one article in question by Rohan Samarajiva in a Sunday newspaper deserves a fitting response as he has ignorantly misplaced economic theory in the sphere of lifesaving healthcare.
Firstly, to clarify doubts let’s analyse the health system of India. Few would argue that it is among the most stressed and least maintained in the world. Statistics-wise, it has an astronomical infant and maternal mortality rate, a life expectancy marginally better than most central African countries and a rising HIV epidemic to which it has no answer. Infectious diseases rarely occurring in the developed world frequently occur as epidemics in India, and it has made no attempt to arrest its rate of population growth. Above all, its standard of medical training is highly variable owing to the large number of medical colleges, some of which are even privately run. This is proved by the poor results of Indian trained foreign graduates sitting for the Sri Lankan ERPM examination.
Thus there is no further need to discuss India’s health system as compared to that of other Asian countries, for example Singapore, which are worlds apart. Taking into account Sri Lanka’s health system, there are many points which the healthcare professionals of this country can be proud of, namely the low maternal mortality rate, high life expectancy, successful control of malaria and free availability of healthcare to all citizens. All this has been achieved at the mere cost of only 1% of national GDP, due to the skill and dedication of our healthcare professionals. Furthermore, our standard of medical training is uniform and invariably excellent.
According to Rohan Samarajiva, the middle class of Sri Lanka wish to be treated by foreign medical specialists, notably Indians. The fact is, most patients visiting private hospitals in Colombo are unaware of the dangers of consulting foreign specialists. Note that Indians practicing at Apollo Hospital are not registered with the Sri Lanka Medical Council, neither their basic medical degree nor their specializing qualification.
The lack of regulations for medical specialists in this country is what is being exploited and allows them to practice here irresponsibly. In the case of medical negligence by an Indian doctor practising here there would be problems in obtaining compensation due to his lack of registration with the SLMC, and would allow him to leave the country without a hassle, as was the case a few years back when an Indian paediatrician disappeared across the Palk Strait after a fatal error. It is this lack of answerability to the Sri Lankan people that would cause problems with the implementation of CEPA. The lives of Sri Lankan patients are at stake. If the ERPM exam was made mandatory for all Indian consultants in Sri Lanka, I seriously doubt any would be able to practice here. As foreign graduates, this should occur.
Thus I doubt, despite Rohan Samarajiva’s pleading, that the Sri Lankan middle class opt for foreign doctors because they are unhappy with the quality of Sri Lankan medical personnel. At some of the best research hospitals in the developed countries a Sri Lankan specialist can be found. What drives Sri Lankans who are critically ill to foreign hospitals, whether in Mumbai or Singapore, is the presence of advanced medical infrastructure and better technology essential to their condition. The answer to this problem is not to import the Indians here, but to import state of the art (non-Indian) equipment, allowing Sri Lankan specialists to train in the latest methods of healthcare, and making our universities research intensive. Though improvements have been made in medical infrastructure, much more is required in Sri Lanka. Also, investments are mostly from the private sector, while the government response has been very poor.
To be frank, India has been a curse to Sri Lanka’s healthcare system. Cannot be believed? Then look at these facts. A simple example is that Sri Lanka eradicated the polio virus many years ago, but the certificate of eradication has been withheld by the WHO due to the presence of Tamil Nadu, our geographic neighbour, having frequent polio epidemics, with inter regional travel being high. Then again, the sub-standard, low efficacy pharmaceuticals which have flooded our market are all of Indian origin. Remember that tablet manufacture is a cottage industry in India.
Honestly, nobody knows about the details of CEPA except the two governments. Though CEPA may or may not have a positive impact on Sri Lanka’s industries, it would certainly cause harm to the health sector, as even more Sri Lankan specialists would migrate due to the prevalent lower salaries.
Perhaps we could make CEPA beneficial to us by exchanging people such as Rohan Samarajiva for experienced, successful economists who could better plan Sri Lanka’s economy! If the economy ever improves to the high standard and efficiency of Sri Lanka’s health sector, then we would easily be Asia’s new miracle.
Dr A. L. Sujith Silva