Editorial

The health sector has come into public focus in recent weeks, not least due to the outbreak of chikungunya, an increased number of dengue and related mosquito-borne viral illnesses, a new variant of the dreaded COVID lurking around, hospitals partially non-functional, a shortage of doctors and a pharmaceutical issue bordering on a crisis.

The Health Ministry seems immunised, if not anaesthetised, to all that’s happening. In the case of chikungunya, it’s an attempt at shutting the stable doors after the horses have bolted—or the mosquitoes have infected thousands. In the case of dengue, it was so comforting to hear from the ministry’s Anti-Dengue Unit that so far ‘only’ 49,000 cases have been reported when in 2017, it numbered 186,000 with 440 deaths. What an attitude to adopt!

The ministry secretary is on record saying the worst mosquito breeding offenders are government institutions taking the top slot and schools coming second. While COVID is knocking on the house door and the Western Province Governor’s office says, ‘Start wearing masks,’ the ministry says, ‘No need to wear masks.’ What contradictions!

Then, there are the hospitals becoming dysfunctional due to administrative issues that have piled up over decades, an exodus of health professionals, neglect, outdated equipment, an unrelenting shortage of essential medicines and a developing pharmaceutical story. The reasons and obstacles contributing to the latter are multitudinous. Corruption has led to avoidable delays—both at the regulatory and procurement level—creating ‘artificial’ delays and ‘emergency situations’. These then necessitate, or so we are told, expedited purchasing that enhances the risk of slapdash regulation, including insufficient vetting.

The latest concern is a plan to import essential medicines on a government-to-government (G2G) basis. Health authorities argue that it is the best way to break the stranglehold of a cartel of five (or so) pharma companies that they say are holding the government hostage, rigging bids and citing exorbitant prices. But the industry argues that there are better ways to tackle the issue, such as granting new registrations to more importers/manufacturers in a larger number of drug categories.

They have also raised the very real danger of low-quality drugs entering Sri Lanka through this mechanism. Already, most global brands and multinationals have quit this country, and the pharma sector is almost entirely ‘Indianised’.

If all these don’t raise red flags, the future doesn’t look any brighter either with medical colleges embroiled in what seems like ideological warfare within the government.

The intake at the Kotelawela Defence University’s Medical School has already created waves. Sri Lanka is not producing enough doctors for its own population in the future. Considering the exodus of young qualified doctors and hundreds who qualify for medical studies after their Advanced Levels unable to find a place in state medical colleges due to some skewed qualifying system overlooking merit and opposition to private medical colleges, it is a wake-up call in every sphere of the health sector.

Serious introspection is required by the Government in general and the Ministry of Health in particular.

Missing important multilateral meetings

 

The well-being of the ocean was at the centre of multilateral efforts this week in Nice, France, at the UN Ocean Conference co-chaired by France and Costa Rica. The issues contained in the Political Declaration and the Nice Ocean Action Plan adopted at its conclusion were directly relevant to Sri Lanka as an island state.

As the current Chair of the Indian Ocean Rim Association (IORA) and as an island reliant on the ‘Blue Economy’, including in trade, ports, fisheries and tourism as well as potential sea-bed resources, Sri Lanka’s lacklustre official participation at the conference was particularly disappointing. In the past Sri Lanka has been in the forefront of multilateral issues involving the world’s oceans.

One such broad topic gaining high visibility in Nice was the debate relevant to the rape of Sri Lanka’s marine resources, including its stagnant offshore mining prospects.

The UN Secretary-General at the interaction with the media in Nice, when asked specifically to respond to sustainable fishing and what the UN can do to assist small states like Sri Lanka—struggling with bottom trawling and IUU (Illegal, Unreported and Unregulated) fishing practices—that are without the capacity to enforce and control external actors to protect their fish stocks and marine ecology, could only admit that developing countries are being exploited by “predators”.

Everyone knows the predator in Sri Lanka’s territorial waters engaging in bottom trawling and IUU fishing. But it ends there. There’s no one willing to help Sri Lanka, and small states fight off these predators. The UNSG himself admits that “international accountability mechanisms are extremely limited and inefficient”. Then, he says, “The urgency of the moment cannot be overstated.”

The UNSG raised the current hot topic of seabed mining. He said he hoped this exercise, now in its nascent stages, would not lead to a ‘Wild West’ syndrome. All the signs are in the making. Again, the UNSG could merely say the International Seabed Authority is charged with monitoring the ‘minerals rush’ on the ocean floor. For Sri Lanka, which has applied for permission to extend its economic zone, the same ‘predators’ are at work.

At the recently concluded Shangri-La dialogue, it was clear that contemporary geopolitics had brought the ocean back into the limelight and great power rivalry back to the Indo-Pacific. High-level representatives of major powers flexed their ocean muscles in the interest of maintaining a ‘free and open Indo-Pacific’, while reaching out for ‘allies and friends’ in the region.

Several high-level visitors have made Sri Lanka a necessary stopover in recent visits to the region, with the broader issues of freedom of navigation, secure supply chain routes and maritime safety and security as predictable bilateral talking points. Poised between the ongoing war in West Asia, the tensions in the subcontinent and the daily skirmishes in the oceans of East Asia, such interactions can only increase.

Sri Lanka will benefit if these topics are channelled effectively in official-level discussions, opening up space for autonomy and manoeuvre in our external relations while contributing to stability and security in the region.  However, if we are virtually absent at the table, as in Nice, or fail to make a mark in our diplomatic role, as in the recent IORA ministerial meeting—reportedly a failure on multiple fronts—we have squandered the opportunity that the ocean has bestowed on us.