Columns

The corridors of the country’s national hospitals, have once again become theaters of uncertainty. The familiar spectacle of the Government and the Government Medical Officers’ Association (GMOA) locked in a bitter standoff has returned, this time over a contentious doctor transfer system. While the GMOA decries the system as a politically motivated assault on transparency, the State dismisses these concerns as mere resistance to administrative necessity.

But as the rhetoric sharpens and the doors of clinics are shut, one must ask: who truly pays the price for this stubbornness? It is not an affluent citizen who can afford private medical care but rather the marginalised sections of society. The victims are the silent majority who are poor and vulnerable—for whom the public health system is not a choice, but a lifeline.

The burden of governance

It is time for recognition of a firm, unvarnished truth: the ultimate responsibility for the health of the nation rests squarely on the shoulders of the State. This is not a duty that can be abdicated, delegated or diluted by pointing fingers at “unreasonable” medical professionals. The Government is the custodian of the public’s well-being. When the system grinds to a halt, it is a failure of governance, regardless of who casts the first stone.

In the current impasse, the Government’s posture appears to be one of rigid defiance. There is a prevailing sentiment within the halls of power that to negotiate in the face of “unreasonable” demands is a sign of weakness. This is a dangerous fallacy. In the realm of essential services, negotiation is not a concession; it is a fundamental instrument of statecraft. Even if the Government is of the firm conviction that the GMOA’s demands are excessive or politically tainted, it cannot afford the luxury of being stubborn. A State cannot allow its people to suffer because it finds its interlocutors difficult. The Government must be prepared to bend over backwards to find innovative, middle-ground solutions. To refuse to talk is to effectively sanction the suffering of the poor.

The human cost of rigidity

For a family living on the margins, a cancelled clinic date is not a mere inconvenience. It is a day of lost wages, a wasted journey on a crowded bus, and—most crucially—a delay in treatment that could mean the difference between recovery and permanent disability. Chronic conditions like diabetes or hypertension do not pause for industrial disputes.

By allowing these disputes to linger, the State is essentially gambling with the lives of those who have no other cards to play. This is more than an administrative lapse; it is a profound matter of social justice. A system that functions only when the weather is fair is a failed system. What the country needs is a framework that protects the patient from the fallout of professional and political friction.

A call for professional maturity

While the primary burden of resolution lies with the State, the medical profession is not exempt from the dictates of conscience. The GMOA and its members would do well to ensure that while their grievances regarding transparency and fairness may be valid, they should show flexibility in their negotiations and minimum disruption to patients.

The medical profession is a calling before it is a career. When doctors insist on absolute, uncompromising adherence to their demands at the cost of the critically ill, they risk eroding the very public trust that sustains their status in society. Reasonableness and flexibility are not signs of defeat; they are hallmarks of professional maturity. The profession must be willing to meet the State halfway, ensuring that the sanctity of patient care remains inviolate even as they fight for their rights.

Moving beyond reactive
crisis management

The tragedy of the Sri Lankan health sector is that it is trapped in a reactive loop. The pattern is as predictable as it is exhausting: tensions simmer, a strike is called, the public panics, the Government offers a “stick-and-carrot” settlement, and a temporary peace is bought until the next crisis erupts. This is an unsustainable way to run a nation.

The State must move toward a structured, institutionalised mechanism for dispute resolution in the Health Sector that removes the shock from the system. Some of the more critical pillars of such a system could be:

1. Early engagement: Disputes must be nipped in the bud. There should be a permanent, high-level forum where grievances are aired and addressed at regular intervals, not just when a strike notice is served.

2. Independent mediation: A “buffer zone” is required. An independent body of retired jurists, healthcare experts, and civil society leaders could act as a neutral mediator, stripping the politics away from the professional issues.

3. Binding arbitration: In the context of an essential service like the medical sector, there must be a point where the talking stops and a decision is made. Recourse to binding arbitration, conducted by a neutral panel, ensures that a finality is reached without the need for work stoppages.

4. Essential service guardrails: It is necessary to codify the “minimum service” requirement. No dispute, however heated, should ever result in the closure of Emergency Treatment Units, pediatric wards, or maternity theaters. The right to protest must be balanced against the right to life.

The vision of a just society

A contented and motivated medical workforce is an investment in the nation’s quality of life. Doctors and other medical personnel who feel undervalued, unfairly transferred, or politically targeted are less likely to provide the compassionate care the citizens deserve. Therefore, it is in the State’s best interest to address legitimate professional concerns with urgency.

However, the integrity of the health system is not measured by the comfort of the doctors or the convenience of the administrators—it is measured by the accessibility of care for the man in the village and the labourer in the city.

The Government must stop treating these disputes as battles to be won and start treating them as crises to be solved. This might mean adopting new approaches for transparent transfers, creating decentralized grievance cells, or radically overhauling the communication channels between the Ministry and the unions. For instance if the Government and the GMOA had sat together and jointly formulated the transfer scheme in question rather than the Ministry of Health imposing it from above, the current crisis may have been averted.

Negotiation is the way out

In the final analysis, this perennial conflict is a mirror held up to society. Is the ego of the State or the demands of a union more important than the life of a marginalized citizen?

The time for wait-and-see politics is over. The Government must lead, not just rule. It must negotiate, not just dictate. And the medical profession must serve, not just demand. Anything less is a betrayal of the social contract. Our public health system is one of the strongest  pillars of our democracy; if it is allowed to crumble under the weight of recurring disputes, it is the poorest who will be crushed in the ruins.

The State must act now—not with the arrogance of power, but with the humility of service—to ensure that the doors of the country’s  hospitals never close on those who have nowhere else to go.

 (javidyusuf@gmail.com)