• Situation improved after 2021-’22 crisis period, but deteriorating once again

Concerns have been raised over the Government’s medicine procurement procedure, as hospitals across the country struggle to meet daily requirements for medicines and medical equipment amid an increased influx of patients to State hospitals.

Over the past three years, due to the high costs of medicines, private hospital in-house treatments, and private medical consultations, State hospitals have witnessed a drastic increase in both inpatients and clinic attendees seeking medicines. However, according to health staff in major hospitals nationwide, the Government has failed to adequately meet this rising demand.

Speaking to The Sunday Morning, a medical doctor attached to a State hospital in Kandy, who wished to remain anonymous, said that even before the economic crisis hit the country, medicine shortages were present but were at a manageable level.

“At present, the situation is different. As doctors working directly with patients every day, we can say the situation is better compared to 2021-’22 during the peak of the crisis, but it’s deteriorating again. 

“One of the main issues we have faced since last year has been the lack of options. We do have substitutes for some medicines, but many are not effective in managing patients’ conditions. This is the reality in major hospitals in the Central Province. We have also heard reports that the situation is worse in peripheral areas, with some rural State hospitals reportedly lacking even basic medicines like paracetamol,” the doctor said.

He explained the consequences of medicine and equipment shortages: “When essential medicines or equipment are unavailable, we are forced to prescribe them from outside pharmacies, even after failed attempts at local purchasing. But most of our patients simply cannot afford to buy these costly items privately. As a result, they delay treatment or wait until the medicine is available at the hospital, which seriously impacts their health, especially in the case of non-communicable diseases.”

Procurement delays and administrative challenges

In such a backdrop, The Sunday Morning reliably learns that over 100 types of medicines are currently out of stock in State stores. 

Although procurement processes have been initiated, delays in approvals and finalisation have stalled progress. However, no official confirmation of these figures has been provided, nor has any comprehensive list of unavailable medicines or medical equipment been issued by the authorities yet.

The Government Medical Officers’ Association (GMOA) raised alarm over these delays, criticising a Health Ministry circular that aimed to address shortages. According to GMOA Media Spokesperson Dr. Chamil Wijesinghe, the procedures outlined in the circular are impractical and difficult for most hospitals to implement.

“The circular requires hospital administrations to compile daily lists of unavailable medicines and equipment and distribute them to relevant staff. But due to logistical constraints, many hospitals struggle to comply,” he said.

He added that the requirement for patients or relatives to fill forms and obtain approvals from several parties to procure medicines externally further burdened already distressed families.

Dr. Wijesinghe also commented on the chilling effect of recent legal action taken against a specialist at the Sri Jayewardenepura General Hospital in a medicine-related case, saying: “Doctors had been sourcing items from outside after discussing and obtaining patient consent when shortages arose. But after the legal scrutiny in this case, many have now stopped recommending outside purchases. As a result, certain surgeries and treatment procedures have come to a halt.”

Administrative vacuum

Furthermore, GMOA Secretary Dr. Prabath Sugathadasa announced plans to request a meeting with Health Minister Dr. Nalinda Jayatissa and the Director General of Health Services (DGHS) to discuss the rapid deterioration of public healthcare services.

“Instead of taking concrete steps to solve medicine and equipment shortages, the National People’s Power (NPP) Government is creating an environment where patients are pushed to buy items from the private sector,” Dr. Sugathadasa alleged.

He criticised the recent circular as one that worsened hospital operations and further burdened patients.

“It’s absurd that patients must get hospital approval to obtain essential items from outside, simply because the Government has failed to meet basic healthcare needs,” he added. “This circular undermines free healthcare and forces more out-of-pocket spending on citizens.”

Despite escalating concerns, the critical post of Deputy Director General (Medical Supplies) at the Ministry of Health has remained vacant for an extended period. A temporary appointee is currently overseeing responsibilities. Although the vacancy was advertised on 15 July, applications will close only tomorrow (28).

Meanwhile, the State Pharmaceuticals Corporation (SPC), although central to procurement processes, has remained silent amid rising public scrutiny.

A senior Health Ministry official, speaking on condition of anonymity, admitted that rigid bureaucracy was worsening the crisis: “Officials are sticking to outdated protocols and are unwilling to be flexible. This fear of accountability has paralysed the system. Unless the Government intervenes to reform the procurement framework, the public healthcare system could collapse in a few months.”

New guidelines for prescriptions and testing

Against this backdrop, doctors at State hospitals have now been officially allowed to prescribe medicines, surgical items, and lab tests for patients to purchase from outside pharmacies and laboratories, if those items are unavailable in hospitals. The directive was issued by DGHS Dr. Asela Gunawardena through guidelines released on 16 July, following repeated requests from medical professionals for clarity.

According to the new guidelines, doctors in Outpatient Departments (OPDs), clinics, and wards can prescribe such items externally, but only after confirming their unavailability in the hospital. Written consent from the patient or a next of kin must also be obtained. For diagnostic investigations essential for treatment, external testing is permitted with the approval of the hospital head.

The guidelines also establish a transparent process for accepting donated items from patients or suppliers, which must be documented and reported monthly. Heads of institutions have been directed to monitor stock levels closely, provide daily updates to medical staff, and take early action to prevent shortages. Local purchasing is allowed under the 2023 medical supplies manual in the event of limited availability.

President steps in

President Anura Kumara Dissanayake has instructed officials to take immediate steps to address the reported medicine shortages across hospitals.

The directive came during a high-level discussion held at the Presidential Secretariat on Tuesday (22), attended by Health Minister Dr. Jayatissa, Deputy Minister Dr. Hansaka Wijemuni, and senior Ministry of Health officials.

The meeting focused on reviewing procurement and distribution mechanisms in detail. The President emphasised the need for a complete overhaul of the system to ensure a consistent and uninterrupted supply of essential medicines to the public.

He stressed that while the Treasury had already allocated necessary funds, a coordinated effort by all stakeholders was crucial to improve healthcare delivery. Long-term plans to prevent future shortages were also discussed, with a focus on efficiency, transparency, and accountability.