Although many seem to think that what they endured last year (2022) in the form of power cuts, the shortages of goods and disrupted services was the worst part of the economic crisis, the people are gradually coming to terms with the reality that it was merely the tip of the iceberg. The food crisis and malnutrition, unbearable but mostly necessary tax hikes, restrictions pertaining to financial transactions, import restrictions and brain drain are the most noticeable elements of the long term impacts of the crisis.

“Did we survive the worst part of the economic crisis to get killed by diseases?,” a Facebook post about the worsening brain drain in the health sector read, which is indicative of how hopeless the people are feeling with regard to the crisis-affected availability and accessibility of the health services. 

Even though the crisis in the health sector, especially the public health sector, is not limited to medical experts leaving the country in throngs, it appears to have received more attention with the people, the Government and health sector professionals raising concerns about it. During the past few months, a number of medical consultants left the country, leaving some hospitals with zero consultants in specialised areas such as anaesthesia. It was also reported recently that a doctor who returned to the country after a specialised training and became a board consultant had decided to go back because the duty stations that he was assigned to, which were located considerably far from each other, were not acceptable to him.

The people’s response to this worsening issue revolves around the medical experts’ ‘moral duty’ to serve the country that spent a massive amount of public funds to provide them with education to become experts, regarding which many opine that the Government should impose restrictions to make it mandatory for such experts to serve their country, at least for a certain period of time, after becoming qualified as medical experts. The Government, on the other hand, appears to be resorting to legal, regulatory and procedural restrictions to prevent medical experts from leaving the country, especially without permission.

However, as much as this is a pressing issue which is likely to beget unprecedented challenges to universal healthcare coverage in which Sri Lanka has for a long time taken pride, the basis on which the said approaches are considered are largely flawed and unilateral. Everyone’s talking about how brain drain in the health sector could be disastrous. But, thus far, the health authorities and the Government have failed to go beyond what is being said at press briefings about this issue and statistics pertaining to medical experts migrating for employment, by holding proper discussions with medical professionals.

As was pointed out by doctors’ trade unions and leading medical professionals, there are both short and long-term steps that the Government and the health authorities could take to alleviate the impacts of this issue. While maintaining their stance that doctors should receive tax reliefs and salary hikes as inadequate income is the main factor behind the increased brain drain among medical experts, doctors’ trade unions have noted that there are however, short-term, simpler steps that the Government and the health authorities could take, to encourage doctors to remain in the country’s health sector. Among those proposals are improving infrastructure, such as official quarters given to doctors working in hospitals in rural areas, and supporting them to manage travelling difficulties and costs when serving in such areas. These proposals seem simple, realistic and more affordable than medical professionals’ long-term demands. However, they are yet to reach the ears of the Government and of the health authorities, as direct talks between the concerned parties are yet to take place. Trying to resolve or at least discuss this issue without the inputs of medical professionals will be futile, because the challenges that they are facing in the current socio-economic context is the origin of this crisis.

Without further delay, the Government and the health authorities should take the obvious first step, which is, understanding the true nature and gravity of the issue and also potential immediate and short and longer-term solutions in collaboration with individual medical professionals, health sector trade unions and health sector professional bodies. It is self-evident that resolving the crisis in the health sector is not something that could be achieved overnight, in one round of discussion, or with one policy or some other form of decision. The most essential data required to decide on an approach to deal with this issue are the medical professionals’ issues, needs and proposals. Therefore, the systematic process through which this crisis could be alleviated should begin by looking into what steps that the Government and the health authorities could take in order to entertain those professionals’ demands.