• Already grappling with medicine shortages and quality concerns

Operations at many State hospitals could soon come to a standstill unless the Government takes immediate action to counter the ongoing brain drain in the health sector, some health experts have warned.

Statistics reveal that a significant number of migrations of healthcare professionals, spanning from lab technicians to specialised doctors and nurses, are currently underway. It is learnt that a significant number of nurses are also migrating, putting additional pressure on understaffed hospitals which have managed to retain doctors to maintain regular services.  

With the flight of thousands of medical specialists out of the crisis-hit island and with thousands more poised to follow suit in the coming months, the future of Sri Lanka’s once-robust public health sector is now shrouded in darkness.  

The gravity of the situation demands immediate intervention to address the factors triggering this most recent mass exodus. 

Over the last four decades, many Sri Lankan doctors, nurses, and other professionals have migrated in search of greener pastures, but the current trend indicates an uptick in the numbers – a scenario which the island nation has not seen in the past, even during its darkest days of armed conflict.

In the past year alone, close to 1,200 medical doctors, including specialists, have left the country. The depletion is especially noticeable in the consultant pool, with approximately 125 consultants migrating by the end of August last year. From January to August the same year, around 477 doctors, including 125 consultants, left the country. 

Currently, Sri Lanka counts around 20,000 serving doctors and approximately 2,800 consultants, as per statistics revealed by the Government Medical Officers’ Association (GMOA). According to the GMOA, yet another 5,000 medical officers who have already met the qualifications are waiting in line to pursue foreign job opportunities.

Crisis looms

Last week, GMOA Secretary Dr. Haritha Aluthge reiterated their concerns and raised a red flag regarding the significant number of doctors leaving the country. “This emerging crisis requires immediate attention,” he stressed. 

As the largest professional association in the country, the GMOA raised this issue seven months ago, yet Government action has been lacking. 

This inaction has worsened the situation, elevating the outward flow of doctors to a critical level, Dr. Aluthge pointed out, adding that the number of departing medical professionals exceeded the typical rate seen in the past. He argued that the numbers signalled a severe brain drain from Sri Lanka’s healthcare sector.

The brain drain comes as the sector is grappling with issues such as medicine shortages and concerns about quality. The departure of experienced medical professionals further exacerbates these challenges, risking the deterioration of healthcare services in the country, Aluthge stressed. 

“This departure of medical professionals is significantly higher than the usual rate, therefore indicating a brain drain from the country’s healthcare sector,” he said. 

It is clear that immediate attention and action are needed from the Government to address the concerns raised by the GMOA and prevent the worsening of the healthcare crisis, he said.

Stagnant salaries amplify brain drain

Meanwhile, GMOA Spokesman Dr. Chamil Wijesinghe spotlighted the glaring issue of salary stagnation.

According to him, medical professionals have not received any salary increments or transport allowance adjustments since 2016. Despite the subsequent surge in fuel costs, these financial challenges have not been addressed, leaving healthcare professionals financially strained.

Dr. Wijesinghe drew attention to the salary disparities between medical professionals and counterparts in other fields within Sri Lanka. “The 2016 salary increment of Rs. 10,000 serves as a stark reminder of the last positive change in doctors’ earnings. However, the landscape of their profession has evolved significantly since then,” he stressed. 

Interestingly, Dr. Wijesinghe pointed out that the period post-2016 had witnessed significant inflation in fuel costs. Despite this economic reality, these cost escalations have not translated into improved salaries for doctors, a fact that has left many medical professionals feeling undervalued and financially strained. 

As doctors confront an unequal work environment, they are also grappling with infrastructural hurdles that impact their quality of work and life. 

Dr. Wijesinghe stressed that in addition to the salary issue, the access to adequate living quarters and proper canteen facilities, essential for their wellbeing, remained insufficient. Furthermore, the scarcity of essential medicines compounds the challenges faced by healthcare providers, placing immense strain on their ability to deliver quality care.

Workforce diversity

The health sector in Sri Lanka is predominantly composed of women, accounting for 64% of the workforce, as outlined in the International Labour Organisation’s (ILO) report on fair and ethical recruitment practices in the country’s health workers’ mobility framework. 

The workforce is well-educated, with 90% of physicians possessing advanced education. Among health care assistants, 59% have intermediate-level education, while eight out of 10 nurses and midwives also possess this level of education. Around 10% of male workers and 16% of female workers are employed on casual or temporary contracts. 

Although labour shortages exist in some job categories, the Ministry of Health projects that these shortages are being addressed, though saturation points vary by profession (e.g. medical officers vs. nurses). These factors collectively influence health workers’ decisions to seek employment opportunities abroad.

Freezing overseas leave

In response to the escalating brain drain crisis in the healthcare sector, the Ministry of Health announced a decisive move to curb the exodus of specialist doctors last week. The ministry’s response comes as a bid to address the critical shortage of medical experts in key fields, including anaesthesiology. 

Health Ministry Secretary Janaka Sri Chandraguptha declared a freeze on granting leave to doctors specialising in disciplines where the number of specialists is limited. This bold step aims to mitigate the alarming shortage of doctors that has begun to wreak havoc on the nation’s healthcare infrastructure.

Chandraguptha highlighted that certain sectors had been severely hit by the scarcity of doctors, leading to critical service gaps and a compromised healthcare system. He underlined the importance of retaining specialists in the country, particularly in fields where their expertise is crucial.

In a move to enforce accountability, the Health Ministry has also mandated that specialist doctors must inform the Ministry before travelling overseas. Failure to adhere to this directive will result in disciplinary action, including dismissal from service.

Concerns over ministry decision

The move to restrict overseas leave for specialist doctors has sparked concerns within the medical community.

Medical professionals argue that the directive might inadvertently limit opportunities for further education, collaboration, and exposure to advanced medical practices. While they acknowledge the necessity of retaining specialists in the country, they stress the importance of finding a balanced solution that does not hinder doctors’ professional growth. 

Amid these concerns, the GMOA urged to reveal the ministry’s plan to address the brain drain issue comprehensively. It emphasised the need for open dialogue and collaboration between the ministry and the medical community to find a sustainable resolution that did not compromise the growth and development of doctors. 

“We haven’t seen any official statement from the ministry. It’s just that several officials are commenting on the matter. What is needed right now is to take action to avoid brain drain. The alarming factor is the 5,000 doctors who are right now in line to depart. The issue is there and the Government should stop them from leaving. Those who have left the country have already left and maybe if a proper mechanism is adopted, they will return. But the focus should be to stop the 5,000 who are waiting to leave now,” the GMOA Spokesman stressed.

Auditing workforce, fair compensation

Meanwhile, offering an alternate point of view, Association of Health Professionals (AHP) President Ravi Kumudesh highlighted the necessity of conducting a thorough audit of the healthcare sector’s human resources to accurately assess the shortage of medical specialists. 

He questioned whether the shortage truly reflected a lack of medical doctors or a more complex issue. He also accused the GMOA of pursuing a salary increase under the guise of addressing the specialist shortage and called for a fair approach to any salary increments. 

He told The Sunday Morning that there was a shortage of medical specialists due to the low numbers in Sri Lanka, but that he was not sure whether the country lacked medical doctors. 

“A proper audit should be conducted by the Health Ministry on its human resources. It is a fact that there is a shortage of medical specialists. The Government spends a large sum of money to train medical specialists and that is also done as per the requirements. Therefore, the specialists have a moral obligation and a legal bond to serve the country. However, there is uncertainty over the shortage of doctors,” he stressed. 

Kumudesh lashed out at the GMOA, claiming that it was trying to get a salary increase by highlighting the shortage of specialists. 

“We believe that the Government or the Health Ministry should conduct an audit on its human resources. At the same time, we urge the Government to be fair. If it is to increase the salaries of the doctors, it has to give that salary increment to the entire health sector workforce,” he pointed out.