- Shortage of qualified consultants, doctors, and nurses
The Health Ministry is grappling with a severe shortage of health workers, including qualified consultants, doctors, and nurses, leading to a strain on State hospitals, particularly in rural areas. This exodus is adversely affecting the quality of health service delivery as the existing staff shoulders an increased workload.
All Ceylon Nurses’ Union (ACNU) President S.B. Mediwatta highlighted the merging of wards in many hospitals to manage patient numbers due to insufficient doctors and nurses, with rural hospitals being the worst impacted.
Nurses, in particular, are working extra shifts without an increase in salaries, posing risks to their well-being and potentially compromising the quality of patient care.
Mediwatta stressed that the most affected hospitals were those in rural areas. “Many nurses are now working extra shifts, but the salaries remain the same. The worst-affected healthcare workers are nurses, working day and night without rest. This risky situation, if it continues, will affect the quality of treatment,” Mediwatta lamented.
Mediwatta further disclosed that there were presently 2,595 qualified nurses awaiting appointments, yet the Government’s commitment extended to employing only around 1,000 nurses, causing discontent. This not only triggers seniority concerns among nurses, but also leaves a substantial number of highly-qualified professionals without employment. Nurses are advocating for the filling of all vacancies to address the urgent demands of the healthcare system.
Highlighting the Government’s calculations, Mediwatta clarified that the nation’s requirement of nurses had been assessed at 42,157, while the current number of nurses was approximately 41,000.
NAO reveals vacancies, excesses
In this backdrop, the National Audit Office (NAO) audit report for 2022 has revealed significant vacancies and excesses in various positions within the Ministry of Health. This includes shortages and surpluses in senior executive, tertiary, secondary, and primary level posts, impacting critical roles such as specialist surgeons, dental surgeons, medical administrators, specialists, and medical officers.
Notably, Lady Ridgeway Children’s Hospital and other health institutions have employed medical professionals in excess of approved positions, revealing a disconnect between actual employment and sanctioned posts. The financial crisis in the country further restricts recruitment, complicating efforts to address the workforce shortages.
Specific positions, such as those for senior biomedical engineers, molecular biologists, procurement specialists, psychologists, and orthopaedic technicians, remain vacant or understaffed, exacerbating the strain on the healthcare system.
The NAO also flagged unimplemented annual transfer orders for doctors and other medical professionals, calling attention to delays in administrative processes.
As per the NAO, there were a total of 1,586 vacancies for 39 senior executive-level posts and 11 excesses related to three positions at the Ministry of Health as at the end of last year. Additionally, there were 405 vacancies for 61 tertiary-level posts and an excess for a single post.
The secondary level witnessed 5,565 vacancies across 83 posts, with 597 excesses pertaining to 37 of these positions. Furthermore, the primary level reported 8,626 vacancies distributed among 46 posts, accompanied by 2,370 excesses related to 20 posts, the report revealed.
The audit further revealed an excess of three specialist surgeons in two hospitals, coupled with a shortage of 12 specialist surgeons in 15 hospitals. Furthermore, there was an excess of 20 specialist dental surgeons in 13 hospitals while 97 hospitals faced a shortage of specialist dental surgeons.
The report also highlighted an excess of five medical administrators (senior grade) in five hospitals and institutions, contrasting with a shortage of 43 officers in 40 hospitals and institutions.
Moreover, an excess of 146 specialists was noted in 23 hospitals, while 156 hospitals reported a shortage of specialists. The audit identified an excess of 282 medical officers in 21 hospitals and institutions, with a simultaneous shortage of 1,613 medical officers in 89 hospitals and institutions as of 31 December 2022.
Notably, Lady Ridgeway Children’s Hospital employed 20 specialist doctors, Kandy National Hospital employed 15, Colombo National Hospital employed 14, and Kurunegala Teaching Hospital employed 16, despite the absence of approved positions by the Ministry of Health, resulting in the employment of 18 specialists in excess, as revealed by the NAO.
Likewise, 61 medical officers had been employed in excess of the approved number of medical officers for the Ministry of Health.
In addition, all positions for three senior biomedical engineers, two molecular biologists, and four procurement specialists were found to be vacant. Among the approved 28 biomedical engineer posts, only 13 had been filled. Similarly, out of the 59 physicist posts approved, 21 were vacant and 20 out of the 29 approved research officer posts remained unfilled.
It is further revealed that all seven approved psychologist positions were vacant, and, notably, all four approved positions for the National Institute of Mental Health (NIMH) were also unfilled. Additionally, 13 out of the 15 approved orthopaedic technician positions were vacant, with all nine approved positions at the Ragama Rehabilitation Hospital remaining unfilled.
Unnecessary post?
In the meantime, the NAO revealed that the Department of Management Services had granted approval on 7 November 2017 to the ministry for the creation of one post in the special grade of the Sri Lanka Planning Service, titled Director General (Planning). However, as of 25 March 2023, the position remained unfilled, despite approval.
The Planning Division of the ministry primarily handles activities related to the health sector and currently these tasks are managed by medical officers. While the Director General (Planning) post has been approved, it appears that there is no perceived need for such a position, leading to a lack of action in appointing an officer to the role.
Among the 53 institutions subjected to the audit, it was discovered that 564 annual transfer orders issued to doctors in 28 hospitals and institutions from 2015 to 2020 had not been implemented by 31 December 2021. Similarly, 57 annual transfer orders issued to officers in the nurse officer, pharmacist, and medical laboratory technician services in six hospitals between 2017 and 2020 had not been implemented by 1 January 2021.
While the implementation of annual transfer orders for specialist doctors, other doctors, and officers in various services within hospitals and health institutions under the ministry is ongoing, certain transfers face delays due to specific issues. Instructions have been issued to relevant officers to address and prioritise the execution of future annual transfers, particularly focusing on those that have not been implemented to date.
Ministry stance
Nevertheless, the Health Ministry has stated that a substantial workforce, comprising senior executive level, tertiary level, secondary level, primary level, and various other employees belonging to the all-island service, combined service, and departmental services, operates within the ministry and its affiliated hospitals and institutions.
Despite the annual occurrence of vacancies across these services due to staff departing for various reasons, the prompt filling of these positions faces delays owing to the intricacies of the required processes, according to the ministry management.
To address this issue, directives have been issued to the concerned parties, the Health Ministry has told the NAO.
Accordingly, the instructions given by the Health Ministry include expeditiously filling vacancies, seeking approval for positions that are currently unapproved, initiating procedures to augment the sanctioned staff numbers, refraining from assigning excess staff to workplaces beyond the approved post count, and, if such assignments occur, ensuring approval for those positions. In cases where staff is deployed to a workplace without obtaining post approval, measures are to be taken to secure the necessary approvals.
Furthermore, related parties have been instructed to consider excesses and vacancies during the annual transfer process and take actions accordingly when assigning staff, it is stated.
However, it is acknowledged that the current financial crisis in the country has imposed restrictions on the recruitment process for these positions. Despite these challenges, the emphasis remains on optimising the existing workforce and ensuring that the necessary approvals and actions are taken to address staffing needs within the constraints of the financial situation.
Retention of doctors
Meanwhile, the Government Medical Officers’ Association (GMOA) stated that it was closely monitoring the Government’s response to its requests aimed at retaining nearly 5,000 doctors who are considering leaving the country in the next few months.
In the past year, approximately 1,200 doctors, including specialists, have left the country in pursuit of better opportunities abroad. This shortage is especially felt among the consultant pool, with around 125 consultants departing by the end of August last year. From January to August of the same year, about 477 doctors, including 125 consultants, sought greener pastures overseas, according to data from the GMOA.
The GMOA further revealed that around 5,000 qualified medical officers, who had already met the necessary qualifications, were eagerly awaiting opportunities to embark on careers abroad, in search of better prospects.
GMOA Secretary Dr. Haritha Aluthge stressed the importance of the Government’s involvement in adequately funding the medical sector to prevent the closure of medical centres and hospitals due to the exodus of medical personnel.
Dr. Aluthge revealed that almost 5,000 more doctors were expected to leave the country in the next three to four months, with over 400 medical centres facing potential closure within the next two months.
The GMOA had issued an ultimatum to the Government last month, warning of intensified strike actions that could severely impact the nation’s healthcare system.
The association presented a set of demands to address the urgent crisis in the healthcare sector, covering issues like compensation for doctors, upgrading living quarters, improving transportation facilities, addressing shortages of medicines, etc.
Attempts made to contact Health Minister Dr. Ramesh Pathirana and Secretary Dr. Palitha Mahipala were futile.