Curing public healthcare

Sri Lanka’s proud public health system is in the grip of a cancer. During the last five years Rs. 1 billion worth of substandard drugs have been imported, often repeatedly, because testing and identifying fraudulent purchases and companies is a systemic problem.      

Whatever its shortcomings, the vision of free health has kept basic indicators such as infant mortality, life expectancy and vaccination schemes high, providing the country with a healthy workforce. Despite moderate per-capita income levels and other socioeconomic challenges, the people have had Government backing for universal healthcare.

But the latest revelations by the Committee on Public Enterprise (COPE) when reviewing the State Pharmaceutical Corporation (SPC) showed it has no mechanism to conduct quality checks and expiry dates on medicinal drugs that arrive at customs, raising serious concerns about the quality assurance aspect of drugs brought in to the country.

Usually health authorities only react to complaints from the public. But by then the medicines have been distributed and used. Officials have pointed out SPC and the State Pharmaceutical Manufacturing Corporation SPM does not have proper coordination, which has led to serious procurement issues.

State hospitals have been facing continuous medical drug shortages over the years. In 2013, incidentally when the Health Ministry was held by President Maithripala Sirisena, the Government blacklisted four Indian drug companies but the step barely scratched the surface. No efforts were made to hold officials accountable, even though billions of taxpayer money is spent on medicine purchases. 

Last month, the Government had to airlift a number of critical medical drugs, which had been in short supply in State hospitals. Emergency spot purchases are popular and are usually sporadically resorted to by successive administrations but they generally tend to be more expensive.

COPE has recommended the institutions devise mechanisms to conduct quality checks at the port of entries and properly coordinate between SPC, SPMC and other organisations. But cleaning up the system and releasing cost effective but good quality drugs into the market continues to be a challenge. A key component would be having a transparent procurement process where even Cabinet committees release documents to the public. To make matters worse, there are greater threats looming. As Sri Lanka becomes more prosperous, so too does the propensity for non-communicable diseases that already make up an estimated 85% of deaths. The World Bank points out demographic transition stems from a larger proportion of older people in a population as a result of increased longevity and reduced fertility that usually accompany economic growth. As a result, older populations often face different types of diseases that can be more chronic and expensive to cure. A South Asia regional study found that South Asians suffer their first heart attacks six years earlier than other groups worldwide.

This burden of NCDs will rise in the future, in part, due to further ageing of the population with the doubling of the population over the age of 65 from 12.1% to 24.4% over the next 30 years. Clearly Sri Lanka’s limping health system is unprepared to deal with such challenges. Financial irresponsibility, mismanagement, corruption and that universal evil – politicisation – have made the healthcare system sick.