*By Kalinga Seneviratne
The mass migration of doctors, specialist consultants, and public health staff, has led to a critical shortage of personnel needed for emergency response. This directly limits the number of field health teams available to deploy to safety centers and affected areas.
Since the 2022 economic crisis, more than 2,500 doctors have left Sri Lanka, with nearly 800 of them specialists, says the Government Medical Officers Association (GMOA). Added to this are other health professionals such as nurses and radiologists, bringing the total to around 4,000 professionals migrating to richer countries such as Australia, the UK, and recently also to Singapore and wealthy Middle Eastern countries.
Shortage of psychiatrists
Speaking at a professional conference in Colombo in August, Dr Sajeewana Amarasinghe, President of the Sri Lanka College of Psychiatrists, warned that a shortage of psychiatrists has reached alarming levels, as a result of migration to mainly Australia and the UK. He complained about a serious shortage of Psychiatrists in the former war-zones of North-East Sri Lanka where suicide rates have been high for years.
Following the recent floods, the Health Promotion Bureau has raised concerns over a potential surge in mental health issues among those affected by the recent floods. Consultant Psychiatrist Dr. Vindya Wijayabandara told the Daily Mirror that flood-impacted communities often exhibit signs of emotional trauma, including sleep disturbances, prolonged stress and even suicidal thoughts, and need professional help.
Medical education system
Most of Sri Lanka’s doctors have been trained by the country’s public universities where the education is free, as it is seen as an investment for the country’s development. Sri Lankan doctors are held in high esteem overseas where over the decades medical professionals who have migrated have done very well, especially in English-speaking countries like Australia, the UK and Canada. In 2024, according to GMOA, the College of Respiratory Physicians in Sri Lanka, received an email from the National Health Service (NHS) in the UK, advising about 30 vacancies for respiratory physicians there.
The poaching of Sri Lankan doctors by rich countries has reached such alarming rates, that at the 78th World Health Assembly in Geneva in May this year, Sri Lanka’s Health Minister, Dr. Nalinda Jayatissa, called for ethical international recruitment of health personnel to prevent the exodus of medical professionals from countries like Sri Lanka. He called on destination countries to adhere to the WHO’s Code of Practice on the International Recruitment of Health Personnel, emphasizing global cooperation to address the health workforce migration crisis and protect developing countries.
“The health system of Sri Lanka is basically centered around the doctor. If you don’t have a doctor in the hospital, it will collapse. Nothing will happen because no one is there to prescribe the drugs or to order the investigations, x-rays, the blood investigations”, Dr Chamil Wijesinghe, media spokesman for GMOA told IDN.
Professor of Community Dentistry, Dileep de Silva, a Health Finance Specialist, says that migration of health professionals from the system is around 10 percent now, and warns that it is racing towards a crisis point. “System turbulence does not come from one or two percent shortage. It comes when it hits 15 percent”, he told IDN.
“When doctors go, replacement is not that easy. It takes so long to educate them. You’re looking at five to six years”, Professor Saman Nanayakkara, Dean of the Faculty of Medicine at Peradeniya University explains. “The government is sending us students, and if we are to increase the number of students, then infrastructure has to be improved. Facilities have to be expanded”.
“What has happened is because of this exodus of health staff, both academic and non-academic, our faculty is affected, and we can’t take more students and teach more”, Prof Nanayakkara told IDN. “So, you’re also having a problem with the academic staff, when doctors leave, the academic staff leave as well. Over the last five years, we have lost five members in my department”.
With the public health system approaching a crisis point, there is a debate in the country on whether new graduates need to be bonded to serve the country for a number of years, and if they will be asked to pay back the investment in their education if they leave.
Push & pull factors
While the government spends over SLR 500 billion (USD 1.65 billion) a year on the public health system, Dr Wijesinghe argues that it needs to provide accommodation, schooling for children, and safety aspects of doctors working outside of city locations. “We have to understand that a huge number of doctors in Sri Lanka are female,” he notes, pointing out that 65% of medical students are women.
Prof Nanayakkara, who has worked in Australia for many years and returned home, points out that a major push factor for doctors migrating are the living conditions in rural areas. In Australia, he points out, “if a doctor is working in a rural area, he is given extra facilities, extra allowances. Moving from the city to rural sector is arranged by the government, that is paid. Sometimes given a house with free internet and digital TV, everything is given”.
He pointed out that is not the case in Sri Lanka, and if a doctor is assigned to a rural hospital, the families are split, because children need to go to city schools. Doctors are worse off economically as well. “We don’t make a rumble on our salaries, because we can work in the private sector. But the private sector predominates in big cities. That’s the reality [that drives doctors overseas]”, adds Prof Nanayakkara.
Prof de Silva feels that “why they [rich countries] don’t train people, is not because they can’t train. They know it is easier for them to buy a product from a supermarket,” he argues.
“Poaching of professionals from developing countries has been a long-standing practice of developed countries,” says Dr Palitha Kohona, former Sri Lankan ambassador to the UN and China, and a former head of the UN Treaty section in New York. “The professionals from the South are attracted by better wages and living conditions in the developed world”.
“While it may be possible to continue to raise this issue, I doubt whether the North will agree to any curtailment of current practices, from which they benefit considerably,” he told IDN”. It would be best for developing countries themselves to impose restrictions on professional outflows, for example by asking students following professional university courses to sign a bond, especially if they are enjoying free education”.
* Dr Kalinga Seneviratne is a Dr Kalinga Seneviratne is IDN Special Correspondent for Asia-Pacific. He is currently a research fellow at the Shinawatra International University in Bangkok.