Sri Lanka's acute economic crisis has begun to tell on its health care system with critical medicines running out for want of hard currency to import supplies, experts say.
"The limited access to US dollars, import regulations and fuel shortages have stalled supply chains and distribution systems so that the health ministry may not be able to order regular medicines and items needed to supply all the hospitals and service providers as during normal times," says Kumari Vinodhani Navaratne, a Colombo-based public health specialist formerly affiliated with the World Bank and currently with the Asian Development Bank.
Navaratne tells SciDev.Net that serious shortages of critical items needed to maintain health services are worrying health care providers and those who need health services. She said that owing to Sri Lanka's current economic crisis, routine non-emergency surgeries, medical procedures and some laboratory tests have been placed on hold to conserve stocks.
The Ministry of Health procures, stores and distributes all required medicines, vaccines, consumables, reagents and commodities to all hospitals managed by the government, Navaratne explains.
An international appeal by the Government Medical Officers' Association (GMOA) asks for "generous support at this crucial time to continue the patient care services in Sri Lanka". The GMOA says it has undertaken to ensure "transparent coordination and direction of your donations of medicines and equipment to hospitals for the patient care within the quality assurance mechanism for drugs and equipment of the Ministry of Health".
The GMOA has published a list of items such as antibiotics and consumables that are running out and can be replenished by donations.
A UK government travel advice warns that "basic necessities" such as medicines, food and fuel are in short supply due to lack of hard currency required to pay for imports. "There may be long queues at grocery stores, gas stations, and pharmacies. Local authorities may impose the rationing of electricity, resulting in power outages," the advice says.
The travel advice also warns about dengue fever, possible terrorist activities and monsoon rains. Dengue fever has long been endemic in Sri Lanka.
According to the World Bank, Sri Lanka faces unsustainable debt and challenges with balance of payments (the difference in value between payments into and out of a country). "Urgent policy measures are needed to address the high levels of debt and debt service, reduce the fiscal deficit, restore external stability, and mitigate the adverse impacts on the poor and vulnerable."
Until last year, Sri Lanka's health care system was considered "strong" by the WHO-hosted Asia Pacific Observatory on Health Systems and Policies. A country with a population of 21.8 million people, Sri Lanka has eliminated important infectious diseases such as neonatal tetanus, malaria, and filariasis while also substantially increasing life expectancy.
In July 2021, the WHO Regional Office for South-East Asia said that the public sector in Sri Lanka provided most of the health care services including inpatient care (95 per cent) and outpatient care (50 per cent) at public health facilities. Government expenditure in Sri Lankan health care as a share of gross domestic product (GDP) was 1.7 per cent during 2013—2016.
According to the WHO, the "[household] contribution to current health expenditure is significant, but catastrophic health expenditure remains low as the government remains a key provider of inpatient care. Medication and investigations are provided free of charge".
To improve Sri Lanka's healthcare situation, Navaratne recommends that the supply chain be restored through the award of tenders for essential items. "This requires urgent and immediate access to US dollar resources, as most required items [related to health care] are imported."