By Dr. Prasanna Cooray
First, we should question whether the age-old notion of “Free Healthcare in Sri Lanka” is valid anymore. Going by the Total Health Expenditure statistics of the country, one would realise it is a misnomer.According to healthcare spending in Sri Lanka, from 1990 to 2019, published by the Institute for Health Policy, in Sri Lanka Health Accounts: National Health Expenditure 1990 – 2019, when it comes to “who pays for health”, the people of the country bear the most of health spending. In 2018, this stood at 52 % for the private spending (patient paying out-of-pocket or through insurance packages) as opposed to 48 % by the state (See Figure 2).
This spending pattern had been much worse till around 2014, when the private: public ratio stood around 57: 43, a trend that prevailed for almost three decades or longer. There was a positive trend in government spending on health between 2015 and 2019 though private spending was still above that of the government.
As a percentage of GDP spending, in 2019, health expenditure was at 3.4 %. When it comes to governmental spending it has been around a dismal 1.3 – 1.6 %.
Figure 2 shows how the two lines for the private and public sector have been fluctuating over the last three decades. The former has always been dominating the latter, except for the duration between 2014 and 2019, when the latter came close to the former. This means that when it comes to total health spending in the country, the public has been pocketing out health costs amidst unbearable hardships.
Sri Lankans have faced a double whammy—a decrease in health expenditure and an increase in health costs.
However, the post-2019 economic mismanagement and socio-economic turmoil in 2022, which resulted in severe shortages of goods and services in the government health sector, besides spending cutbacks, pushed the state hospital system to the brink of collapse; it survived thanks to the efforts of the health workers who have made do with available resources with assistance from local and foreign philanthropists.
What we are grappling with today in the public health sector, such as the non-availability of essential medicines and allegations of substandard medicines, strikes and the exodus of doctors, are the consequences of the crisis in the health sector, which has gone unattended.
However, surprisingly, this issue of underspending has hardly been on the agenda of the trade unionists or health sector activists. It is imperative that the people decide that there will be no fund cuts in the already poorly-funded public health sector. The above figure shows how meager Sri Lanka’s health spending is in comparison to even the low and lower middle-income countries.
As such, what we need is a strong campaign to increase health spending to at least 2.5 % of the GDP. Health sector may take a leaf from FUTA’s book
Take a bow Federation of University Teachers Association (FUTA). Your unrelenting efforts to have state expenditure on education to be increased 5 % of the GDP are praiseworthy though they have not yielded the desired results. Activists, trade unions, administrators and other workers in the health sector should take a leaf out of the FUTA’s book and start to campaign for more spending on health and denounce all forms of cutbacks on health spending. That alone will help prevent the collapse of the poorly-funded health sector.