“The health of the people is really the foundation upon which all their happiness and all their powers as a state depend.” – Benjamin Disraeli, former British Prime Minister
The day Dr. Senaka Bibile died mysteriously in a foreign land, Sri Lanka’s future of public medicine was jeopardized. Dr. Bibile was not only an influencer in Sri Lanka but also in many South Asian and other developing countries. However, it was clear that the West, led by the United States, was not in favour of Bibile’s public health policy as their pharmaceutical companies struggled to penetrate the local market. With Bibile gone, his public health policy also disappeared, marking the beginning of the decline of Sri Lanka’s public health sector.
Since then, many pharmaceutical companies have flocked to Sri Lanka, and private hospitals have boomed. However, the public health sector has survived by overcoming greater challenges. Yet, the system itself is now in peril, and the entire system may soon shut down. While successive governments are responsible for this breakdown, the medical community as a whole bears a greater degree of responsibility. Irregularities in medical education, acutely politicized trade unions, and excessive staffing have added fuel to the fire.
Now, it is evident that giant corporations originating from the US and India will take over the entire system, and the once well-functioning, internationally acclaimed public health sector will soon be a thing of the past in Sri Lanka. Sri Lanka was not alone; many countries faced the same scenarios. Let’s take Chile as an example.
Chile is often cited as an example of how neoliberal policies can have a devastating impact on public health. In the 1970s, the Chilean government implemented a series of neoliberal reforms, including privatizing the health care system. The government provided subsidies for private health insurance while cutting funding for public hospitals and clinics. The result was a two-tiered health care system, where those who could afford private health insurance received quality health care, while the poor and vulnerable were left to suffer. The privatization of health care also led to skyrocketing healthcare costs, making it even more difficult for those who could not afford private insurance to access quality care.
The decline of Sri Lanka’s public health sector is a significant loss, not only for Sri Lankans but also for the entire South Asian region. Dr Bibile’s public health policy was based on the principles of affordability, availability, and accessibility of medicines. However, with the rise of multinational corporations, the focus has shifted from public health to profit-making. The multinational corporations’ primary objective is to make profits, which means that drugs are often expensive and inaccessible to the poor. This is not the case with Dr Bibile’s public health policy.
It is crucial to revive Sri Lanka’s public health sector and restore Dr Bibile’s vision if Sri Lankan policymakers have the mind and heart to protect the country’s basic foundation. This requires political will, a commitment to public health, and a shift in focus from profit-making to public service. The medical community must also play a significant role in restoring public confidence in the public health system. By working together, Sri Lanka can restore its once world-renowned public health system and once again provide affordable, accessible, and quality health care to its citizens.
The rise of private hospitals in Sri Lanka has also contributed to the decline of the public health sector. Some private hospitals operate like mafia enterprises, pursuing profit at the expense of human lives. Patients are often subjected to unnecessary tests, procedures, and surgeries, all in the name of maximizing profit. Doctors are incentivized to perform more procedures and prescribe expensive drugs, regardless of whether they are necessary or not.
Moreover, private hospitals often cherry-pick patients based on their ability to pay. Wealthy patients receive preferential treatment, while poor patients are left to fend for themselves in overcrowded public hospitals. This has created a two-tiered healthcare system in Sri Lanka, where those who can afford it receive the best care, while the poor and vulnerable are left to suffer. Private hospitals have also contributed to the brain drain of Sri Lanka’s healthcare system. Doctors and nurses are lured away by the promise of higher salaries and better working conditions in private hospitals, leaving the public health sector understaffed and under-resourced. This has further weakened the already fragile public health system, making it difficult for it to compete with the private sector.
To address this issue, there is a need for greater regulation of the private healthcare sector in Sri Lanka. The government must ensure that private hospitals are not operating like mafia enterprises and that they are held accountable for their actions. There is also a need for greater investment in the public health sector, to ensure that it can compete with the private sector and provide quality health care to all Sri Lankans, regardless of their ability to pay. As Dr David Satcher, former Surgeon General of the United State says that “public health is the science of social justice, the art of preventing disease, and the calling of healers and caregivers.”
The decline of Sri Lanka’s public health sector is a significant loss for the country and its people. The rise of private hospitals driven by profit has only exacerbated the problem, creating a two-tiered healthcare system that is inaccessible to the poor and vulnerable. It is time for Sri Lanka to prioritize public health over profit, and to restore the vision of Dr Senaka Bibile, who believed in affordable, accessible, and quality health care for all. Otherwise, successful control of the Covid-19 pandemic will be marked as the last national endeavour of Sri Lanka’s public health system.