HEALTH, EDUCATION AND YAHAPALANA Part 5
Posted on April 18th, 2019

KAMALIKA  PIERIS

The final essay in this series  is on health.

We start with Sunshine stories”. Here they are:

  • European standard hospitals will be established in Hambantota, Panadura, Dambulla, Matale and Embilipitiya with German, Netherlands and French aid.
  • New accident wards are to be established in 24 General Hospitals and Teaching Hospitals located island wide.
  •  A total of 48 blood transfusion centres have already been established island wide.
  • A  clinical wastage recycling project, spending Rs. 2600 million will  be launched.
  • A foreign company will invest in E-Health system and issue E-Health cards for Sri Lankans .the company will include all State hospitals in the E-Health system. It has provided E-Health cards for 40 million people in Andhra Pradesh in India.

The country’s health care system will be digitized via an E-Health policy. According to the E-Health policy, all citizens will be issued E-Health Cards which will record their health conditions so that any doctor can have history of their patients. The E-Health System will be introduced to 45 Hospitals in the next two years 2018-19 .it is to be expanded to 300 hospitals following the initial implementation.

  • The government is to launch a project to manufacture a key ingredient in medical products using liters of blood plasma daily unused in the country. We will have a joint project with United States of America and India to produce certain ingredients which are very important in some medical products. When we export blood plasma, these countries manufacture these ingredients and export them back to our country for very high prices. With this new project, we will receive a quantity of these products for our local use.

***

In 2017, The Government Medical Officers’ Association (GMOA) urged  the Health ministry to appoint a suitable officer to the post of Director General of   Health services. This is the apex position in the health services and the post has been vacant for nearly one year now with an acting DGHS.

***

In 2018 The GMOA asked the Health Ministry to fill the 148 Deputy Director posts which had fallen vacant instead of creating  ‘Acting Deputy Directors’. There were 180 Deputy Director posts in the country and 148 of them were vacant. the vacancies had been advertised about one year back. But, no attempt had been made to fill them. Medical Superintendents in Base hospitals, Deputy Directors in all major hospitals, Deputy Regional Directors come under the category of Deputy Director. State-run hospitals are facing a crisis due to the delays in appointments. 

***

In 2018 the Government Medical Officers’ Association  warned it would resort to a strike if the North Central Provincial Council attempted to bring doctors serving in the province under the Provincial health service. North Central Province (NCP) had, in a letter, informed the Provincial Director Health Services that the Council had taken a decision to absorb doctors under its purview. GMOA said doctors belonged to the All-Island service.

The doctors had also wanted to take up with the Governor NCP several other issues including Indian medical officers conducting mobile clinics in the East, the misuse of World Bank funds and the delay in paying doctors’ overtime. A group of GMOA representatives in the East who attempted to take up those issues at a meeting with Governor on March 29 had been threatened.

***

Puttalam nurses staged a demonstration in March 2018 saying that they had worked in Puttalam for nine years and had got transfer orders but the hospital is not letting them go.

***

Doctors protested in 2018 against an appointment of a second vascular surgeon to the Ragama Teaching Hospital (Colombo North Teaching Hospital) from outside the annual transfer list. The surgeon involved was sent to the Anuradhapura Teaching Hospital in 2016.Two years later a special position had been created for a second vascular surgeon at Colombo North Teaching Hospital (CNTH), Ragama and this surgeon appointed to it, in violation of the annual transfer list. Doctors allege that the second position had been created to accommodate this particular surgeon. Director of the Ragama hospital told the Director General Health Services, that two vascular specialists are not required in his hospital as the hospital doesn’t have a specialized unit for vascular surgery.

***

The post of the Chief Epidemiologist was always held by a qualified epidemiologist but a doctor without the required medical knowledge  was   appointed to this position in 2017. Protests were made by the GMOA, former Chief Epidemiologists, current Epidemiologists and senior academics.

Chief Epidemiologist, Dr. Paba Palihawadana, sought and obtained no-pay leave from the Health Ministry to join the UN service for one year, in 2017. While she was on no-pay leave, another senior public health specialist of the Epidemiology Unit acted for the Chief Epidemiologist. However, when Dr. Palihawadana reported back for duty as Chief Epidemiologist on January 1, 2018, she found that another person had been appointed to the post.

Dr. A.  Dissanayake was appointed as Chief Epidemiologist on December 19, 2017, There was an advertisement, I applied and I was selected,” he said, pointing out that the appointment was made by the Public Service Commission in accordance with the prevailing medical minutes. Dr. Dissanayake said he had headed the National Blood Transfusion Service for several years.  Before that he was Regional Director of Health Services (RDHS) in Kalutara, where he was handling everything”. The medical profession did not agree. They said Dr D. did not have the necessary qualifications.  He had a M.Sc in Medical Administration.”

According to  circular No. 02-132/2000 dated September 26, 2000, the Chief Epidemiologist should be a Board certified Consultant in Community Medicine with work experience in epidemiology,. These criteria are also included in the Medical Services Minute of 2014. All Consultants attached to the Epidemiology Unit have these qualifications and field experience in epidemiology-related activities.

The Epidemiology Unit is responsible for controlling communicable diseases. If there is a major outbreak of a communicable disease, the Epidemiology Unit, will not be able to handle the crisis with a non-technical head without a background in epidemiology, Sri Lanka’s much-commended public health system would crash with the next outbreak of disease.

All epidemiological-related activities — which include communicable disease control and the immunization programme – are coordinated and implemented through Regional Epidemiologists based at district-level. When the Regional Epidemiologists need any technical input, it has to be provided by the Chief Epidemiologist. the Chief Epidemiologist has to provide technical advice and guidance to these Consultants. The doctors will not be ready to follow the medical instructions given by a doctor who does not have the requisite knowledge. That is why we think that the current Chief Epidemiologist cannot handle the job,”

Doctors pointed out that a non-technical doctor  had been appointed to head the Dengue Control Programme. He had abandoned” his post during the height of the dengue epidemic in 2017. The main reason for influenza reaching the epidemic level in the Southern Province is the appointment of a  doctor without the relevant medical knowledge to the post of Chief Epidemiologist, said the GMOA in May 2018.

The influenza started to spread in the Southern Province one month ago, but nothing was done to control it, The Chief Epidemiologist kept mum. Now it is up to the parents and the school authorities to control the outbreak and prevent it from spreading all over the country.  The Epidemiology Unit and the Chief Epidemiologist is not ready to face any possible disease outbreak that could occur as a result of the present floods, either.

***

Cardiothoracic surgeon Dr. Namal Gamage has decided, in July 2018, to stop performing surgeries as the air-conditioner at the Karapitiya Teaching Hospital was not functioning. There were around 3,000 heart patients waiting to undergo heart surgery at the hospital. Although a number of requests had been made for repairing the central air-conditioning system, no action had been taken, The patients also made the same request to the authorities.

***

The Health Ministry said in 2017 it would make use of theatres at private hospitals to perform cardiac and eye surgeries to clear waiting lists at government hospitals. The surgeons and staff would be from the government and private sectors.  Health Ministry would meet the cost. The private hospitals  have submitted their charges for each surgery and the time table during which the operations could be performed. The Private Sector Regulatory Authority would study the report and come up with an action plan.

***

The Emergency medical Service system of the country will soon be strengthened with eight Airbus Helicopters and 28 state-of-the-art emergency vehicles, said the Ministry in 2017. Steiger Foundation of Germany will provide 24 helicopters, 1,025 ambulances and 24 emergency vehicles. Helicopters will be  useful addition to the system,  considering   road traffic congestion . Sometimes ambulances could not travel through roads due to traffic congestion.

The government  announced that it has decided to continue with Sri Lanka’s pioneering  Pre Hospital Emergency Care Ambulance Service, Suwasariya, launched with Indian financial backing  in 2016. the free ambulance services now operating in Western and Southern Provinces will be expanded covering the entire country by  2018. Joint Opposition pointed out in Parliament  that  it was the ambulance service in the hospitals which should be expanded.

The Indian firm GVK EMRI LANKA operated the free ambulance  service through a Public-Private Partnership with the Ministry of Health,. The operation is a 24 hour, 7 days a week, round the clock service, the Control Centre received over 322,000 calls and has served over 32,000 cases, out of which, cardio, trauma, and stroke were the major cases.

In a Memorandum to the Cabinet of Ministers, Wickremesinghe had said that the Pre Hospital Emergency Care Ambulance Service, which was launched in the Western and Southern Provinces with GVK EMRI Lanka Limited and assistance of the Indian Government on July 29, 2016 had by April 2017, responded to 236,000 calls with an average responding time of 12.52 minutes and transported 130 to 135 patients daily.

In a ‘letter to the editor’ which was supposedly to praise a hospital ward, ‘Concerned woman’ heaped praise on the Indian ambulance service which she said was excellent. The service included a  doctor, a nurse and nurse aide. They were trained in India,  including  the driver. They knew emergency medical action. they were considerate and capable. They helped revive her husband with emergency first aid. All this at no cost thanks to the present government, she said.

***

Health Ministry has. in 2018,  outsourced the laundry services of hospitals in the Western Province to an Indian Company, complained Government Medical Officers’ Association  . The GMOA wanted this outsourcing of the laundry in government hospitals to an Indian Company, stopped.

The Ministry said that the new  laundry  service would be provided  by the Sri Lankan affiliate of India’s Sugram Hospital Solutions, which is engaged in laundry services at several hospitals worldwide, The service is a Board of Investment (BOI) project under the Build, Operate, & Transfer (BOT) method with a  USD 4 7.5 million investment. The government does not bear any expenses for the project. Constructing  of  buildings and installing required machinery, will be done at the expense of the investors, After 15 years the project, with up to date technology will be transferred to the Ministry of Health. More than 300 unemployed youths will be given employment.

Under the project, the garments used by the patients and staff during the surgical procedures will be sterilized using modern methods, washed and ironed, sealed in protective covers, and transported to the hospitals in sterilized trucks. The Ministry of Health will spend less than the cost incurred by the hospitals on local laundry services at present.

 The Ministry said doctors in Western Province had complained about the local providers who were engaged in the laundry service for the hospitals in the Western Province. They were using substandard materials for sterilization,  they were not sterilizing, there was  delay in providing cleaned laundry to hospitals during rainy season,  and the possible spread of skin related diseases due to incomplete cleaning also, white-colored bed linen are brownish. They were washed with water from the Beira Lake.

GMOA replied that the local agencies involved in washing hospital linen had been registered with and certified by the Health Ministry after calling for tenders. They were experienced and met the required standards. The charge that Beira Lake water was used for washing hospital linen was incorrect. GMOA wanted to know whether cleaner water was to be brought from India or whether linen was to be sent to India to be washed and brought back to Sri Lanka.

This was yet another instance of Sri Lankan politicians acting as agents of foreign countries. They were selling government institutions and services to foreign companies, said GMOA.   GMOA had warned that the Economic and Technology Corporation Agreement (ETCA) would threaten the services and professions in Sri Lanka. Now, it seems that not even small enterprises and family trade would be safe with ECTA,  said GMOA. This project has no relevance to ETCA, replied the Ministry.

***

there were 13 local drug manufacturers who locally produce 82 items for the State Pharmaceuticals Manufacturing Corporation, said the Ministry at a media briefing in 2017. Ten more local manufacturers producing 40 more items will join the local drug manufacturing in the near future. a total of 38 agreements have been signed between the government and the local drug manufacturers to produce drugs in Sri Lanka .Sri Lanka has already begun local drug production at two factories situated in Kandy and Horana.

Sri Lanka expects to produce 80% of its drug requirements by the end of 2018, which will save USD 400 million plus annually which the government spends for drug importation. Accordingly, the importation of all drugs which can be produced locally, will be stopped by the end of 2018.

**&

The State Pharmaceuticals Manufacturing Corporation of Sri Lanka (SPMC) and Pharma Zone (Pvt) Ltd entered into an agreement in January 2018, to build the first ever exclusive pharmaceutical manufacturing zone (Pharma Zone) of Sri Lanka. It will be located on 50 acres in Welipenna, Kalutara district at an investment of over US $ 10 million. to be.

The Pharma Zone is a BOI approved company whose principals are the Sultan of Johor and Patrick Lim Soo Kit, a leading Malaysian entrepreneur. This is a 100 % Malaysian investment and it underlines the high regard that the Sultan and the people of Johor for Sri Lanka, said the Ministry.

The Zone will be run and administered by Pharma Zone, headed by Patrick Lim Soo Kit, while the SPMC along with the Ministry of Health will set the standards and monitor quality. Electricity, water, road infrastructure, security, waste water management,  will l be provided to the companies operating within the Zone. it is the intention of Pharma Zone to attract overseas investors to set up operations within the Zone as well. “We will be marketing Pharma Zone regionally,” said Lim.

Pharma Zone will facilitate the local pharmaceutical manufacturers with sufficient land for manufacturing plants and basic infrastructure facilities for the manufacture of pharmaceutical products. So that the government can achieve its target of localising production of essential pharmaceutical items to a value of US$100 million. with the completion of the Pharma Zone, envisaged to be in operation within one year, the country’s dependency on imported drugs will soon become a thing of the past, said the Ministry.

**&

 In 2017 the Health Ministry announced an exclusive agreement between the government and the staff of the State Pharmaceutical Corporation (SPC) to grant a staggering 55 per cent salary increase to the lowest paid employees and 41 per cent pay hike to their highest paid counterparts. This  salary increase had been granted due to an impressive profit of Rs 1,800 earned by the SPC . it would be effective from July 1, 2017 to June 6, 2020.

***

Hospitals do not have adequate drugs to treat cancer patients and are not sure when the drugs will arrive critics said in January 2019. This is due to the delay in appointments to tender boards. That is turn is due to vetting process by the committees appointed by the President. The Boards cannot function until persons are formally appointments to tender boards. the Medical Supplies Division  of the Health Ministry and the State Pharmaceuticals Corporation (SPC) responsible for supplying the required medicines confirmed that delays in appointing tender boards and the release of payments to suppliers had adversely affected the supplies.

 The resulting delays in completing tender processes has  particularly affected the purchase of vital drugs for cancer patients.. medical authorities have been forced to defer treatment of cancer patients throughout the country. the country’s main Cancer Hospital, ‘Apeksha’ in Maharagama  was forced to tell patients to come back later for treatment or advise them to by the medicine from private pharmacies. Hundreds of patients have already been turned away, reported the media.

***

in September 2018,  Health Ministry officials said that a crisis is looming in the health sector due to the Treasury not releasing more than Rs 20 billion to settle bills for essential items, including medicines,  it is the first time such a large amount has been outstanding. Of this, Rs 10 billion is owed to the Health Ministry. Another Rs 10 billion is due to the State Pharmaceuticals Manufacturing Corporation (SPMC) which has not been paid up to five months for production of essential medicines. Arrears to the tune of Rs 450 million are owed to one supplier.

The SPMC takes out loans to manufacture close to 200 pharmaceuticals. When Treasury reimbursement is delayed, it is forced to reduce the quantity of drugs it produces or cease manufacturing completely. This is because it costs money to import the raw material required to make the medicines in Sri Lanka. All these medicines are for Government hospitals,” said the official. If the outstanding amounts are not settled soon, manufacturers will refuse to provide medicines, plunging the free health service into crisis.”. There is also no money to advertise tenders, meaning those that are in the pipeline will be delayed.

***

 In 2017 Yahapalana government   purchased two clinically untested cancer drugs  Trastuzumab and Bevazizumab, produced and imported from Russia. In 2016, 25 oncologists wrote to the Health Ministry advising it not to import these two  drugs.   The drugs were of low quality and were not used even in Russia. Their price was higher than other drugs which have US Food and Drug Authority (FDA) approval.

The drug was hurriedly registered in the NMRA    and tenders called. There were no Oncologists in the technical committee which approved the tender. The tender was floated by the State Pharmaceuticals Corporation of Sri Lanka (SPCSL). (Tender No. LP/MSD/CPU – DHS/RQ/016/018). The five shortlisted bidders submitted quotations for Rs. 64,700, Rs. 93,950, Rs. 109,000, Rs. 135,900 and Rs. 190,000 per vial, respectively. The second highest bidder wasawarded thetender, despite a substantial price difference of Rs. 39 million for the whole stock of 557 vials.

The company which submitted the lowest bid wrote to the authorities, complaining about the unjust manner in which it was elbowed out and the tender awarded to the second highest bidder. The lowest bidder  said that he too was able to supply 100 vials ex stock (with three vials free of charge) and the balance within 14 working days on receipt of the confirmed order.

A second purchase  order was placed on October 3, 2017 with the local supplier for another 2,500 vials of Trastuzumab at a staggering cost of Rs. 360,250,000, despite a competitor offering a time-tested, FDA approved product, at a competitive price. The move to purchase another 2,500 vials of a product which has generated much controversy is beyond belief, said critics. Somebody is making a big kill on the bid. Otherwise, why opt for a higher price when a better, time-tested drug is on offer.

After the appointment of Mahinda Rajapaksa as Prime Minister and Chamal Rajapaksa as Health Minister,  in October 2018, the SPC had ordered a better and cheaper drug, but when a court order preventing the Prime Minister and the Cabinet from functioning was made, the SPC  cancelled the order and again ordered the Russian drug.

The SPC bought 557 vials from this company at the second highest bid price of Rs. 135,900 each at a total cost of more than Rs. 75 million. The lowest bidder had offered the stock for Rs. 36.37 million which meant that the government had spent an additional Rs. 39 million. analysts said this was done to prevent losses to the local importer of this drug.  The importer was holding large stocks of this very expensive drug. It had known that the Ministry  will definitely purchase the drug from them. These three purchases have resulted in a colossal loss of more than Rs. 108 million to the country, said critics.

***

From the time Yahapalana government took power,  the GMOA has been actively opposing  the government  on economic issues such as ECTA. They  antagonized the government and the government  retaliated . In November 2016, the tyres of cars belonging to doctors has been deflated at the Ministry. Doctors at Kandy, Kurunegala and Matara had suspended work for four hours as protest.  

There were several disagreements between the doctors and the  Health Ministry. GMOA said government has cut down vehicle permits, their children were not given good schools when transfers were made and did not grant schools to their children  when they returned from abroad, Government said schools had been given. Doctors said , no. Not all children had  got schools. only     20 out of 138 children had got schools. Doctors were contemplating trade union action

doctors also complained of an inordinate delay in the implementation of enhanced transport allowance as well as the amendments in respect of duty free vehicle scheme. They objected to the  way they were taxed in Budget 2017. they  staged a lunch hour protest demanding that the government solve several issues of the Budget 2017. Western province doctors would stop private practice for a day, against the budget proposal to tax government employees  private practice. 

Association of Medical Specialists said in June  2018 they would refrain from private practice  in protest over the new tax policy for doctors All specialists doctors will strike if the discussion with the Finance Minister fails. Yahapalana gave in and said they would give the disturbance, availability and transport allowance. and allowances will be increased. Also doctors  private practice will not be subject to tax.

In 2017, the Ministry said that GMOA was preventing  the routine transfers. GMO said that was nonsense. The GMOA has always participated in the transfer process for years and it is only  in 2017 that GMOA has clashed like this with the Health ministry. The ministry has still not got the transfer list ready,  they said. The list should have been published in December last year and by now the doctors would have been in their new stations. ( Concluded)

Leave a Reply

You must be logged in to post a comment.

 

 


Copyright © 2019 LankaWeb.com. All Rights Reserved. Powered by Wordpress