KAMALIKA PIERIS

The subjects of Health and Education were devolved to the Provincial Councils in 1988. The transfer was not difficult. Both services had been successfully de-centralized decades ago, and it was these decentralized services that were transferred to the utterly unprepared Provincial Councils. Health and Education are specialized services, which were delivered by trained personnel  in  the  central government .The Provincial Councils   lacked  this  expertise and one survey concluded that the 13th Amendment when applied to health and education has ‘been a disaster’.

Before the 13th Amendment, the island had a decentralized education system, with educational regions and a good network of schools. After the 13th Amendment there were three central government ministries and nine provincial education ministries. There were Provincial boards of Education, Provincial Teachers service and a four tiered Provincial Education Authority as well.  All government pre-schools  and over 9000 primary and secondary government schools were handed over to the Provincial Councils. 328 national schools continued under the central government. Recruitment, transfers and discipline of teachers came under the Provincial Councils but   school principals were appointed by central government.

The Provincial Councils have not delivered a satisfactory education service.  327 schools   were closed by 2002.     In the Western province   alone, 129 closed by 2009. There were other issues. Southern Provincial Council owed salary arrears of more than Rs 275 million to 12,960 teachers in 11 educations zones in 2010. Western Province was short of nearly 1000 principals making it almost impossible to run the schools. There was a surplus of teachers in Kurunegala, while Puttalam had a shortage of teachers.

In the North Central province around 1500 teachers had got themselves transferred out of the province. 425 teachers in Sabaragamuwa had asked for transfers to Western province in 2003. Since most were science and maths teachers, about 100 to 150 schools in Sabaragamuwa will have to be closed down, ‘if they go’, informants said. Teachers could be transferred only if replacements were given, but central government could not transfer a teacher from a national school to a provincial school.  School principals faced political interference of a special sort.  A principal could find himself caught between the village politicos and Provincial Council politicians and yet have to follow education regulations.

Schools were subjected to term tests prepared by Provincial Education Departments. These term tests were full of serious errors and blunders.  The following were reported in 2009 and 2013.  Grade 11 Buddhism paper at Anamaduwa division in Puttalam was to have 40 questions but only 20 were given. Elsewhere students had been asked to answer 4 questions but only 3 questions were provided. .  For the    grade 6 Sinhala paper in North Central Province the answers came with the questions. In Southern Province also the answer sheet has been provided with the question papers.

Western Provincial Council found that the 16 locations where the term test papers were printed had no procedures to ensure secrecy. A laborer had sold some of the question papers. The excuse was lack of staff. There were only 200 staff, but 460 were needed, also the staff were recruited on temporary basis. In 2009, it was decided that central government would prepare the test papers, printing and distribution would be carried out by the Provincial Councils. No country in the world carries out term tests at provincial level as Sri Lanka is doing. This is ridiculous and should be abolished, said an educationist. Term tests should be set by the school.

‘The centralized system was far better than the PC system. Most people who have experience both will agree’ said another educationist.     However,   Provincial Councils are not giving in.  Provincial Chief Ministers conference of 2006 passed a unanimous resolution, against the decision to bring the Provincial Teacher service under the central government.

Sri Lanka’s health service was, from its inception, administered by the central government.  It was decentralized around 1954. Each region had a Superintendent of Health services (SHS) who did the transfers and also hospital repairs. He reported to the Director of Health Services in Colombo. Though decentralized, doctors, nurses and paramedical staff were transferable throughout the island, excess drugs in one hospital could be sent to another hospital, and infectious diseases could be controlled through all-island strategies.

After the 13th Amendment was passed, all hospitals other than teaching hospitals went to the Provincial Councils.  The curative services got divided but the preventive services, including the Medical Officers of Health (MOH) went completely to the Provincial Councils.  Each province had the following hierarchy: Provincial Minister of Health, Provincial Secretary of Health (who is a SLAS officer), Provincial Director of Health services, Deputy Director and several Regional directors. The Provincial Director reported to a SLAS (Sri Lanka Administrative service) officer, not to a medical person as in the centralized service. This massive increase in  the medical administration sector,  including cars, offices, and staff, added a huge extra sum to the  all ready overstretched   health budget of the central government .

The Provincial hospitals were heavily dependent on the central government for funds, drugs and staff.  Doctors in the provincial service remained a part of the all- island service and their salaries, transfers and training were looked after by the central government. They were members of GMOA. The Finance Commission which funded the Provincial Councils allocated money for hospitals based on the returns sent. ‘Government never gives what is asked’, one doctor complained.   Drugs were purchased by the central government and distributed to the provinces, according to the funding allocated to that province and the drug estimates they had sent.

The Provincial Councils have not provided a good   health service. In 2004 hospitals in Wayamba Provincial Council lacked ambulances and drugs. Anamaduwa hospital ambulances were generally out of order.  In 2012 Ginigathhena hospital   had only two doctors, the others had gone on transfer and were not replaced. There was also a lack of nurses and laborers.  In 2014 hospital employees in North Central Province staged a protest, demanding that their appointments be confirmed.

In an attempt to reduce costs, Sabaragamuwa Provincial Council had issued a circular ordering the staff to work only one Sunday a month. Extra duty time was also reduced to twenty hours.  Trade unions pointed out that doctors, nurses and other health workers   worked 60 to 70 hours owing to the severe dearth of hospital staff. ‘This showed how little the Provincial Council knew about hospital services’, the unions observed. ‘You cannot simply close a hospital on a weekend or take a Sunday off leaving patients unattended’.

The Provincial Councils ran their large hospitals so unsatisfactorily, that the central government was compelled to take over many of them. Central government took over Polonnaruwa, Chilaw, Gampola, Hambantota, Kantale, Ratnapura and Kegalle hospitals , with the consent of the Provincial Councils. Nuwara Eliya General Hospital was taken over in 2006 after a series of poor performance reports, which showed, among other things, an increase in maternal and infant mortality. Trincomalee General Hospital was taken over at the request of the Eastern Provincial Council.

Doctors had been asking central government to take over Anuradhapura hospital since 1994. Anuradhapura hospital, with 1348 beds, is the third largest hospital in Sri Lanka, after Kandy and Colombo. The takeover attempt in 2000 failed. Provincial Council refused to hand over.  In 2003, the doctors again urged the ministry to take over the hospital, saying the hospital had gone from bad to worse under the Provincial Council.  The Hospital did not have even the basic medicines. Surgeons could not operate since the operating theatres and the Medical intensive Care Unit were in a ‘state of continuous collapse’.  Air conditioning and lights did not function. There was a constant water leak.  The hospital had stopped conducting routine surgeries and only did emergency ones.  Some surgical cases were transferred to Colombo or Kandy. That was too far away. The Joint trade Union action committee of the hospital   exerted pressure (‘agitated’) and the North Central Province handed over the Anuradhapura General Hospital to the government in 2006. (http://www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=138897)