CURATIO – Perspective

Doctors are the backbone of the entire health system. Migration of doctors and other healthcare professionals from this country has a long history. However, the number has drastically increased in the last year due to the economic crisis and political uncertainty followed by the COVID-19 pandemic. In the period between May 2022 to May 2023, a total of 842 graded medical personnel has left the country, and 274 specialist doctors have left the country [1]. Applications for leaving the country are increasing rapidly on a daily basis [2]. If this trend continues, there is no doubt that our entire health system would collapse in the coming years.

It is important to analyze the reasons for the migration of healthcare professionals. Sri Lanka’s annual inflation rate rose above 70% as of August 2022[2], the worst economic crisis in over seven decades. However, wages did not keep up with this inflation. After long working hours, they were paid less. In addition to that, doctors also suffer from higher Pay As You Earn (PAYE) tax rates [2]. Therefore, doctors were facing difficulties providing a comfortable lifestyle for their children and family. Consequently, most doctors intend to move towards the Middle East or Western countries for better salaries and lifestyle [4].

Doctors who have gone for foreign training are reluctant to return to the country because of the prevailing political and economic instability. Nearly half of the doctors who left the country for foreign countries did not return back in the last year (2022) [6]. Countries with political stability and a lower crime rate are suitable for long- term stable settlement. The Government Medical Officers Association (GMOA) revealed in February 2023 that there was a shortage of 140-150 out of 1500 essential medicines, even commonly used ones like aspirin, metformin and anesthetics, as well as medical equipment like cannulas and syringes, were not supplied according to demand [3]. This deprivation of essential resources hampers doctors’ ability to perform their duties properly, leading to a lack of trust in the healthcare system and doctors among the public.

Doctors pursue better research facilities and a wider variety of specialties [5] and subspecialties in their field, which tends to lead them to migrate to foreign countries. Some doctors believe that foreign countries offer a better work- life balance compared to Sri Lanka, with reduced working hours and more time allocated for personal space and leisure activities. In Sri Lanka, due to prevailing situations, the workload on existing doctors has drastically increased because they have to perform the duties of the emigrated doctors as well [3]. This increased workload is affecting the mental peace of the doctors.

Remedies that can be done to minimize the exodus of doctors include: governments taking initiatives to provide salaries, tax incentives, and allowances that can reasonably match the benefits that doctors get by practicing abroad [4]. Doctors practicing in rural areas should be provided with special care by offering proper housing facilities and transport incentives to encourage their stay. The government should fund and support research facilities with foreign collaboration to provide better access to research. Additionally, they should take necessary action to provide a better working environment with manageable patient numbers, reasonable working hours, allocation for personal space and leisure, and proper recruitment of an adequate number of other healthcare staff to reduce workload. The government should increase the amount of money allocated in the annual budget for the health sector to purchase advanced medical equipment for public healthcare and improve infrastructure facilities to provide a better working environment [2]. Policymakers should provide necessary actions to bring back specialists and other senior doctors who have migrated with prior notice or without proper permissions.

If the government fails to take initiatives to overcome this problem immediately, then there will be a collapse of the entire public health system of Sri Lanka in the coming years. It is also a moral obligation of doctors to stay in the country during its worst period and to support its health sector in order to rebuild the nation rather than escaping the country by giving more importance to their personal benefit.

References

1. de Silva, N. L., Samarasekara, K., Rodrigo, C., Samarakoon, L., Fernando, S. D., & Rajapakse,S. (2014). Why do doctors emigrate from Sri Lanka? A survey of medical undergraduates and new graduates. BMC Research Notes, 7(1), 1-7.
2. Apr 11, 2023 — Title: Framework for Sri Lanka’s health workers’ mobility adopting fair and ethical recruitment ISBN: 978-92- 2-038114- 4 (web PDF).
3. Mudugamuwa, M. (2023), Skilled migration: About 700 doctors left Lanka in 2022. Skilled migration: About 700 doctors left Lanka in 2022 | The Morning (accessed on Oct 1, 2023).
4. De Silva, P., Liyanage, I.K., De Silva,S.T.G. et al. Migration of Sri Lankan medical specialists. Hum Resour Health 11, 21 (2013). https://doi.org/10.1186/1478-4491-11-21
5. De Silva, P., Liyanage, I. K., De Silva, S. T. G., Jayawardana, M. B., Liyanage, C. K., & Karunathilake, I. M. (2013). Migration of Sri Lankan medical specialists. Human resources for health, 11(1), 1-6.
6. Silva, M.D. (2017). How many Medical specialists do Ministry of Health- Sri Lanka need by 2025: Use of system dynamics