The Health Professionals Association (HPA) of Sri Lanka cancelled strike action that was to occur on August 4. The stoppage had been called to demand that the health ministry withdraw a circular banning its employees from speaking to the media on issues related to the public health service.
The circular, issued on July 20, included a blanket ban on public health staff making any statements or expressing their views on the sector. It cited a Supreme Court ruling that state employees have no right to make comments to the press without prior approval from their departmental head.
The circular warned that violation of this regulation is punishable under the Establishment Code governing state sector employees. Disciplinary actions include warnings, suspensions or termination.
Justifying the cancellation of industrial action, HPA leader Ravi Kumudesh said that the ministry secretary, Janaka Sri Chandraguptha, had given a written assurance that the ban would not apply to the union and similar associations. It would, however, continue to apply to rank-and-file health employees, Kumudesh added.
In effect, the union has agreed to the ministry using the anti-democratic regulations to penalise health workers speaking about or exposing the collapse of the health sector, something that affects the lives of patients, employees and the population as a whole.
This censorship is an outright betrayal of the democratic right to freedom of expression. It underscores the role of the union as an industrial police force of the government and the corporations.
Last Monday, Health Minister Keheliya Rambukwella defended the circular, saying: “Some people are trying to use health as a very sensitive area to bring another agitation in the country.” Without a shred of evidence, he cynically branded all comments circulating in the media about the worsening health crisis as “false.”
The attempt to silence health professionals, including doctors and nurses, is tantamount to insisting they breach their medical oath to serve their patients. They are forbidden from speaking about the consequences of the government’s cuts, which have brought the public health system to the brink of collapse.
The Health Ministry circular was first issued in May 2021 amid the COVID-19 pandemic, provoking anger among employees and the public more broadly. Former President Gotabhaya Rajapakse declared that “responsible officials should not unnecessarily hold media briefings and panic the public about the pandemic.”
In the same month, Rajapakse imposed the Essential Public Services Act on key government services, including health. This act bans all industrial action, with penalties including jail, fines and dismissal.
Last November, the health ministry suspended Dr Chamal Sanjeeva, president of the Medical Professional Association for Civil and Medical Rights, accusing him of “causing inconvenience to the government” by presenting “false” information to the media.
Sanjeeva had revealed to the press that in one region of the southern Hambantota district of Suriyawewa, 30 percent of children were suffering from severe malnutrition and 50 percent from mild malnutrition.
He told the World Socialist Web Site that the figures were based on a scientific survey, adding: “It is my democratic right to reveal its results to people.”
The circular was reissued last month amid mounting anger among health workers and the broader population. A number of deaths and serious illnesses have been reported in state hospitals that are thought to have resulted from low-quality drugs and injections.
On July 11, a 24-year-old woman died at the Peradeniya Teaching Hospital after being administered a Ceftriaxone antibiotic injection. Similar deaths and more than 15 allergic reactions have been reported in Colombo, Kandy, Ragama, Nuwara Eliya, Kilinochchi and Panadura hospitals.
The State Medical Supplies division has been forced to remove 64 drugs and items of surgical equipment from use because of complaints from hospitals over their low quality. The lack of drugs and frequent malfunctioning of medical equipment is forcing the postponement of scans, dialysis and urgent surgery, including heart operations and kidney transplants.
Public anger has also been fueled by reports that pharmaceutical companies and ministry officials involved in importing low-quality drugs have engaged in corrupt practices and underhanded deals.
In a television discussion on July 11, Dr. Ananda Wijewickrema, a medical specialist at the National Institute of Epidemiology, said the health ministry was importing drugs not approved by the National Medical Regulatory Authority.
Health employees, patients and their relatives have spoken to the media, including the World Socialist Web Site, about the situation they confront.
A nurse working at the Peradeniya Teaching Hospital said she and her colleagues are working in terrible conditions due to the lack of adequate staffing. Though it is necessary to do dialysis for kidney patients three times a week, it is happening only two times. In the Kandy National Hospital, it occurs only once a week.
She spoke about a death of a young girl at her hospital who had been administered a cefuroxime injection: “Our colleague who administered this injection has been condemned on Facebook and is facing mental stress. It was not her fault. This is the only medicine available. Employees have to pay for the health crisis. Not a single trade union has come to her defence.
“Instead, the unions have now agreed to the authorities using this anti-democratic circular against employees. Unions could use this circular to silence criticism of themselves.”
A doctor at the Kandy National Hospital told the WSWS that there was a serious shortage of medical drugs earlier. The situation had improved slightly. However, because of the poor quality of these drugs, staff had to explain the situation to patients and ask whether they wanted to use them.
“Those who have money can buy the relevant drugs from outside. What about the others?” the doctor asked. “We have been compelled to use these drugs as we are government employees. Because of the ministry secretary’s circular we cannot explain this true situation to people.”
While the HPA leaders met with health authorities, other union leaders issued perfunctory statements or called limited protests to let off steam among angry workers.
On July 18, thousands of state health employees held demonstrations to oppose the regulations at key hospitals including the Colombo National Hospital and at regional facilities. Protesters displayed placards with slogans such as: “Prevent the importation of inferior medicines,” “Patients’ lives are in danger,” “Stop the privatisation of health services,” and “Let’s get rid of the dysfunctional government that takes the lives of patients.”
This limited action was called by the All Ceylon Health Employees Union, which is controlled by the opposition Janatha Vimukthi Peramuna (JVP). The JVP’s overriding interest is not the democratic rights of workers but to boost its bid to form the next government.
The COVID-19 pandemic exposed the deep crisis of the country’s health system, which was unable to cope with the deadly disease. Successive governments have provided a small allocation for public health in their annual budgets—on average about 1.5 percent of gross domestic product.
Now, the government of President Ranil Wickremesinghe is implementing the austerity demands of the International Monetary Fund (IMF), one of which is to slash state expenditure, including on public health. At the same time, the government is taking steps to privatise health care and liquidate what remains of the free public health service.
The trade unions bear responsibility for the present crisis in the health sector. Since 2021, the unions have been forced to call more protests and strikes in the sector than in any other state institution. But those actions have been aimed at sowing illusions that the government can be pressured to make concessions.
Health employees must take matters into their own hands and form action committees independent of the trade unions and capitalist parties to defend their democratic and social rights. The Socialist Equality Party (SEP) is campaigning to build such action committees, democratically elected by workers in every workplace. We say:
- Withdraw the repressive censorship circular! Withdraw the Essential Public Services Act!
- Provide adequate staffing, medical drugs and vital equipment!
This means billions of rupees must be allocated for public health. However, the Wickremesinghe government is intent on repaying foreign debts and boosting the profits of big business and investors at the expense of the working class.
The proper provision of resources for health, education and vital welfare programs is bound up with the broader struggle to reorganize the economy for the benefit of the vast majority of society. This requires the repudiation of all foreign debt and the nationalisation of the banks, large estates and big companies under the democratic control of the working class.
The Socialist Equality Party (SEP) is fighting for these socialist policies and a workers’ and peasants’ government to implement them as part of the broader struggle for socialism in South Asia and internationally.