Free Education

2017-03-24

How GMOA exploits

Doctors are educated from Grade 1 to MBBS Final

exam with taxpayers money
Private hospitals increased from 66 in 1990 to 125 in
2011 and they keep growing
Government medical doctors who worked part-time
in private hospitals almost indispensable
Private hospitals, now service 27% of hospital
services
 Private hospitals need permanent medical doctors to
serve them
medical mafia can only be challenged by the people
Recent media reports say the GMOA has decided to keep
away from private practice and channelling for 02 weeks
from 30 March. Available numbers in past years show the
month of April as a lean month for both private and public
healthcare. Probably the habit of seeking medical
treatment even for the common cold is overtaken by the
festive mood, especially in the first two weeks up to
Sinhala and Hindu New Year. The GMOA has thus chosen
that lean period for their protest while proving they were
desperate now.
Not surprisingly, they dont say they would stop private
practice altogether on principle. That they would never
say. In fact their slogan of free education with no
private sector medical faculties is to continue
monopolising the lucrative private medical sector and not
strengthen Free health
in any way.
Sri Lankas proud achievement in life quality was gained
through national health programmes carried within free
health. What we have gained on the mortality rate, life
expectancy at birth, infant mortality rate, live births,
eradication of Malaria, Poliomyelitis, etc. were on the
strength of the network of trained field staff. Public Health
Inspectors, Medical Officers of Health, Family Health
Officers (previously known as mid wives) and also
Apothecaries (RMPs) who were posted to outpatient
dispensaries in rural areas played vital roles in making life
healthy and above average. National free education
played a catalytic role. This very effective healthcare
system with emphasis on preventive community health
evolved after the State Council was established under
colonial rule and was strengthened and expanded post
independence, during the first decade.

In these early post independent period, government

medical doctors were accepted as noble practitioners,
with private practice (PP) being more a personal pasttime
than another income source. In mid 60s with more
government doctors taking to PP, then government
banned PP to ensure government hospitals remained the
main curative health service provider. Private medical
practitioners were no doubt there outside the government
service, a few in mostly urban areas, where the middle
class preferred to have a family doctor.

The open market economy after 1977 once again allowed

PP. Free market economy cultivated new choices and
needs within a growing middle class. It led not only to
private clinics that mushroomed in city kerbs, but also in
remote villages too. There was no effective regulatory
mechanism to keep a tab on PP and channel practice
that emerged.

Growth and expansion of private medical practice during

the next decade did not mean, government medical
professionals left the service for private employment.
Instead, they spent more time in private practice and
channel service to earn more and more for a fast and
fastidious life. This also changed attitudes and priorities
of the medical profession. As observed in the working

paper An inquiry into the regulation of

pharmaceuticals and medical practice in Sri Lanka co-
authored by Nimal Attanayake and Laxman
Siyambalagoda, .the opening up of the economy along
with the rapid expansion of private practise resulted in a
new behaviour pattern among medical practitioners.
Initially, a hidden effort seems to have existed amongst
professional bodies to safeguard their members from
allegations. (HEFP working paper 05-03, LSHTM, 2003 /
page 16)

That cannot be contested and it is no more a hidden

effort. It is worth asking the SLMC, how many complaints
on medical negligence and unethical practices they
receive annually and how many were found guilty. There
cannot be any in this set up, with investigators, witnesses
defending the accused and the accused, all being medical
professionals who safeguard their members from
allegations.
Another quote from page 10 says, .the extensive
competition emerging in the medical market, particularly
due to the escalation of private practice, gradually
changed the attitudes as well as behaviour of public
medical doctors who were engaged in private practice.
The medical profession is now moving sharply towards a
pure profit oriented venture by neglecting its ethical
considerations. (emphasis added)

Who are these public medical doctors, after all? Pubic

medical doctors are all government employees. Employed
by the Health Department, they are paid and maintained
by taxpayers money. Their salaries, their allowances from
DAT to telephone to travel, scrounged from successive
governments holding patients lives to ransom, their 120
hour personally calculated overtime, their duty free
vehicle permits, their childrens education with exclusive
rights to very popular, privileged government schools are
all borne by the Citizens of this country who contribute
80% indirect and 20% direct taxes. Before that, these
doctors are educated from Grade 1 to the MBBS Final
examination with taxpayers money, the GMOA says is
free education. Thus people have paid for 13 years of
their formal education and 05 years of medical college
education and thereafter they are also paid and sustained
with undue privileges and perks from peoples money as
government doctors. Do they have any moral right to
charge these very people for medical care after all what
the people have done for them?

Medical doctors should be morally, economically and duty

bound to first serve the people free and safeguard free
health. Yet that is no more their calling and not their
preference either. Increased involvement of government
medical doctors in the private medical service turned the
early channel and private practice into a huge private
medical industry in just 20 years. Private hospitals
increased from 66 in 1990 to 125 in 2011 and they keep
growing and spreading. They now have modern
laboratories equipped with state of the art facilities and
they train their own nurses. But they are yet unable to
turn out medical professionals of their own due to
government restrictions pressured by GMOA.

In 2011, according to numbers given by the Private

Health Sector Review 2012 (revised in August 2015), only
424 medical doctors were employed full time in private
hospitals while 4,845 worked part-time. These part-time
medical doctors no doubt are all government medical
doctors. That same year there had been 266,000
admissions the private hospitals wouldnt have ever coped
with their 424 doctors. That makes government medical
doctors who worked part-time in private hospitals
almost indispensable.

For that sole reason, The biggest risk faced by the

private hospitals is the shortage of trained medical
practitioners. Most specialist consultants are with the
public sector. says Fitch Ratingsof September, 2015.

These private hospitals, now service 27% of hospital

services. They are very much concentrated in and around
Colombo, with expansions to Gampaha, Kandy and Matara
according to Fitch Ratings. Of all available private
hospital beds, Western Province accounted for 65% and
also 88% of all private sector revenue says, Private Health
Sector Review 2012.

This is how SAITM becomes a threat to the GMOA. Private

hospitals need permanent medical doctors to serve them
and there is potential for growth if they can employ full
time doctors. If SAITM is allowed to produce medical
doctors it would then become a precedent with other
major players also establishing their own medical
colleges. That would then provide the private medical
health sector with medical professionals available full
time.That would make government medical doctors
qualifying fromState universities unimportant inthe
private medical sector.

For that sole reason GMOA would not allow the private
sector to produce medical doctors. That depends on
government policy.The GMOA for over 02 decades has
forcibly entrenched itself in the health administration in
influencing government policy. Now it is no easy task for
any Health Minister to decide independently of the GMOA.
It is this unholy strength within the administration and not
so much the strength of its membership that still holds
the health ministry from taking a straight, clean decision
on SAITM.
This stranglehold on health administration has also
allowed government medical doctors to hang around in
hospitals in and around Colombo and its periphery where
private business is most lucrative. This is an anomaly
highlighted by Fitch Ratings. It says, Furthermore,
physician distribution is highly skewed towards the
Colombo district, while 73% of the population is faced with
a physician density much below the national average..

It is for all these reasons the GMOA wants a hold in

medical administration and Free Education given total
monopoly in producing medical doctors. They dont want
to leave government service as that denies them the
strong hand they now have in policy making. They dont
want the government to change policy to accommodate
private medical faculties as that would provide private
hospitals with permanent medical professionals.

If private hospitals can have their lot of medical doctors,

government doctors become nonentities in the lucrative
private health sector.They would therefore go to any
length in keeping their hold on policy making and selfishly
denying permission for private medical colleges.

This medical mafia can only be challenged by the people.

People have a right to do so and tell them public policy
is whats best for the people. A call to ensure public
interest on it is quite easy. People fund their education.
People pay their salaries. People have a right to supervise
their service. It is therefore time now to organise
Peoples District Supervisory Committees with the RTI
Act in hand, to keep check on daily attendance of medical
doctors, their availability in hospitals and other related
issues. It is time now to organise a referendum in
government hospitals to ask patients if they want their
doctor to do PP and channelling. It is peoples intervention
that could stop medical professionals turning butchers of
Free Health under cover of free education.
Posted by Thavam