Sri Lanka’s public health service has plunged into a severe crisis as a result of drastic funding cuts, which are now continuing under the Janatha Vimukthi Peramuna (JVP)-led government. It is plagued by aging and malfunctioning equipment, collapsing infrastructure, a lack of essential medicines and laboratory supplies, and a dire shortage of medical personnel.

Hundreds of thousands of patients who cannot afford the luxury of private hospitals and rely on the “free” public health system are suffering immensely. Some live as if on death row.

When presenting the 2025 budget earlier this year, President Anura Dissanayake—who is also the finance minister—said there would be a “significant increase” in health expenditure to 604 billion rupees (US$2 billion). He claimed that 185 billion rupees would be allocated for the supply of medicines.

Contrary to Dissanayake’s promise, the reality is that the government has slashed public health spending, allocating just 383 billion rupees this year, down from 410 billion rupees in 2024, as part of the austerity program dictated by the International Monetary Fund (IMF).

On June 22, the Association of Medical Specialists (AMS) sent a letter to Health Minister Nalinda Jayatissa, stating that medical professionals are increasingly forced to advise patients to obtain medications, supplies and laboratory tests from external sources.

The letter questioned whether, in the absence of written instructions from the ministry, they should “choose to inform patients [to buy them from outside] or stay silent.”

The Health Minister publicly replied: “We [the government] can’t provide all the medicines [that] specialists demand. Patients can buy them from the cheapest places.”

What is being unleashed is a ruthless social counterrevolution against public health, in line with IMF directives.

Hospitals across the country are experiencing a major shortage of essential medicines. On June 14, the Government Medical Officers’ Association (GMOA) told the media that 180 essential medicines were out of stock at the central drug store. These include painkillers, antibiotics, and medications for diabetes, hypertension, and kidney disease. Over 50 of these medicines are unavailable in hospitals.

An investigative report by the Daily Mirror on June 18 stated: “A wide range of crucial drugs including those used to treat cancer, diabetes, psychiatric disorders, epilepsy, and infections are either unavailable or in dangerously limited supply.”

The report listed shortages of several critical drugs, including: Insulin 10ml (unavailable for over four months), Filgrastim injection, Cisplatin injection, Diltiazem 30mg/60mg, Phenobarbitone 30mg, Chlorpromazine 50mg, Imipramine 25mg, Atropine eye drops, Sodium Valproate syrup, Oxybutynin 2.5mg, Oseltamivir 30mg/45mg/75mg, and Jeevani (ORS).

Such is the crisis, public hospitals across the country are unable to perform vital medical tests.

A worker from the National Hospital in Kandy—Sri Lanka’s second most prominent hospital—told the World Socialist Web Site (WSWS) that there is only one MRI (Magnetic Resonance Imaging) machine available for the entire region. Patients must wait over a year to receive an MRI scan, and some die during the wait without proper diagnosis or treatment.

The Ceylon Wire News has reported that there are indefinite delays in essential Tacrolimus level tests for kidney and liver transplant patients in government hospitals. Officials at the Colombo National Hospital and Sri Lanka Institute of Medical Research confirmed that this crucial test has been unavailable for the past three months.

Failure to monitor Tacrolimus levels can be life-threatening. While the test is available at private hospitals, it costs around 26,000 rupees—an amount unaffordable to many patients.

State hospitals also face severe shortages of medical devices required for life-saving treatments.

The cardiology units of the country’s two major children’s hospitals—Lady Ridgeway Hospital for Children in Colombo and Sirimavo Bandaranaike Specialised Children’s Hospital in Peradeniya—lack critical devices needed for heart-related treatments for children.

The deteriorating conditions and lack of maintenance in public health infrastructure are also having devastating consequences. For instance, health workers report persistent water leaks in the Accident Service theatre complexes at Colombo National Hospital.

Hospitals are also chronically understaffed, forcing nurses and doctors to manage overwhelming workloads.

The collapse of the health system has coincided with the continued spread of dengue, Chikungunya, COVID-19, and influenza in hospitals. The government is accused of downplaying the true scale of these outbreaks to avoid allocating additional funding to public health.

At Kandy National Hospital, several nurses told the WSWS that they are exhausted and dangerously exposed to Chikungunya, influenza and other communicable diseases, because of overcrowded wards and the lack of adequate protection. A nurse from that hospital said: “We don’t even have enough chairs for nurses and doctors to sit on.”

Healthcare workers are also outraged by sweeping cuts to their overtime pay and delays in promotions. Many nurses now work excessive overtime hours just to survive amid the rising cost of living. Thousands have emigrated due to the worsening economic crisis.

Unsurprisingly, much of the resistance to the government’s cost-cutting measures has emerged from the health sector.

Amid growing outrage among health workers, major unions such as the Government Medical Officers Association, the Health Trade Unions Alliance (HTUA), and various nurses’ unions, have been compelled to call limited strikes and protests.

Many of these actions, however, have been called off by the unions, on the basis of empty promises from past and present governments to address health workers’ demands.

For example, on March 17–18, around 30,000 health workers—including nurses, midwives, lab technicians, and pharmacists—participated in protest strikes called by the Government Nursing Officers Union (GNOU) and the Joint Federation of Paramedic Professionals. The strike was cancelled on the basis of a pledge by the health minister to discuss matters with the Treasury Secretary.

Sri Lanka’s free public health service is one of the country’s most important social gains, won through decades of workers’ struggles. Though limited, it remains—alongside free public education—a vital support for workers and the poor.

These rights have been systematically eroded by consecutive governments and their “free market” policies during the past four decades. As in other countries, health services have been a victim of government efforts to impose the burden of economic crises on working people.

In Sri Lanka, this assault is being implemented via the IMF program, to which the JVP/National People’s Power government is committed. While lamenting the collapse of public healthcare, the trade union leaderships fully support the IMF program, are loyal to the capitalist system and actively suppress workers’ struggles.

That is why the Socialist Equality Party (SEP) urges health workers to form independent action committees in all health institutions and begin the fight to defend the public health system and the rights of healthcare employees. In this struggle, health workers can unite with the broader population and mobilise their support.

Defending and improving the healthcare system—and acquiring global technological know-how—requires massive financial resources. These funds exist and can be obtained by repudiating the foreign debt and seizing the wealth accumulated by the super-rich.

This is part of a broader struggle to independently mobilise the working class to defeat the Dissanayake government’s austerity measures. The major corporations, banks and all private hospitals and related institutions must be nationalised under democratic workers’ control.

The collapse of the public healthcare system underscores the fact that there is no solution to even the most basic social problems within the capitalist system—either nationally or globally.

The SEP calls on workers and youth to take matters into their own hands. Build action committees independent of the trade unions and capitalist parties in every workplace and among the rural poor!

Take bold steps to build a Democratic and Socialist Congress of Workers and Rural Masses, composed of delegates from these action committees! This will lay the foundations to organise and fight for a workers’ and peasants’ government to implement socialist policies as part of the international struggle for socialism.