A misguided cabinet misguiding Parliament?

By 
Dr. Ananda Wijewickrama. Consultant Physician. 
National Institute of Infectious Diseases.

Dr. Nissanka Jayawardena. Consultant Surgeon, National Hospital 
of Sri Lanka.

Dr. Saman Abeywardena. 
Consultant Paediatrician. Teaching Hospital, Rathnapura. 

Dr. Sanath Lanerole. 
Consultant Obstetrician and Gynaecologist. Castle Street Hospital 
for Women.

Cabinet of Ministers of Sri Lanka has made several decisions over the last few years giving rise to disastrous results to its citizens. Such decisions have been taken due either to misinformation, lack of information or both. Or misguidance. The best-known example is the in-famous fertilizer issue. The cabinet was entirely misguided by the fanatical idea of ‘carbonic only’ agriculture. Some ministers now try to put the blame on a doctor and a few who advise on this, forgetting how naïve they were to take advice on agriculture from a doctor!

It seems that a somewhat similar situation has arisen now regarding the retirement age of medical specialists. The cabinet seems to be completely misguided on this issue and now they seem to be misguiding the entire parliament. 

As for most other public servants, the retirement age for medical specialists also was 60 years. However, in 2019 this was made 63 years. This decision was taken, as proposed by by the then Health  Minister Dr. Rajitha Senarathna, after carefully studying it and due to number of reasons including expansion of services of medical specialists. However, it is not clear whether these facts were looked at when it was decided to change the retirement age again to 60 years. In fact, many countries have increased the retirement age due to multiple reasons. In India this is 63 years, and they plan to further increase this to 67 years by 2027. In Taiwan the retirement age is to be increased gradually and reach 68 years by 2028. In Singapore while the pension age is currently 62, employers are required to provide “rework” to eligible workers up to age 67. In fact, in 2019, in its annual report, Central Bank of Sri Lanka (CBSL) recommended “a possible extension of the retirement age could be considered” for Sri Lanka too. 

In Sri Lanka reducing the retirement age to 60 years was a general decision for all public servants. It is widely assumed this was done to cut down the number of public servants, which is a staggering 1.5 million, in the country. A state-run daily newspaper on June 24, 2022 reported this figure as 1.7 million. Their salaries and other expenditure were seen as a huge burden to the government. The same newspaper article reported that “The Sri Lanka Public Service started to get politicized with the introduction of the 1978 Constitution and this process was accelerated after 2009.” It is widely known the number of public servants was unnecessarily increased due to ad hoc appointments given by politicians for their own benefit. It is because of this the CBSL recommended in 2019, “a well-planned policy of recruitment to the public sector, thereby containing the rising expenditure on salaries and wages and pension liabilities”. The decision to reduce the retirement age again to 60 years was taken with this background. However, it is not the purpose of this article to examine the erroneous nature of the decision to reduce the retirement age. We believe that it is the duty of the experts in the Sri Lanka Administrative service and the Central Bank. 

Since the issue of retirement of Medical Specialists was raised by several forums, the Cabinet appointed a sub-committee chaired by the Prime Minister.  

The reduction of retirement age from 63 years to 60 years for Medical Specialist will have a huge impact on the state health services of the country. The simple fact of retirement of a large number of Medical Specialists within one year, who would have retired over a period of 3 years with the previous regulation, make it very easy to understand the problem. For example, it is learnt that from National Hospital of Sri Lanka alone more than 40 Consultants will be retiring within the year of 2023 and more than 25 from Teaching Hospital Kandy. About 18 Consultants each will be retiring from Teaching Hospital, Ragama and Teaching hospital Kalubowila and another 12 from Teaching hospital, Kurunagala. And there will be many more. (These are approximate numbers based on the information we have and may not be the exact figures. The Ministry of Health should be able to give more accurate figures). 

There are not enough Consultants to replace the number of retiring Consultants in many fields. This problem is aggravated by leaving of Consultants for foreign jobs due to the unstable situation in Sri Lanka 
To quote some examples: 19 Senior consultant anaesthetists will retire by the end of 2023: 9 out of 17 at National Hospital of Sri Lanka, 2 out of 2 at De Zoysa Maternity Hospital, 1out of 2 at Castle Street Hospital for Women, 2 out of 5 at Colombo South Teaching Hospital, 2 out of 5 at Colombo North Teaching Hospital, 2 from Kandy National Hospital, and 1 from Jaffna Teaching Hospital. However, only 07 were certified as new Consultants in Anaesthesia in 2022 and already 4 of them have left the country. Out of 36 Eye Surgeons working in the Ministry of Health, 18 will be retiring with the 60-year rule. Of the 32 Consultants of blood transfusion service in the country, 9 will retire by January 2024 and 6 have already migrated. Therefore, only 17 will be left. Of about 40 ENT units in the government hospitals, at least 5 will have to be closed due to retirement of ENT surgeons. Of the 18 cardiothoracic units, 10 are likely to be closed as 10 of the 18 cardiothoracic surgeons will retire at 60 years by December 2023.  

Sri Lanka’s health service has achieved quite a high standard and is taken as a model to the entire world by the WHO. One of the best-known achievements is the low maternal mortality rate (number of pregnant mothers dying) and more than 99.5% of child births happening in hospitals under a Consultant Obstetrician. The 60-year retirement rule may lead to a collapse of Island-wide maternity care services. Approved cadre for Consultant Obstetricians is 226. However, only 144 are in service at present. Out of the remaining vacancies, 32 were advertised to be filled in 2023. However, with 60-year rule, 21 Obstetricians will be retiring in 2023 and the number of vacancies will increase to 53. But only 10 certified Consultants to fill these vacancies.

One doesn’t need a huge intelligence to understand the impact of this to patients. Whether these facts were presented to the Cabinet, and subsequently to the parliament, is the question. Report of the subcommittee submitted to the Cabinet says that the committee has analyzed all the data on adverse effects on free health by implementing decision on the retirement age of 60 years. But did it present and discuss these simple facts and figures? 

How many units will have to be closed in Base Hospitals due to dearth of Consultants within 2023 due to this decision? The cabinet decision submitted to parliament does not say this.  

In addition to this, due to the retirement of a large number of senior Consultants within a short period, the post graduate medical training is going to get affected severely. This will jeopardize intake of medical specialists to the country and once again the ordinary people in the country will be affected. Prof. Senaka Rajapaksa the Director of the Post Graduate Institute of Medicine has already indicated this in writing to the secretary to the Minister of Health.  Most of these Consultants will continue their private practice after retirement and obviously will have more time for it. And more time to spend with their families. Economically and socially, they are likely to be better off since they will have more time for those aspects. 

We have seen in the media the minister of Health, Keheliya Rambukwella telling parliament about two groups of Consultants: one group asking to keep the retirement age at 63 and the other asking to reduce it to 60 years. This is very much more than the requests of two groups of individuals. The minister should tell the parliament about the impact on the health sector from this. Of course for people who go abroad for medical treatment will not have any impact from this. 

Recently Dr. Asela Guanawardena, Director General of Health Services (DGHS), in his presidential address as the president of the College of Medical Administrators, said that the inadequacy of Medical Specialists in peripheral hospitals is going to get worse with this retirement at 60 years. He said this to a large audience which included the Governor of Central Bank. DGHS sounded frustrated. By telling this in public did he want to show his displeasure with political authorities who do not listen to these facts? Did he want to show that another ‘fertilizer issue’ is in the looming?