Sri Lanka's blundering health bureaucracy

THE right to health occupies an ambiguous place in Sri Lanka's constitutional and legal framework. Whilst the Constitution recognises a range of fundamental rights, it does not explicitly codify the right to health. Nevertheless, the State delivers a range of health services and exercises substantial, centralised control over the medical sector-from training and appointing doctors to regulating drug imports, pricing, and distribution.

- By Devinda de Silva

This article explores the question of whether such State control, exercised under the pretext of public welfare, has paradoxically created systemic inefficiencies and bureaucratic bottlenecks that hinder, rather than facilitate, public access to healthcare.

In the aftermath of the country's economic crisis, recent scandals and failures in medicine procurement have raised new questions about the effectiveness and legitimacy of the State's control over healthcare. It is not without precedent to say that, even in the absence of an explicitly codified right to health, the State may be acting in breach of its implied social contract by presiding over a regulatory system that undermines public access to healthcare.

Consortium of State control

The State's involvement in the health sector is both far-reaching and deeply embedded in law and policy. The National Medicines Regulatory Authority (NMRA) is the principal institution responsible for registering all medicine products, issuing waivers of registration (WOR), and ensuring the quality, safety, and efficacy of pharmaceuticals. The NMRA's ability to fulfil their mandate is questionable though, given the deficiency in resources at their disposal. It's akin to being given a butterknife and sent out to hunt a grizzly bear.