Sri Lanka searches for solutions amid exodus of doctors

After working at a major hospital in southern Sri Lanka through the height of the pandemic and the country’s worst-ever economic crisis, Rishdha Riza called it quits.

“It came to a point where there was no basic medicine and equipment, and as health care providers, we were expected to work around it,” says the medical officer. “Working in Sri Lanka became extremely taxing. I couldn’t do it anymore.”

Since Dr. Riza moved to the United Kingdom last August, the situation in Sri Lanka hasn’t improved.

Government officials recently sounded the alarm over Sri Lanka’s collapsing medical system, reporting that nearly 1,000 doctors – including 274 specialists – migrated overseas between May 2022 and May 2023. That’s on top of some 2,000 nurses and other health care professionals, including the country’s only pediatric radiologist. Hospitals have had to cancel surgeries or shutter their pediatric wards because of the brain drain.

Before declaring bankruptcy last year, the island nation actually punched above its weight by most health care indicators. The public health system covers half of all medical treatment, 95% of hospitalizations, and 99% of preventive care needs in Sri Lanka. But now doctors and other professionals are leaving the country en masse, as experts and policymakers scramble to find solutions. What’s clear is that if Sri Lanka can’t slow the exodus or replenish its supply of health care workers, the impact will be felt for years to come.

“When we were juniors, we were trained by senior doctors with decades of experience, and they transmitted their skills to us,” says Rajeev Menon, a medical doctor at the National Institute for Nephrology Dialysis and Transplantation. “But when more and more senior doctors and nurses are leaving, who’s going to train young graduates? How are we going to assure continuous care? You can’t make a doctor or nurse overnight.”

Pushed to the brink

After inflation rose to an all-time high of 73.7% last September, the Sri Lankan government introduced intense austerity measures to secure a $3 billion bailout from the International Monetary Fund. The crisis hit the health care sector hard. Supply shortages made it nearly impossible to provide a consistent standard of care, and wages did not keep up with inflation. After working day and night, says Dr. Menon, “when you look at your paycheck at the end of the month, you worry how you are going to live with that money.”

But that’s not the sole factor, says Chandima Arambepola, a migration researcher at the University of Sheffield.

“Today, most health care workers feel that their ability to contribute and support their families has been curtailed,” she says. “Children’s future, their education and aspirations are primary concerns for health care workers to migrate, not just their wages.”

Leaving Sri Lanka is not an easy decision. Many workers feel a deep obligation to see their country through its compounding crisis, especially since a vast majority received their education free at public universities.

“I couldn’t bring myself to leave because there were only two of us [doctors] at the hospital,” says a medical officer from eastern Sri Lanka who didn’t want to reveal his name out of fear of backlash. “My colleague would have had twice the workload, and the hospital might not have been able to care for all the patients. But then I looked at my children. I realized my salary is no longer enough, and I can’t build a comfortable future for them.”

He left his small public hospital – and family – to find temporary work in the Middle East.

Some Sri Lankans who travel overseas for professional training and postgraduate education are simply choosing not to return home, worried about the country’s instability. Less than half of the doctors who left for foreign training last year didn’t come back. Others are recruited to work in wealthy nations that face their own dearth of health care workers. Sri Lankan anesthesia, intensive care, and emergency medicine specialists are in particularly high demand. Only seven emergency services doctors remain in Sri Lanka today, down from 30 in early 2022.

Unless Sri Lanka reverses this trend, experts say it will be hospitals in the country’s small towns and rural areas – where staffing was already a challenge – that will suffer most.

As health care staff declines, “the compromise will happen in already marginalized areas,” says Dr. Menon. “This needs to be addressed immediately because once the problem arises – and by the time the political hierarchy realizes it – it’s going to be too late.”

Seeking compensation and respect 

Speaking with health ministry officials last month, Sri Lankan President Ranil Wickremesinghe said that he believes Sri Lanka should be compensated for the health care talent the nation is involuntarily exporting to other countries.

He proposed a system similar to the Loss and Damage Fund established at the 2022 United Nations climate conference, demanding that countries that recruit Sri Lankan doctors to prop up their own health care system, such as the U.K., should pay for that.

“Your people are leaving. That’s not our fault,” he said. “Either change your system and keep your doctors, or otherwise compensate us.”

The president also urged health officials to train students from art and commerce disciplines as nurses, and the Ministry of Health has asked to amend recruitment qualifications.

Ms. Arambepola, the migration researcher, agrees that authorities also need to study migration rates and adjust the intake of medical graduates, but she also expects the trend to shift with time.

During the height of the crisis last year, “there was a hysteria to get out of the country because everyone felt so helpless,” says Ms. Arambepola. As Sri Lanka acclimates to its new normal, migration may naturally slow down.

“People may start to assess, and think, ‘We went through a tough period, what can I do now? Should I still go if I overcame this?’” she says. “These are not only individual decisions but family decisions as well.”

Other leaders have proposed tightening migration rules – something Dr. Menon believes will only lead doctors to resign. Instead, he says, the government should ensure that medical professionals are properly compensated, introduce incentives like transport allowances to match today’s economy, and encourage health care workers to stay in rural hospitals by providing better accommodation and facilities. 

Respect and recognition can be incentives, too. Ms. Arambepola says that Sri Lanka’s medical sector is extremely doctor-centric, at the expense of nurses, physiotherapists, and other technicians. “There are no administrators from a nursing background. Nurses have no voice. It’s doctors making decisions on what nurses should do,” she says. “You can control the migration in some way if authorities change this structure.”