Ceylon Today Editorial

Is the health regulator doing his job?

08 December 2016

Health Minister Rajitha Senaratne is trying to reinvent the wheel. Speaking in Parliament on Monday, he has said that the Government of Sri Lanka (GoSL) will bring in laws to regulate private hospitals. (Ceylon Today of 6 December,2016).

This was in respect of the charges made by private hospitals. The specific costs that he spoke of in that article, was the need to regulate OPD (Out Patients' Department) charges. Here he brought out the example of an alleged charge of Rs 14,000 made to a patient for dressing his/her wound.

The other two matters he referred to were with regard to an alleged charge of Rs 400,000 made in connection with admitting a dead person to the ICU of a private hospital and of an alleged charge of Rs nine million made in respect of politico, the late Alavi Mowlana.

He also went on a'rigmarole' to state that the maximum charge (already allowed) in the country's channelled medical service is Rs 2,000. And added that a patient should be examined for 10 minutes and subsequent to a surgery, the surgeon should stay with the patient for an hour.

Everybody worth his salt here knows such requirements are more often than not, openly observed in the breach. The Minister however, went on to say in his parliamentary discourse that it was President J.R. Jayewardene who initially began regulating (such) prices.

This is an admission that the private sector health service is already regulated as far as pricing was concerned at least in certain areas such as channelling charges, but what was needed was enforcement.

Whereas, there may be lacunas as far as the country's health laws are concerned with regard to charges levied on the admission of a dead body, OPD and in-house costs, what Senaratne his Private Health Services Regulatory Council (PHSRC), established at enormous cost to the taxpayer, is to ensure that the existing health laws are observed by private healthcare institutions and related caregivers such as doctors and physicians, whilst simultaneously addressing lacunas in the existing health laws of the country.

The question is whether the health regulator is doing his job? If not, what is the purpose of having such a regulator, obviously at a cost to the taxpayer?

According to the PHSRC website, it operates from a private building in Colombo. Unless the owner of that building is a philanthropist, in general the rent charged in Colombo is expensive. Who's bearing this cost? The taxpayer?

The PHSRC, also according to its website was formed in December 2006 during the tenure of Nimal Siripala de Silva who was the Health Minister, then. Its membership comprises 28 persons. They consist of the Director General of Health Services (Chairman); Director Private Health Sector Development (Secretary);

Provincial Directors of Health Services (nine members); Sri Lanka Medical Council, Sri Lanka Dental Association, Independent Medical Practitioners Association and Medical Practitioners Association (one member each); Association of Private Hospitals and Nursing Homes (nine members) and from the Field of Law, Field of Nursing, Field of Finance and Field of Management (one member each).

Its members such as the Director General of Health Services, Director Private Health Sector Development, and Provincial Directors of Health Services are directly maintained by the taxpayer. These are in addition to the other costs involving the Provincial Directors of Health Services, which costs, who is to bear, is it the taxpayer or anybody else? That is a seemingly grey area.

Meanwhile, the Institute of Policy Studies (IPS), a semi-government think tank, had this to say of the PHSRC, according to a recent report published by a local daily, which said, '....Private sector regulation reform is of utmost importance due its current lack of effectiveness....Returning the regulatory functions back to the Health Ministry (as is the case in other countries with similar backgrounds) is an option that needs to be considered. Alternatively, the effectiveness of the PHSRC needs to be reinforced by limiting private sector provider representation and training and strengthening the regulatory capacity of officers in charge...'

Therefore, the need of the hour may not necessarily be new laws to regulate private hospitals as espoused by current Health Minister Senaratne, nor by handing back such regulatory functions once more to the Ministry, but, probably by strengthening the regulatory capacity of the PHSRC.

Daily News Editorial

A home away from home

08 December 2016

Parliamentarian Hirunika Premachandra's disclosure of the existence of a mafia inside the prisons, offering special privileges to influential inmates should engage the serious attention of the authorities. That there is a subterranean underbelly in our prisons where murky deeds are reported from time to time cannot be denied. But, that all is not well even on the surface of things too is a matter that should be dealt with in all earnest if our prisons are to be salvaged from plunging into the pits it is already sinking into. There is not a lot that goes behind the prison walls that the public are not aware of.

Speaking in parliament, during budget debate, the MP also made other startling revelations, including the presence of over 10 prison doctors who were involved in producing fake medical certificates to get VIP prisoners transferred to the Merchant ward. She also went onto detail how certain influential prisoners were receiving ‘special treatment’ and also frequent family visits. One such prisoner, who is on death row, and presently cosily tucked up in a prison hospital bed, even has had the rare privilege of celebrating his birthday behind prison walls, thanks to the facilitation of the prison mafia, Hirunika went onto state.

What the MP has disclosed is nothing new. It is public knowledge how certain prisoners fall ill no sooner the iron gates of the cell clangs shut behind them. We had a certain Basil Rajapaksa, who took a nocturnal flight to the US on election night, when the results showed his brother was doomed, returning a few months later, waving and gesticulating to the throngs who came to greet him at the airport, oozing good health and stamina, only to fall ill soon after being taken to the state run lodge, a few days later, and promptly getting himself transferred to the Merchant ward. There was also another politician, who spent his entire two year prison term at the self same Merchant ward, after being convicted for contempt of court in 2004. More recently we had even the fiery and rambunctious Galagodatte Gnanasara Thera, who is the epitome fitness and bustling activity, making a beeline to the prison ward after being briefly put behind bars, also for contempt of court. These are but examples of those who had no reason to go to the prison hospital.

The whole affair of VIP prisoners accorded special treatment and provided with special facilities have now become commonplace so much so that the public have come to treat these episodes with scepticism, nay contempt. Have our politicians developed such thick hides so much as not give a thought to the public perception about them?

The authorities should take a serious view of this whole business of VIPs, and those with influence, making our prisons a sort of home away from home. A prompt investigation is called for into Premachandra's claim of doctors fobbing off prison authorities to get certain prisoners transferred to the Merchant ward. Whatever happened to the committee that was to be appointed to go into the malpractices of prison doctors? How come politicians develop sudden blood pressure and a spike in their sugar levels once thrown into the slammer? Is it due to, fear, tension or a guilty conscience?

The government should put a halt to the prison system being a made a mockery of in the eyes of the public. It should certainly put a halt to convicted politicians being allowed to raise their manacled hands on their way to prisons from the court in a display of heroism. The country was recently witness to the spectacle of politicians who had robbed public funds going to prisons with broad smiles, as if they welcomed the journey. A penitentiary is an institution that should evoke fear and dread, where the lawbreakers are confined, as punishment for their felonies. Politicians should not be allowed to treat this institution with disdain and contempt. Those falling ill, soon after entering prison, after being convicted, should be examined by a special board of medics. Prison doctors providing bogus medical certificates to allow “special” inmates enter the Merchant ward should be exposed and their licenses cancelled.

All prisoners are equal, like the law is equal to all. There cannot be some prisoners more equal than others. It is also an open secret that the whole prisons set up is corrupt to the core, with the highest to lowest member of the prison staff on the take. Newspapers are full of stories of how certain drug kingpins are continuing their businesses from behind the prisons walls, often times with the help of their jailers. Some inmates are also in possession of mobile phones to keep contact with the outside world. There were also reports of certain inmates shuttling between the prisons and their homes. There are also accounts of sleaze, with the connivance of prison officials. What the MP has touched may be only the tip of the iceberg.

The Island Edtorial

Stop colossal waste, help save little hearts

Some politicians fancy erections. Mahinda Rajapaksa, in his wisdom, launched the Lotus Tower project, which is said to be nearing completion. With the funds spent on that structure many flyovers could have been built in the city and its suburbs to solve the problem of tailbacks and the attendant delays. Fuel and man hours worth billions of rupees could have been saved a month that way.

Minister Arjuna Ranatunga, too, embarked on an Ozymandian project while inveighing against the previous government for extravagance. He wanted to erect the world’s tallest Christmas tree, of all things. Perhaps, bereft of achievements after winning the ICC World Cup two decades ago, he may have sought to boost his XXL ego, of course, at the expense of the taxpaying public. Much hyped as it is, his project hasn’t impressed even the men of the cloth; they have, in unison, denounced it as an utter waste of money.

Outspoken Archbishop of Colombo Malcolm Cardinal Ranjith, addressing the media on Tuesday, called for abandoning such useless projects and channelling the funds being spent thereon for a worthy cause.

More than one half of the people of Colombo are living in slums and shanties, which are fertile breeding grounds for the underworld. A meal is a luxury for them whereas food sufficient for 2,000 mouths are said to be discarded a month at Parliament. Malnutrition is rampant among the children living in the poor quarters of the city.

This is the seamy side of Colombo, where hell and heaven exist cheek by jowl. The situation is no better in the conurbation with people belonging to all ethnic and religious communities living on canal banks and in low-lying areas which become a vast billabong during heavy rains. The government is planning a Megapolis without solving the basic problems of the city poor!

It is against this background that the criminal waste of public funds should be viewed. The government has recently obtained more than Rs. 700 mn through a supplementary estimate for super luxury vehicles for ministers and granted MPs pocket money to the tune of Rs. 100,000 each a month. With the money so wasted to pamper politicians, enough soup kitchens, as it were, can be opened to feed the city dwellers living in abject poverty.

Meanwhile, we are informed that about ten out of 1,000 infants born in Sri Lanka, which is home to four great religions, die before they reach their first birthday owing to congenital hearts diseases, the main cause of infant deaths in this country. A campaign, Little Hearts, has mercifully got under way to raise funds for the construction of a cardiac and critical care complex to provide timely treatment to all children with heart diseases at the Lady Ridgeway Hospital for Children, Colombo. The Sri Lanka College of Paediatricians has thrown its weight behind this noble campaign, the organisers of Little Hearts say. Infant mortality can be reduced significantly if the facilities needed for treating the tiny, weak hearts are made available, we are told. Parents of these unfortunate children are hopelessly poor and cannot afford private sector health care. They are left with no alternative but to seek public assistance to save their precious ones who are dying slowly. Newspapers are full of their heart-rending appeals. The President’s Fund dishes out only paltry sums to them while settling politicians’ medical bills in full!

It looks as if the Cardinal’s words of wisdom have sunk in. Ranatunga’s Christmas tree project is reported to have been suspended. It must be abandoned and the money saved can be donated to Little Hearts. The same goes for the mindless waste of funds during other religious festivals such as Vesak.