From 2022 to 2024, 1,489 doctors, including specialists, migrated from Sri Lanka, resulting in a financial impact of Rs. 12.5 billion (approximately US$41.5 million) on taxpayers, according to recent research. This migration, driven by economic challenges, has strained the healthcare system, necessitating analysis of retention strategies, investment needs, and system sustainability. This article examines the factors, consequences, and potential measures to address this issue.
Migration Scope and Economic Drivers
Between 2022 and 2024, 1,489 doctors left Sri Lanka for opportunities abroad, representing a significant loss of trained professionals. The Rs. 12.5 billion cost encompasses subsidized education expenses and economic effects on healthcare delivery. Training a doctor, from medical school to specialization, requires substantial public investment, which yields no return when professionals emigrate. The migration rate accelerated due to the 2022 economic crisis, with inflation reaching 69.8% in September 2022, as reported by the Central Bank of Sri Lanka. Currency devaluation and shortages of fuel and medical supplies further compounded challenges.
The economic instability reduced doctors’ purchasing power, while shortages of medical equipment and pharmaceuticals disrupted hospital operations. Limited resources and outdated infrastructure restricted the ability to provide care consistent with training. Insufficient career advancement opportunities and salaries diminished by inflation encouraged migration to countries like the United Kingdom, Australia, and Canada, which offer higher salaries, better working conditions, and streamlined immigration processes.
Healthcare System Impact
The departure of 1,489 doctors has reduced healthcare capacity in Sri Lanka. The doctor-to-population ratio, already below the World Health Organization’s recommended 1:1,000, has declined further, affecting a population of approximately 22 million, particularly in rural regions. Understaffed hospitals have led to increased workloads for remaining doctors, longer patient wait times, and reduced access to specialized care, such as oncology or cardiology. Rural healthcare facilities, dependent on general practitioners and specialists, face significant challenges, with patients often traveling to urban centers or forgoing treatment.
A regional report, Health Dynamics of India 2022-23, indicates an 80% specialist shortage in rural areas, a trend now observed in Sri Lanka. The migration also affects medical education, as fewer experienced professionals are available to train future doctors, potentially exacerbating shortages over time. Increased workloads may contribute to fatigue among remaining doctors, impacting care quality.
Financial and Public Impact
The Rs. 12.5 billion financial impact includes direct and indirect costs. Direct costs arise from subsidized medical education, covering faculty, infrastructure, and clinical training. When doctors migrate, this investment benefits foreign healthcare systems. Indirect costs include increased healthcare expenses due to delayed treatments and complications from reduced access to care. The government may incur additional costs recruiting foreign doctors or outsourcing specialized services, further straining public finances.
Public sentiment, as observed on platforms like X, reflects concerns about funding education for professionals who leave. A post stated, “Every time I bring up free tertiary education, there are some who get hot under the collar. Pray tell me why I should be paying for this!!!” This indicates taxpayer dissatisfaction with the financial implications of migration, highlighting the need for policies to address public investment returns.
Retention and System Strengthening Strategies
To mitigate doctor migration and strengthen healthcare, several approaches could be considered. Increasing salaries and providing incentives for rural service could improve retention, with wage adjustments aligned to inflation to support financial stability. Investment in modern equipment, consistent medical supplies, and hospital upgrades could enhance working conditions, potentially through public-private partnerships to manage costs.
Expanding access to specialization, research, and professional development could encourage doctors to remain, while international training partnerships might offer development opportunities without requiring migration. Implementing service commitments, where doctors serve in Sri Lanka for a set period post-training, could recover public investment, though such policies are debated. Incentives for rural service and investments in community health facilities could reduce urban-rural disparities and improve access. Collaboration with medical associations and public engagement on healthcare funding needs could support policy development to address migration causes.
The migration of 1,489 doctors and the associated Rs. 12.5 billion cost from 2022 to 2024 highlight systemic challenges in Sri Lanka’s healthcare system. The economic crisis exacerbated issues such as underinvestment and suboptimal working conditions. Addressing these requires focused retention strategies, infrastructure investment, and policy reforms. Without action, healthcare access, economic costs, and professional shortages may worsen. Coordinated efforts involving government, medical professionals, and stakeholders are necessary to maintain a sustainable healthcare system.