Health sector corruption reaches deadly levels

Huge medicinal drug contracts given to Indian company dealing in Ayurveda medicine and garlic oil MPs call for Parliamentary Select Committee to probe health sector malaise, hold bipartisan meeting to discuss malpractice in procurement

The best joke is that when we inquire about it, the same persons who are accountable at the NMRA are filing cases with the CID saying that the documents were forged. Though the no-confidence motion was won by the government, the malpractices are continuing. What we can say is that Health Minister Rambukwella should remove the NMRA officials responsible

IMF issues statement telling government to address 16 areas of concern before obtaining second tranche; state finance minister says, “We are on track”

That Sri Lanka’s public health services are free from the cradle to the grave is known worldwide. However, the deterioration of the health services—widespread corruption, import of poor-quality medicinal drugs or their nonavailability and medical negligence among others—is fast ruining this image. Ironic enough, it is affecting a vast segment of Sri Lankans, from the rich to the poor, fearfully raising the spectre of death than a healthy life.

This explains why a group of government and opposition MPs, casting their differences aside, gathered at a bipartisan event in a room in Parliament, with Opposition Leader Sajith Premadasa in the chair, last Thursday to discuss the growing malaise. That many parliamentarians vent their feelings over the health sector during a vote of noconfidence on Health Minister Keheliya Rambukwella on September 8 did not deter them. Not even though it was over the alleged importation of substandard medicines and surgical equipment. That move, the motion said, weakened the health sector and caused the deaths of several patients receiving treatment at public hospitals. The vote on the motion went on party lines. Voting against were 113 whilst 73 voted in favour. Thirty-eight members were absent.

“We discussed how to proceed with a serious situation that is worsening due to corruption and other malpractice at the Health Ministry and the health sector,” Samagi Jana Balawegaya General Secretary Ranjith Madduma Bandara told the Sunday Times. Revelations during the no-confidence motion, he said, had not led to any improvement in the situation. To the contrary, it had worsened, he said. He added that the opposition would now call for the appointment of a Parliamentary Select Committee (PSC) to study the current situation in detail and recommend immediate remedial action.

Wasantha Yapa Bandara, one of the convenors, was highly critical of the National Medicines Regulatory Authority (NMRA), the state body responsible for authorising the import of medicinal drugs. He charged that the signature of the Chief Executive Officer had been allegedly forged to import drugs. He quoted Minister Rambukwella as saying during his no-confidence motion debate that complaints regarding this had been made to the Criminal Investigation Department (CID). He said shipments had been cleared from Customs using the forged documents. The question is: what happened to the medicinal drugs imported with such forgeries? Were they of poor quality and thus a health hazard?

Another serious issue, he said, was medical negligence. The body of a person who died due to the alleged negligence of a doctor was simply handed over to the next of kin. There was no legal mechanism to disciplinarily deal with the doctor. The meeting decided to call upon Yapa Bandara, an attorney-atlaw, to study the existing laws relating to medical issues and submit a report. He was one of the convenors of the meeting. The other convenor, Kavinda Jayawardena, has been tasked to formulate a report on how to deal with medical negligence.

Among those taking part in the meeting were Channa Jayasumana, Gamini Waleboda, Duminda Dissanayake, Udaya Gammanpila, Sajith Premadasa, Ranjith Madduma Bandara, Vasudeva Nanayakkara and Gunapala Ranasinghe,

Prof. Channa Jayasumana alleged that an Indian company had been registered only to supply ayurvedic drugs and garlic oil. It had been awarded a billion-rupee tender to supply human immunoglobin. This is one of the most important therapies used to treat severe antibody deficiencies, which is the most common type of primary immunodeficiency. “We are told the import has been made on forged documents. If this is so, it is an extremely serious issue for which the NMRA is responsible,” he said.

Added Gamini Weleboda: “The meeting discussed alleged malpractice in the NMRA. There are issues with imports. There are three different signatures and three different stamps (seals) of the Chief Executive Officer issued to three different companies. “It is revealed that one of the lifesaving drugs was imported from an Indian supplier who is known to supply Ayurveda medicine and garlic oil, that supplier never had supplied medicine to the country before.”

“The best joke is that when we inquire about it, the same persons who are accountable at the NMRA are filing cases with the CID saying that the documents were forged. Though the no-confidence motion was won by the government, the malpractices are continuing. What we can say is that Health Minister Rambukwella should remove the NMRA officials responsible.”

There were suggestions at the meeting that the group conduct public meetings in every district to educate the people on the status of the Health Ministry and the health sector. However, Opposition Leader Premadasa was not in favour of such a move.

This raises the issue of the resignation of Health Minister Rambukwella on September 30, as reported in these columns. It was also reported that Plantation Industries Minister Ramesh Pathirana would take over the portfolio. Of course, there was considerable pressure from sections of the SLPP over Rambukwella’s removal. Last Wednesday, he had a lengthy meeting with President Ranil Wickremesinghe. It is not immediately clear whether he will be allowed to continue to hold the same portfolio in the light of this. There was also an error last week over the appointment of a new Inspector General of Police. It is the Constitutional Council that wrote to the Presidential Secretariat saying it would not entertain a third extension of service for the present Police Chief, C.D. Wickremeratne and not the Police Commission.

These developments come in a week amidst the prospects of a delay in the disbursement of the second tranche of the International Monetary Fund (IMF). The IMF delegation leader, Peter Breur, told a news conference at the end of talks in Colombo that the next tranche was not time, bound though government leaders were hopeful it would come by September.

Concerns over governance issues

Early this week, the IMF issued a statement setting out its position and calling upon the government to fulfil 16 different demands. Here are the highlights:

“The International Monetary Fund (IMF) has recommended sixteen priority actions in its recently released Governance Diagnostic Assessment (GDA) on Sri Lanka to address systematic and severe governance weaknesses and deep-rooted corruption vulnerabilities across State functions in order to unlock the country’s growth potential.

“Sri Lanka became the first country in Asia to undergo an IMF governance diagnostic under the global lender’s rescue package. Accordingly, an International Monetary Fund (IMF) mission undertook a governance diagnostic assessment from the 9th of March to the 31st of March this year.

“The technical assistance report released last week revealed widespread corruption vulnerabilities and governance weaknesses originating from ad-hoc tax policy practices, half-baked approaches to AntiMoney Laundering/Combating Financing of Terrorism (AML/ CFT), lack of a robust legal framework and poor processes utilized in SOEs, the absence of public procurement legislation, ad-hoc tax policy practices frequently modifying tax laws, conflict of interest concerns of Central Bank managing EPF and regulating NBIFs, and absence of clear mechanisms for information sharing among tax authorities.

“Despite the widespread public outcry leading to mass protests and social unrest last year, the report pointed out that the authorities were yet to take action on recovering stolen funds, while civil society participation remains discouraged.

“Current governance arrangements have not established clear standards for permissible official behavior, acted to deter and sanction transgressions, nor pursued individuals and stolen public funds that have exited the country. Regular civil society participation in oversight and monitoring of government actions is restricted by limited transparency, the lack of platforms for inclusive and participatory governance, and by the broad application of counter-terrorism rules.

“GDA stressed that the impunity for misbehaviour enjoyed by officials continues to undermine trust in the public sector and compounds concerns over limited access to an efficient and rule-based adjudication process for resolving disputes and hurts the integrity of the judiciary.

“Although the new AntiCorruption Act (ACA) is in force, it noted that key accountability institutions, including the Commission to Investigate Allegations of Bribery and Corruption (CIABOC), lack both the authority and competency to successfully fulfill their functions.

“Improvement brought about by the passage of the ACA needs to be complemented by the drafting and enactment of a modern law on Asset Recovery. Rapid operationalizing of the ACA will be critical to address current corruption vulnerabilities associated with the lack of a functional system for receiving, publishing, and reviewing asset declarations by public officials, and procedural and competency issues in the investigation and prosecution of corruption cases.

“Among priority actions, the GDA has recommended the government abolish or suspend the application of the Strategic Development Projects Act until the promulgation of an explicit and transparent process for the evaluation of proposals and costing of investment promotion conditions………

“…….It noted that a holistic, impartial, and transparent analysis is required to decide whether a specific project is viable and whether the potential benefit exceeds its social costs – which include revenue forgone, an increase in administrative costs, market distortions, and potentially perceptions of unfairness.

“While the BoI is likely well-positioned to understand the investment potential of specific projects, it lacks an understanding of the wider fiscal framework and budgetary needs which are necessary to evaluate the net social value of a specific project. The DoFP should evaluate