The Hon. G.G. Ponnambalam

¶ 01 Hon. Deputy Chairperson, unlike usual, I wish to read a note I prepared after consulting doctors in the Northern and Eastern Provinces.

¶ 02 Within the current constitutional framework, health is a devolved subject. The Line Ministry is mandated to manage only three categories of hospitals: national, teaching, and special hospitals. All other hospitals, including Sri Lanka’s 28 District General Hospitals (DGHs), fall under provincial councils. Nearly 1,100 institutions are under provincial councils versus about 50 under the Line Ministry. Any takeover for legal upgrade must follow the constitutional path. Yet, 21 of the 28 DGHs have been taken over without the mandatory legal upgrade. This illegal annexation extends to base hospitals, often without formal provincial council consent, undermining democracy. The Education Ministry, while centralizing schools, at least upgrades them to National Schools first. The Health and Mass Media Ministry, however, has absorbed hospitals in direct constitutional violation. Only seven DGHs remain with provincial authorities, including all four DGHs in the Northern Province.

¶ 03 The Central Government employs a strategy to make provincial hospitals fail, manufacturing public demand for takeover by blocking two key areas. First, infrastructure strangulation: restricting capital allocations to provincial health ministries, preventing new works and essential equipment procurement, leaving Northern hospitals dilapidated. Second, human resource starvation: restricting cadre increases and new appointments. This neglect results in poorer care and erodes trust in provincial governance. Staff and public then believe handover is the only way to get resources. The Bishop of Mannar’s request to take over Mannar DGH is a plea born of State-orchestrated crisis, not choice. The narrative that central takeover brings development is false. Evidence from Tamil-majority serving institutions shows systemic neglect due to discriminatory resource allocation, not administrative control.

¶ 04 Take Jaffna Teaching Hospital, the Line Ministry’s flagship in the North. Despite central control, intentional neglect cripples operations. Its cardiology unit—the third largest by clients served in 2024—has the lowest staff complement compared to other teaching hospitals. There are shocking deficiencies, including no proper maternity ward since 2013 and inequitable cadre allocations across departments.

¶ 05 As for Trincomalee DGH, after takeover a decade ago, there has been no significant development or service improvement. Management change alone is meaningless without equitable investment and political will. Institutions serving Tamil people are systematically deprived regardless of control. Takeovers are political power grabs, consolidating control while continuing inequitable service denial.

¶ 06 Funding deception underpins the model. The large, debated health budget—especially capital—serves only the ~50 Line Ministry institutions. We ignore over 1,100 provincial hospitals and public health units which serve most citizens. Provincial funding, including Northern services, flows through constrained, centrally controlled mechanisms such as the Finance Commission, which holds absolute power over allocations, distribution, and approvals, rendering autonomy fictional.

¶ 07 The Provincial Specific Development Grant is grossly inadequate for the North; formulas ignore post-war reconstruction and historic deficits. For example, the Mullaitivu DGH ward complex was estimated at Rs. 1,500 million in 2021—about 150 per cent of the Northern Province’s entire annual health capital allocation—making development mathematically impossible.

¶ 08 There is systemic exclusion from national/donor projects; nine recently approved mega health projects included none for the North. Abandoned promises and stalled projects compromise care: the A&E Unit at DGH Kilinochchi had a foundation stone laid in 2019 by then Prime Minister Ranil Wickremesinghe—no further work. The Mullaitivu DGH ward complex was denied funding. The A&E Ward at DGH Mannar was rejected. At Tellipalai Cancer Hospital (TTCH), a cancer hospital administratively placed under a Base Hospital and thus the Provincial Council, there is scarcity of manpower and drug funding. I again request: make TTCH a separate specialized institution with a dedicated allocation.

¶ 09 I am winding up, Madam. Please also allocate separate staff for cancer services; the Base Hospital is Grade III, not even “A” grade, resulting in gross staff inadequacy. The hospital lacks a CT scanner essential for cancer care. Reliance on Jaffna Teaching Hospital for CT, MRI, and mammography causes limited slots, multiple trips, delays in images/reports, and challenges for urgent cases. Ensure Tellipalai Base Hospital cadre meets “A” grade standards, expedite an ICU, and allocate funds for a CT scanner. Thank you.