Hon. (Dr.) Nalinda Jayatissa - Minister of Health and Mass Media and Chief Government Whip

¶ 01 Mr. Chairman, as someone who has served as a medical practitioner and health administrator, I am pleased to open, on behalf of the Government, the Committee Stage debate on the Head of Expenditure of the Ministry of Health and Mass Media while you are presiding.

¶ 02 As Hon. (Dr.) Kavinda Jayawardhana said, from December 2015 for five consecutive years I moved to cut Rs. 10 from the Health Head when opening the Budget debate. The views we expressed on health then are what we are implementing in practice today.

¶ 03 Today we are speaking on Health and Mass Media. This portfolio now encompasses functions of four former ministries: Health, Indigenous Medicine, Mass Media, and Posts. The Department of Posts is now under Mass Media. The Sri Lanka Foundation, once under the Head of State, is also now under us. I intend to touch on these institutions within the limited time.

¶ 04 In the last five months, the Cabinet twice approved the policy programme “A Prosperous Country – A Beautiful Life,” and recently decided to integrate it into the State policy framework. One key theme is “A Sustainable Life – A Healthy Nation,” under which “Healthy Lives and a Healthy People” is a priority. Our policy platform is aligned with the UN Sustainable Development Goals. SDG 3 is good health and well-being. A core principle we accept is Universal Health Coverage—ensuring dignified, equitable access to health services with State responsibility, and delivering to global standards. On that basis, this Budget provides the highest-ever allocation for health.

¶ 05 For Health and Indigenous Medicine, Rs. 386 billion is allocated for recurrent and Rs. 92 billion for capital, totaling Rs. 479 billion. Including provincial health services, the entire health sector receives Rs. 604 billion—Rs. 496 billion recurrent and Rs. 107 billion capital. In 2024, it was around Rs. 352 billion; now it is Rs. 604 billion. We will use these funds effectively for the public.

¶ 06 We will develop all systems—Allopathic, Indigenous, Ayurvedic, Traditional, Siddha, Unani, and Homoeopathy—through five streams: - Strengthen primary healthcare. - Upgrade secondary and tertiary hospitals. - Ensure uninterrupted, quality medicines supply. - Address the human resources issue. - Develop health tourism to earn foreign exchange.

¶ 07 Primary care is essential. Though we have 22 million people, annually 90–100 million OPD visits occur in State hospitals; a similar number in private OPDs; Ayurveda sees about 6 million visits. Altogether 200–210 million OPD/clinic visits annually—10–11 per person per year—an issue to resolve.

¶ 08 Non-communicable diseases are a burden: around 14 percent with diabetes, 34 percent with hypertension; about 70 percent of deaths are from NCDs, of which around 70 percent are cardiovascular. We must act fast on NCD prevention.

¶ 09 Our aging population is growing: by 2032, those 60+ will be 20.8 percent; by 2037, 22.1 percent. Therefore, everyone should be within 2–2.5 km of a primary care facility to access prevention, treatment, supportive care, and rehabilitation.

¶ 10 Our goal is a primary care center for every 5,000 people with an identifiable team, ending the need to hop between OPDs, clinics, and systems. Two major projects supported this: the World Bank’s US$200 million PSSP covering 550 hospitals (ended June 2024) and ADB’s US$60 million HSEP covering 135 hospitals (extended to end-2025). Building on this, we allocate Rs. 12.1 billion this year for PHC development—Rs. 6 billion central and Rs. 6 billion provincial—and plan a new US$100 million World Bank project over five years to construct 1,000 PHC centers close to communities, with work starting this year as announced by the President.

¶ 11 We have 486 divisional hospitals and 545 primary medical care units—1,031 facilities—to be upgraded under this Budget, with implementation steps underway.

¶ 12 I invite donors to provide 20-perch plots along main roads (one PHC per three GN divisions). We are ready with designs and to partner with local/foreign philanthropists. Family Medicine consultants are few but vital for PHC; we invite them to serve more in primary care. We will integrate exercise and lifestyle interventions—“Exercise is Medicine”—into PHC to protect citizens through lifestyle change.

¶ 13 We face the plantation hospital issue since 1998: land ownership lies with estates, complicating upgrades. We are discussing with the Lands Ministry, LRC, and the Plantation Infrastructure Development Ministry to secure necessary rights for the Health Ministry, and will soon take over 44 such hospitals via Cabinet.

¶ 14 On secondary and tertiary care, Sri Lanka has 52 national/teaching/specialized/district general hospitals and 80 base hospitals—132 in total at those levels. We will staff and equip them as per standards. No more politically driven upgrades; we will follow the 2020 Health Ministry circular that specifies criteria, staffing, beds, services, and equipment. Requests like upgrading Puttalam Base to DGH and Bandarawela to Base will be assessed by a committee led by the Secretary and DG Health, based on national need, demographics, development plans, and capacity.

¶ 15 In this Budget we allocate Rs. 1.5 billion within eight months to develop five Emergency Treatment Units (Kandy, Trincomalee, Kegalle, Ampara, and Chilaw), with Rs. 4.6 billion more in 2026–27 to complete the programme.

¶ 16 Cardiac patients face long waiting lists; some die before surgery. A JICA project to establish cardiac catheterization units in five hospitals—Kandy, Kurunegala, Anuradhapura, Badulla, and Trincomalee—was halted due to past corruption. We have re-engaged Japan, and will soon start these units.

¶ 17 We allocate Rs. 1,600 million to build the cardiac center at Lady Ridgeway Hospital for children.

¶ 18 Cancer care is a major issue: about 36,000 cases identified annually; 24,000 treated; services now need upgrading. We completed Phase 1 and signed Phase 2 this January to provide LINAC machines to Anuradhapura, Kurunegala, Badulla, Ratnapura, and Hambantota. Construction of bunkers will be completed imminently at Ratnapura and Badulla, within four months at Hambantota, within six months at Kurunegala, and within a year at Anuradhapura. We allocate Rs. 1,150 million for bunkers.

¶ 19 Equipment breakdowns are common. We allocate Rs. 25 billion for maintenance of biomedical, lab, and medical equipment.

¶ 20 We will also prioritize routine maintenance (A/C, water, electricity, sewerage) of developed hospitals over the next three years, strengthening services in 130 secondary/tertiary hospitals.

¶ 21 For Ayurveda, the Borella Teaching Hospital was built but lacked basics; we allocate Rs. 300 million capital for it and Rs. 368 million more for other Ayurveda hospitals. We have a plan to strengthen the Ayurveda hospital system.

¶ 22 On uninterrupted, quality medicines supply—the biggest current challenge undermining public trust—we allocate Rs. 183.8 billion this year: Rs. 60 billion to MSD, Rs. 35.6 billion to SPMC, and Rs. 44 billion to local manufacturers. Where MSD cannot ensure supply, we allow decentralized procurement, allocating Rs. 35 billion to hospitals for local purchases to ensure quality medicines reach patients.

¶ 23 We plan to expand the State Pharmaceuticals Corporation’s Osusala network beyond the current 61 outlets in 18 districts. Within two months we will open new outlets in Batticaloa, Vavuniya, and Trincomalee, and in two weeks in Kiribathgoda. The main Osusala near the National Hospital, Colombo, will be upgraded within five months as the country’s flagship outlet. We lead the market in IV fluids; we will fund necessary equipment to expand.

¶ 24 As Hon. Jayawardhana noted, we removed VAT on imported packing material for Western and Ayurvedic pharmaceuticals. Along with electricity relief, and together with NMRA, SPC, and SPMC, we are working with importers and manufacturers on a formula to reduce retail medicine prices meaningfully.

¶ 25 To curb substandard medicines, we need a laboratory with SH testing capacity as recommended in Prof. Bibile’s Policy (Clause 7). While we could not allocate a full provision this year, we allocate Rs. 25 million to upgrade the existing lab at NMRA.