By Asoka S. Seneviratne –
Prof. Asoka.S. Seneviratne
“The broad sun of the medical profession should never be eclipsed by the dark clouds of industrial strife, for when the healer and the state clash, it is the patient who bleeds.” — Inspired by the spirit of the Hippocratic Oath.
I am compelled to state again that Sri Lanka stands at a historic crossroads. As the nation grapples with the cascading effects of energy shortages, food insecurity, and economic instability, the healthcare sector—the final safety net for the citizenry—is being shredded by a recurring cycle of industrial action. The current standoff between the Government Medical Officers’ Association (GMOA) and the state is more than a dispute over transfer lists; it is a symptom of a systemic failure. Indeed, it is so sad, frustrating, and hence disappointing to hear and watch that the Minister is openly accused by GMOA while doctors say sorry to suffering parents. Neither is acceptable in many ways. To ensure that no patient ever again pays the price for a bureaucratic or union-led conflict, we must transition from a primitive “Power-Based Struggle” to a sophisticated system of “Rule-Based Governance.” This is not a critique of a single administration or a single union, but a call for a durable, sustainable framework that remains ironclad regardless of who holds power. Indeed, at the heart of my concern is the mounting cries from the public or patients whose sons and daughters are on strike.
1. The Anatomy of the Impasse: Why the Current Model Fails
The recurring strikes in Sri Lanka’s health sector are predictable because they are based on “Ad-Hocism.” In a professional and organizational setting, Ad-Hocism refers to a management or decision-making style characterized by a lack of central planning and a reliance on spontaneous, improvised solutions to specific problems as they come up. Currently, it seems that decisions about recruitment, transfers, and promotions are often seen as being influenced by political pressure or union influence. This creates a “Power-Struggle” environment where the loudest voices tend to prevail.
I want to focus on the moral imperative, beyond the bargaining table. When a government asserts its “right to manage” without transparent criteria (I explain this later), it invites deep-seated suspicion, transforming administrative duty into an exercise of perceived bias. Conversely, when a professional union uses the lives of patients as a bargaining chip to protect historical privileges or geographic stay-put rights, it fundamentally forfeits its moral authority and violates the sacred trust of the healer. In this zero-sum game, the “innocent patient” is treated not as a human being in need, but as a hostage to a technicality. We must move past this “Ad-Hoc” culture where decisions are made by the loudest voice or the strongest hand. The only way to restore dignity to the medical profession and provide security to the public is to “draw the line” with a system that is automated, objective, and blind to political or union pressure. True governance is not about who has the power to stop the system, but about creating a system that cannot be stopped by the whims of any one party.
In this tug-of-war, the rope is the public’s well-being, and it is currently snapping. A rule-based system replaces this tug-of-war with a fixed, transparent track. In other words, the current state of healthcare has devolved into a destructive tug-of-war, where every sharp pull from opposing sides shreds the fibers of national trust until the system itself begins to snap. To mend this fraying national fabric, we must replace political ego with objective engineering, implementing a “fixed track” that removes the friction of human whim and ensures the healthcare engine moves forward based on pre-set logic rather than brute force. By anchoring this system in transparent, rule-based law, we end the era of patient hostage-taking, removing the “middle ground” that serves as a battlefield for industrial friction. This approach offers stability beyond the volatile election cycle, remaining bolted to the floor of the law regardless of changing ministerial appointments or union leadership. Ultimately, automating these “rules of the road” restores the dignity of the healer, freeing doctors to return to their true calling and allowing the government to focus on its duty of provision rather than the perpetual struggle for control.
The Ethical Boundary: Redefining the Right to Strike
In any civilized society, the right to labor agitation must be balanced against the Right to Life. Internationally, the medical profession is held to a higher ethical standard because it governs the most fundamental human right: the preservation of life. Unlike other industries where disputes are settled through economic leverage, the healer’s duty is an immutable social contract that exists independently of labor politics. When doctors prioritize this “fixed track” of ethical logic over institutional friction, they safeguard the sacred trust between the patient and the state. This standard ensures that clinical outcomes are never treated as collateral in a tug-of-war for systemic control. By upholding this higher calling, the profession remains an anchor of stability, protecting the vulnerable from the shifting winds of political and industrial strife.
In most developed healthcare systems, strict ethical codes and legal safeguards ensure that essential and emergency services are maintained without interruption, even during industrial disputes. Professional bodies impose clear obligations on practitioners to prioritise patient safety above all other considerations. Contingency frameworks are typically activated to guarantee continuity of critical care, reflecting a deep institutional commitment to non-maleficence. Moreover, public trust in the healthcare system is treated as a foundational asset that must not be compromised under any circumstances. As a result, actions that risk preventable harm or loss of life are widely regarded as incompatible with the core principles of modern medical professionalism.
We must codify the “Minimum Service Level” (MSL). This law would dictate that even during a strike, life-preserving services—Emergency Treatment Units (ETU), Intensive Care Units (ICU), and Maternity Wards—must remain fully functional.
By legalizing these boundaries, we ensure that a strike becomes a tool of protest, not a weapon of mass suffering. By codifying the “rules of engagement,” we transform the healthcare system from a volatile arena into a predictable infrastructure where patient safety is legally non-negotiable. This statutory framework prevents the most vulnerable citizens from becoming leverage in administrative disputes, ensuring that essential care remains uninterrupted regardless of the political climate. By defining exactly where labor rights end and human rights begin, the law provides a shield for the public while maintaining a voice for the workforce. Ultimately, this legal clarity replaces the chaos of confrontation with the precision of a social contract, anchoring the dignity of the medical profession in a bedrock of accountability.
Data-Driven Transfers: Eliminating the “Human Element” of Bias
The “tip of the iceberg” in the current GMOA strike is the transfer system. The government alleges that union members occupy plum posts for decades, while the union fears political victimization. This is a real conflict like the war in the Middle East, so it is vicious. The solution is to remove “discretion” entirely and replace it with a Point-Based Transfer System (PBTS).
Under a PBTS, every doctor’s career is tracked by an objective algorithm. Points are earned for service in difficult rural stations, years of experience, and specialized qualifications, etc. Transfers would be generated automatically based on these scores. When a computer determines the list based on public data, the “power struggle” between the Ministry and the Union evaporates. There is no one to threaten, and no one to favor. This is at the heart of a solution that can be sustained because it replaces the volatility of human bias with the unyielding fairness of mathematical logic. By stripping away the ability for officials to grant favors or for unions to demand concessions, we eliminate the very currency of corruption. This automated transparency serves as a permanent ceasefire, ensuring that merit—not patronage—dictates the movement of our medical workforce. It transforms a chaotic, personality-driven process into a streamlined engine of equity that operates with clinical precision. With the “human factor” of manipulation removed, the system gains a level of integrity that even the fiercest critic cannot challenge. Ultimately, this algorithmic certainty builds a foundation of trust that allows the entire healthcare infrastructure to function with unshakeable stability.
The “Circuit Breaker”: Mandatory and Binding Arbitration
Currently, when a dispute occurs, the only two players are the Government and the Union. When they disagree, the system fails. A strike-free system needs a third party: an Independent Healthcare Dispute Commission (IHDC). This commission, made up of retired Supreme Court judges, public health experts, and civil society representatives, would serve as a “circuit breaker.” If the Ministry and the GMOA cannot reach an agreement within 14 days, the issue is automatically referred to this commission. Their decision must be legally binding on both sides.
This replaces the “law of the jungle” with the “rule of law,” ensuring that might no longer makes right in the corridors of power. By removing the ability of either side to weaponize patient care as a bargaining chip, we dismantle the primary cycle of threats and retaliation that currently defines our medical landscape. This legal framework forces both parties to trade emotional rhetoric for empirical evidence, presenting their cases before a bench of impartial wisdom rather than a court of public outrage. It ends the era where the loudest voice wins, substituting the chaos of industrial action with the quiet, unyielding authority of a judicial mandate. Under this system, the “winner” is not the side with the most political leverage, but the side with the most rational argument for the public good. We transition from a state of nature, where the vulnerable are collateral damage, to a civilized society where the sanctity of life is protected by the highest legal safeguards. This shift fundamentally redefines the relationship between the state and its healers, moving from a paradigm of confrontation to one of constitutional accountability. By enshrining this “circuit breaker” in the bedrock of our legal system, we ensure that while debates may occur, the heartbeat of the nation never stops. It is the ultimate guarantee that in the face of inevitable friction, the machinery of healing remains untouchable and absolute.
Protecting the Patient: Civil Liability and Accountability
For too long, the “innocent patient” has been treated as a third party with no voice. In a Rule-Based Governance model, the law must recognize “Tortious Interference” with healthcare. In a legal context, Tortious Interference occurs when one person or entity intentionally damages someone else’s contractual or business relationships. When applied to healthcare governance as you’ve described, it moves from a corporate concept to a human rights framework.
If a strike is called without meeting the Minimum Service Levels, or if the government fails to provide essential medicine due to administrative negligence, there must be a mechanism for public accountability. Protecting the patient means that both the state and the union must face legal or financial consequences if their actions result in avoidable loss of life. The public should not be the silent victims of a conflict they did not create.
This framework of liability ensures that the weight of a human life is finally factored into the cost of doing business for both politicians and labor leaders. By establishing a clear path for civil litigation, we empower citizens to hold the powerful accountable in a court of law, transforming the patient from a helpless bystander into a protected stakeholder. No longer should a father or mother have to accept “industrial action” as a valid excuse for a child’s missed treatment or a preventable tragedy. This legal deterrence strips away the immunity of negligence, forcing every decision-maker to pause before placing their strategic interests above clinical safety. It creates a financial and reputational mirror for every action taken, ensuring that those who wield the power to disrupt care also carry the burden of its consequences. When the threat of personal or institutional liability is real, the incentive for reckless brinkmanship disappears, replaced by a culture of extreme caution and professional duty. We must move toward a system where “administrative oversight” or “labor dispute” are no longer shields for malpractice, but triggers for restitution. By codifying these protections, we send an unequivocal message: the life of the citizen is not a disposable commodity in a political game. True justice in healthcare is not found in the rhetoric of service, but in the ironclad guarantee of accountability when that service fails. This shift effectively rebalances the scales of power, placing the sanctity of the individual at the absolute center of the national interest.
International Benchmarking: Lessons from Global Systems
Sri Lanka does not need to reinvent the wheel. Countries like the United Kingdom, Australia, and Singapore have faced similar labor tensions but have mitigated them through institutionalized norms. In these nations, medical unions are partners in policy, not combatants in politics. They operate under strict “No-Strike” agreements or highly regulated frameworks in exchange for robust, independent pay-review bodies. By adopting these global practices, Sri Lanka can elevate its medical service from a site of constant friction to a beacon of professional stability.
Consider the United Kingdom, where the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) acts as a vital buffer. This independent entity evaluates economic data and cost-of-living shifts to recommend fair pay, largely removing salary negotiations from the volatile political arena and preventing the need for the “law of the jungle.” In Singapore, the relationship is defined by a “Tripartite” philosophy, where the government, healthcare providers, and professional bodies operate on a foundation of mutual trust and national interest; strikes are virtually non-existent because the system prioritizes mediation and rapid, high-level resolution of grievances before they ever reach the patient’s bedside.
In Australia, the Fair Work Act ensures that while the right to organize exists, it is strictly governed by “protected action” rules that mandate the maintenance of essential services, ensuring that industrial disputes never compromise the public’s life-safety. Furthermore, many developed jurisdictions utilize Mandatory Final Offer Arbitration, a “baseball-style” system where an arbitrator must choose the most reasonable of two final offers, which effectively forces both the government and the union to move toward a moderate, sensible middle ground rather than extremist positions. By implementing these battle-tested international standards, Sri Lanka can transition away from a culture of confrontation. We can replace the unpredictable “pull” of ego with a sophisticated, world-class framework that guarantees the healer is rewarded fairly and the patient is protected absolutely. This is not a radical experiment; it is the proven path taken by the world’s most resilient healthcare systems to ensure that the national fabric remains whole, even under the pressure of economic or social change.
Conclusion: A Tsunami of Change
A tsunami is a natural disaster that cannot be avoided, but a medical strike is a man-made catastrophe. There is no excuse for the continued suffering of the Sri Lankan people under the weight of these disputes. By transforming our healthcare administration from a Power-Based Struggle to Rule-Based Governance, we can create a system that is transparent, fair, and—most importantly—humane. This transition is not merely a policy shift; it is a moral imperative. We are moving from a fragile system of men to a resilient system of laws, ensuring that the “national fabric” is no longer shredded by the competing egos of industrial combatants. By anchoring the healthcare engine to a fixed track of objective logic and legal accountability, we provide the stability that both the healer and the healed deserve. We must draw the line now: let the doctors have their rights, let the government have its procedures, but let the patient, above all, have their life.
Summary of the Framework
* The Problem: The current “Ad-Hoc” system incentivizes chaos, leading to perpetual power struggles where the patient is used as a bargaining chip.
* The Ethical Shift: Life-preserving services are non-negotiable. We must codify the medical profession’s higher calling into law, ensuring strikes become tools of protest rather than weapons of suffering.
* The Objective Tool (PBTS): By replacing manual, biased transfer lists with a transparent, Point-Based Transfer System, we eliminate patronage and corruption, restoring trust through algorithmic fairness.
* The Legal Solution (The Circuit Breaker): An Independent Healthcare Dispute Commission (IHDC), led by the judiciary, must have the binding authority to resolve conflicts within 14 days, effectively replacing the “law of the jungle” with the rule of law.
* The Accountability Factor: Introducing “Tortious Interference” and civil liability ensures that both the State and the Union face consequences for negligence, placing the sanctity of life at the center of the social contract.
* The Goal: To establish a sustainable, strike-free healthcare system that remains “bolted to the floor of the law,” providing professional dignity for doctors and unshakeable security for every Sri Lankan citizen, regardless of the political winds.
This is more than a proposal; it is a blueprint for a civilized society. For the first time, we have the opportunity to replace friction with flow, ensuring that the heartbeat of our nation never stops for the sake of a political point.
*The writer, among many, served as the Special Advisor to the Office of the President of Namibia from 2006 to 2012 and was a Senior Consultant with the UNDP for 20 years. He was a Senior Economist with the Central Bank of Sri Lanka (1972-1993). He can be reached via asoka.seneviratne@gmail.com
