By Sankalpa Marasinghe –

Dr. Sankalpa Marasinghe

In recent days, the remarks made by the Honourable Minister of Health and Media, Dr. Nalinda Jayatissa, during the inauguration of a new building at Apeksha Hospital, have ignited a firestorm of debate across social media platforms. The catalyst for this uproar was Dr. Jayatissa’s declaration that “donations, of any kind, would not be permitted henceforth to the Ministry of Health.”

While the statement itself raised eyebrows and led to swift condemnation from many, it was his subsequent assertion that caught the attention of seasoned medical professionals, myself included. The Minister proposed the establishment of a comprehensive 20-year development plan for health infrastructure, inviting generous contributors to direct their donations toward specific projects within this framework.

This bold proclamation is a watershed moment in Sri Lanka’s healthcare narrative.

For those unfamiliar with the Sri Lankan healthcare system, this may seem alarming. The widespread but misguided belief that donations are always beneficial and harmless only exacerbates the confusion for the uninitiated.

With two decades of service in the Ministry of Health, I feel compelled to share my experience, which underpins my decision to accept the ministerial position despite not supporting JVP or NPP.

Having worked across various health institutions in the country, it’s well-known that donations of infrastructure to government hospitals are not uncommon. Unfortunately, the overwhelming majority of these donations eventually deteriorate, becoming a burden on both the hospital and the entire healthcare system.

I vividly recall a lesson imparted by one of my esteemed professors, Professor Saroj Jayasinghe, who staunchly opposed medical camps. I once asked if he would join me for a medical camp in a rural area. His response, though blunt, was eye-opening and has remained with me to this day. He advised that, if I truly wished to contribute, I should assist the local Medical Officer of Health (MOH) in his clinic, rather than participating in a short-term event. Medical camps, he argued, were often little more than publicity stunts, providing little real benefit to patients and disrupting the existing healthcare system.

Years later, while working at a peripheral health institution, I experienced the truth of his words firsthand. Many patients who visited our gynaecology clinic had previously received contraception methods from such medical camps. These procedures, done hastily and without proper follow-up, led to complications, and a significant portion of our theatre time had to be devoted to removing those devices. This example highlights how even well-intentioned health interventions, if disconnected from the established system, can ultimately create more harm than good.

A closer examination of government hospitals reveals a troubling reality: not only are buildings and units, but also a vast array of equipment and machines—donated by well-meaning individuals and organizations—lying idle, decommissioned, or broken. The root cause of this issue lies in the lack of maintenance, repair services, and the availability of spare parts.

Step into any ICU or specialized unit, and you will often find valuable biomedical equipment cluttering the corridors, taking up precious space. These donations, offered with the best of intentions, end up becoming a burden rather than a blessing for the healthcare system. While the act of donation itself is noble, the true benefit of equipment comes not from its mere presence, but from its ongoing functionality.

For machines to remain useful, they require regular servicing, consumables, chemicals, software updates, and spare parts—resources that are frequently in short supply. Without these, the equipment quickly becomes obsolete, serving only as a space occupying object rather than a functional tool in patient care.

As a further complication, the presence of donated equipment that remains unused can inadvertently prevent the Ministry of Health from providing necessary replacements or upgrades. When records show an abundance of machines in a unit, it creates the false impression that no additional equipment is required. This leads to a double-edged problem: the hospital is left with non-functional equipment, and the Ministry halts the supply of new machines, compounding the inefficiencies already at play.

Thus, well-intentioned donations, without proper planning for ongoing support, ultimately add strain to an already stretched system.

It is important to note that the servicing and repair of medical equipment in government hospitals falls under the purview of the Biomedical Unit within the Ministry of Health. However, the scope of support provided by this unit is far from universal. The technical assistance offered is limited to equipment brands that have been specifically ordered and purchased through the Ministry of Health. Consequently, if donations consist of equipment from brands not procured by the ministry, they will not be serviced by the Biomedical Unit—regardless of whether they are the same type of equipment.

This is a practical issue often overlooked when it comes to donations. While well-meaning donors may provide advanced or high-quality machinery, if the equipment falls outside the framework of the Ministry’s procurement system, it risks being left without the necessary technical support. The Biomedical Unit is equipped and staffed to handle only the equipment within its designated procurement list, and the lack of service or spare parts for non-standard brands quickly renders these machines obsolete or non-functional.

This reality underscores a critical flaw in the current donation process: the failure to consider long-term sustainability. Without aligning donated equipment with the available technical infrastructure and support systems, such donations, no matter how well-intended, can inadvertently become liabilities rather than assets.

We have started advising our donors recently to check with the brands the biomedical unit supports in service before purchasing and donating to the hospital.

The ad-hoc erection of buildings and the establishment of new units remains one of the most challenging issues within the healthcare system. When a potential donor offers to fund the construction of a particular unit, the sheer scale of the investment often creates a bias toward accepting the donation. The magnitude of the offer can cloud judgment, with many viewing it as an opportunity that should not be turned down.

However, this immediate appeal overlooks crucial considerations such as the order of priority, feasibility, and long-term sustainability. The healthcare system must be evaluated holistically, taking into account existing infrastructure, patient needs, and resource allocation. The decision to accept such donations should not be driven solely by the size of the financial commitment, but by a strategic analysis of whether the new unit aligns with the hospital’s goals, its capacity for maintenance, and its ability to integrate into the broader healthcare framework.

Moreover, the long-term success of any facility or unit depends on its operational viability—requiring not just physical space but the consistent availability of trained staff, equipment, ongoing maintenance, and funding for consumables and services. Without careful consideration of these factors, even the most generous donations can quickly become unsustainable burdens.

Thus, while the prospect of new infrastructure is often enticing, it is critical to approach such offers with caution and a clear-eyed view of the future, ensuring that every addition to the healthcare system is a well-considered investment in long-term success, rather than an impulsive decision driven by immediate opportunity.

There are numerous glaring examples of this issue that continue to persist today. The massive National Nephrology Hospital in Polonnaruwa and the imposing 16-story OPD complex at the National Hospital of Sri Lanka (NHSL) serve as prime testimonies to the consequences of overlooking the actual needs of the healthcare system.

While both of these projects were initiated with good intentions, they highlight the fundamental flaw in how donations and infrastructure expansions are often approached. In the case of the National Nephrology Hospital, while the idea of a dedicated center for nephrology is undoubtedly valuable, the scale of the facility and its location were not adequately aligned with the regional healthcare needs. The hospital, built at considerable expense, has faced challenges in terms of staffing, maintenance, and ongoing operational costs—issues that were not fully accounted for at the planning stage.

Similarly, the 16-story OPD complex at NHSL, a monumental structure in Colombo, is another example of infrastructure being built without a thorough evaluation of its alignment with actual healthcare demands. While the complex is impressive in its scale, the question remains whether such a large facility was truly necessary given the available space and existing services within the hospital. The decision to construct such an enormous building, though seemingly an advancement in healthcare, overlooks the more pressing need for improvements in primary care services, staff training, and the upgrading of existing infrastructure that would have a far more significant impact on patient outcomes.

Both examples underscore a critical flaw in the healthcare development strategy: prioritizing grandiose infrastructure projects over the more immediate, foundational needs of the system. While the desire to showcase progress is understandable, it often leads to resource misallocation. The result is that these high-profile projects, instead of addressing the most pressing needs of the healthcare system, end up being symbols of misplaced priorities. In the long term, they become a drain on resources, diverting attention and funding from the critical, day-to-day challenges that demand immediate solutions.

In the context outlined above, the minister’s comments were, without a doubt, spot on regarding the current practice of donations and the development of hospital infrastructure. Was it the right place for him to express this? Absolutely! The fact that such a significant uproar has arisen among the general public, with many criticizing the minister for “rejecting donations,” indicates that a firm, impactful message was needed to shake the public’s understanding of the issue.

Indeed, there are several remarkable examples of donations that have not only been successfully integrated into healthcare systems but have also provided long-term benefits to countless patients. A prime illustration of this is the Sri Jayawardenapura Teaching Hospital, which stands as a testament to the generosity of a Japanese donation that contributed to the establishment of the entire facility. This hospital has, for many years, served as a cornerstone of medical care, benefiting numerous individuals and communities.

However, there are other, equally inspiring examples of donations that have had a lasting impact. I had the privilege of personally witnessing one such example, which unfolded in the aftermath of the 2004 tsunami. In the wake of the disaster, several foreign travellers who had been rescued and brought to Embilipitiya Base Hospital were affiliated with an organization called Caritas. Grateful for the care and assistance they had received, the organization generously donated a maternity unit to the hospital. I was fortunate enough to be part of the project, observing firsthand the planning, construction, and eventual operation of the unit. I had the opportunity to work in this newly established unit for two years, and during that time, I came to appreciate the critical factors that contributed to its success.

There were two key elements that made this donation particularly effective. First, there was a genuine “need“ for a maternity care unit at the hospital, a need that had been carefully identified by the medical staff. This understanding of the hospital’s requirements ensured that the donation was relevant and would address a significant gap in services. Second, the project was overseen by a dedicated and visionary individual, my boss, a consultant obstetrician and gynaecologist, took a hands-on approach, meticulously planning and managing every detail of the maternity unit, from the laying of the foundation stone to the selection of the curtains that would adorn the rooms. His commitment to creating a facility that was not only functional but also thoughtfully tailored to meet the specific needs of the hospital and its patients played a pivotal role in the success of the unit.

Yet, while this story stands as a shining example of how donations can significantly improve healthcare infrastructure, it remains, unfortunately, an exception rather than the norm. It is important to recognize that not all donations are seamlessly integrated into healthcare systems, nor do they always align with the true needs of the facility they are intended to support. Without careful planning and oversight, well-meaning donations can fall short of their intended purpose, failing to provide the long-term value that they could otherwise offer.

Whether Dr. Nalinda Jayatissa’s intention was to create such a shock is something I cannot definitively say. Moreover, I do not have the insight or the authority to predict whether the minister will translate his words into action. However, when it comes to his speech at Apeksha Hospital, I stand in agreement with many other medical professionals in acknowledging and appreciating the stance he took. The minister’s remarks, though controversial, brought much-needed attention to a critical issue that has long been overlooked. In this moment, he spoke a hard truth that challenges long-standing practices and urges a re-evaluation of how donations and infrastructure are handled in the healthcare sector.