He is a forthright and opinionated politician, who has always stood by his ideology. He believes in a Government that must be strong, one that stands by its policies and promises. Regardless of party affiliations, Dr Rajitha Senaratne, Minister of Health, Nutrition and Indigenous Medicine has always stood by the policies and plans for the betterment of the country. Under his leadership, the Free Health Policy and National Drug Policy have been revitalised, to ensure a universal healthcare coverage where all Sri Lankans receive the best treatment. The healthcare achievements during his tenure, some equaling that of higher income countries, have been recognised internationally. As such, Minister Rajitha Senaratne has been appointed a Vice Chairman of the World Health Organisation Executive Board. Speaking on the many positive initiatives taken by the Government, he adds that the country has much to achieve. Minister Rajitha Senaratne stresses that the country’s progress however depends on moving away from the ‘island mentality’ and above all uniting together as one nation.
By Udeshi Amarasinghe and Keshini De Silva
Photography Mahesh Bandara and Menaka Aravinda
How would you describe the person Rajitha Senaratne?
This is a difficult question to answer, especially because I believe that it is actually others who can describe a person’s character well. However, I am thought to be an outspoken politician. That is the simplest description I can give of myself.
Can you elaborate on your political journey as you are a professional in the medical field as well? How did it all start?
My political thinking started when I was studying at Ananda College. At that time, the school was organising a musical show, and I opposed it. A colleague who supported me was Basil Rajapaksa; he was my classmate and best friend at that time. Back then we started student politics not party politics. I entered the University of Peradeniya in 1970, during which time the JVP dominated student politics at universities. I did not support the JVP, but I sympathised with them because of the great sacrifices made by them for their movement. From there on I started my political career and enrolled in the SLFP student union. However, I was pro-left in my thinking because I had studied about dialectical materialism, Marxism and other similar political ideologies by reading literature from the Faculty of Arts. Therefore, I was attracted to leftist politics. In 1972, I became the student leader of the Peradeniya Student Union. In 1973, I became the General Secretary of the Inter University Student Federation of the SLFP, during which time we were actually spearheading the political campaigns.
After I graduated from the University I continued to be a part of politics. Then, a leftist movement called Janawegaya was started within the SLFP by Kumar Rupasinghe, the then Prime Minister’s eldest daughter, Sunethra’s husband. He had been a Marxist in London and returned to Sri Lanka after marriage. It was after listening to one of my speeches that Kumar decided to engage in SLFP politics. He stated that otherwise he was not interested in Sri Lankan politics because being the Prime Minister’s son-in-law meant that he could not oppose the Prime Minister’s thinking. He however, believed that there were good people within the party with whom he could work. In late 1975, there was a crisis in the Government where the two Marxist parties – the Lanka Sama Samaja Party (LSSP) and Communist Party (CP), were closely working with us from the SLFP. We actually instigated that we should leave the Government and form a left front. We agitated and moved a resolution in the Janawegaya central committee and won. Kumar never wanted that to happen. As a result, there was a crisis within the party. We broke away with around 14 members of Parliament. The LSSP had actually left the government earlier and the Communist Party had followed. At that time those imprisoned during the JVP insurgency were released because once Parliamentarians resigned from the Government, Mrs Bandaranaike lost the two-thirds majority in Parliament and the state of emergency could not be extended. Prisoners such as G I D Dharmasekara and Mahinda Wijesekera, who were detained under the state of emergency, were released. Thereafter we all joined together and formed a broad left movement, but we lost badly at the elections and President J R Jayewardene was elected.
We Always Thought The UNP Was Safeguarding The Interests Of The Capitalists, And That They Were Against The Working Class. But Then I Witnessed Firsthand How Then President D B Wijetunga Defended The Rights Of The Working Class Against The Capitalists.
During the 1982 election, I campaigned for Hector Kobbekaduwa against J R Jayewardene’s Government. I travelled around the country as a member of the campaign team. Even during the 1976 campaign for the left movement, I addressed around 134 meetings throughout the country as a staff grade officer in the public service who did not have the political rights. I thought I would be sacked from public service, but luckily, that did not happen. Even in 1982, despite addressing the public on stage across Sri Lanka, I was able to preserve my position in public service. We lost the election in 1982 and the insurrection took place in 1989. We faced the insurrection, and by that time we had formed the Sri Lanka Mahajana Party with Vijaya Kumaratunga. I was in the central committee with Vijaya and was very close to him. I campaigned for his ideology, especially because of his stand on the National Question. In fact, that was what attracted me to the party. I was one of the main speakers who defended his ideology. After he died, we continued the party, and later formed the Bahujana Nidahas Peramuna, with Chandrika Kumaratunga. While she was party President, I was the General Secretary. The Vice President was Ratnasiri Wickramanayake, former Prime Minister. We campaigned and wanted to form a third front supporting the SLFP, albeit independently.
However, Chandrika later decided to join the SLFP. I did not want to join the SLFP at the time due to family bandism within the party, which I did not like. Subsequently and also quite coincidentally, at the time when we instigated strike action at the Prima Factory in Colombo, we wrote a letter to the then President D B Wijetunga. He invited us for discussions. During these meetings he always took our side. I was well prepared and argued with officials while highlighting all the issues. He defended my argument and granted all the demands against Prima, Singapore. We always thought the UNP was safeguarding the interests of the capitalists, and that they were against the working class. But then I witnessed firsthand how the President defended the rights of the working class against the capitalists. Before I left the meeting, the President said that he would like to meet me again, I agreed and he gave me an appointment. We had a discussion for about two and a half hours, after which he invited me to join the UNP and work towards such policies within the Government. I joined President Wijetunga and worked closely with him. In the 1994 elections, the UNP was defeated.
Gamini Dissanayake became the party leader and I campaigned with him at the 1994 Presidential election upon his request. We travelled throughout the country during the campaign. He was assassinated by a suicide bomb attack. Earlier, during the 1989 campaign I had survived two bombs; I still have three shrapnel in my body. After Gamini’s death, Ranil became the leader of the UNP. In 2001, we toppled the incumbent government. Gamini Athukorala, Karu Jayasuriya, Ravi Karunanayake and myself were instrumental in the Government’s defeat as we planned everything together. Subsequently, we formed the UNP Government from 2002 to 2004. I was the Minister of Lands and Land Development, and it was I who introduced the land policy that exists today. The policy prohibits the sale of state-owned property. It can only be allocated for housing for the poor as well as to the farmers for agricultural purposes. I introduced a policy, which issued a 30-year lease for ownership or partnership with the state as well as a 50-year land lease for limited liability companies. We removed the 99-year lease, with the provision for such a lease to only be provided with Cabinet approval for National Projects. We also introduced the Title Programme, which was supported by the World Bank. This ensured that instead of a deed, one would be issued a title for the state and private properties. We also conducted an aerial survey of all the lands in the country and provided titles to everyone. After the Government was toppled in 2004, this programme was not taken forward as a JVP politician was appointed to the Ministry of Lands portfolio.
I Spoke To The Nation For Around Three Hours That Day, Explaining That This Was A Victory Over Terrorism And That It Had Nothing To Do With The Suppressions Of Tamils In Sri Lanka.
Subsequently, we were a part of the Opposition as we were defeated in the 2004 elections and once again in the 2005 Presidential Election with Mahinda Rajapaksa being elected President. In 2007, in order to fight terrorism, we wanted the UNP to join the ruling party and form a National Government for a specific period until terrorism in the country was under control. However, the party did not agree to the policy. Therefore, 17 people including myself joined the Government to spearhead the campaign against terrorism. I was one of the main spokesman for the Government during that period. After the
Sri Lankan Forces took control of Thoppigala, I addressed the nation with the Military Spokesman. Even after Velupillai Prabhakaran was killed and the war was declared over, it was I who addressed the nation for one and a half hours.
Later, upon the request of President Mahinda Rajapakse, I repeated the address in English for the benefit of the Diplomatic services. I spoke to the nation for around three hours that day, explaining that this was a victory over terrorism and that it had nothing to do with the suppressions of Tamils in Sri Lanka. Since then I hoped that Mahinda Rajapaksa would take measures to restore the rights of the Tamil people in the country.
During the Government of President Mahinda Rajapaksa, I was first the Minister of Construction and Engineering Services. Our achievements were immense during this period. For the first time in the history of Sri Lanka, our Sri Lankan companies were able to secure projects in the Middle East and we encouraged them to take on construction work in Qatar. Those companies are continuing their operations in Qatar and Dubai. I also worked towards making the State Engineering Corporation profitable. Later, I was appointed Minister for Fisheries and Aquatic Resources Development. After the war ended, I worked towards resurrecting the fishing industry and enabling the livelihoods of our fishermen in the North. We started everything from the very beginning; from providing them boats, engines, nets and loans. I did not allow fishermen from the South to fish in the island’s waters in the North. We also arrested all Indian vessels that ventured into our waters illegally and prevented the Indian fishermen from intruding into Sri Lanka waters. We improved the Ceylon Fisheries Corporation and started constructing about six new harbours around the island.
After the war, I continued to campaign with other leftist leaders for the rights of the minority groups. Initially, President Mahinda Rajapaksa agreed with us, but he later took a U-turn on this policy due to the influence of others and instead adopted an extremist line of thought. We were frustrated; this led us to leave the Government in November 2014 and we nominated Maithripala Sirisena as President. It was all planned in secret with the then Opposition Leader, and now Prime Minister Ranil Wickremesinghe. Subsequently, I spoke to the then Minister, Maithripala Sirisena and convinced him to become the Presidential Candidate and persuaded Ranil Wickremesinghe to garner his party’s support. Together we faced the Presidential Election and won; this partnership continues. At present, I am the Minister of Health, Nutrition and Indigenous Medicine.
You have always been very outspoken, how important is this in Sri Lanka?
You need to have the guts to express what you feel. Politicians feel something, yet many do not express their beliefs under the assumption that they would lose votes. Most instead make populist decisions, which have for several years harmed our nation. The war we faced in our country for nearly three decades was the result of decisions made by politicians in this country for the sake of power. This is the difference between India and Sri Lanka. Indian leaders never resorted to division for such motives. That is why they have been able to unite such a large country and save it from division. Despite being a relatively smaller country, Sri Lanka has been threatened by division because our politicians are not outspoken. Every politician must speak on what they feel. They must reveal to the people who they really are, their wants as well as their vision for the country. Only then will the people understand who is better for the country. Sri Lankans always fail in selecting leaders, because they do not understand the correct nature of politicians. Everyone has their own hidden agendas to merely win elections and seize power. In retrospect, the leftist leaders of Sri Lanka were outspoken. They were eventually isolated because of their policies, but at least they were forthright in terms of the country’s National Questions. Other politicians merely changed their beliefs and policies for the benefit of their party.
I Have Overcome Many Problems Because I Have Been Consistent With My Policies. I Still Maintain The Beliefs And Policies I Revealed To The People In The 1980s. However, I Have Changed Parties Because Political Parties Have Never Maintained Their Policies… In Sri Lanka No Party Is 100 Per Cent Good; There Is No Supreme Party.
By standing for what you believe in, you would have faced challenges. How did you overcome these challenges?
I have overcome many problems because I have been consistent with my policies. I still maintain the beliefs and policies I revealed to the people in the 1980s. However, I have changed parties because political parties have never maintained their policies. Some boast that they have been in the same party for many years, but their policies are not consistent. Under the leadership of President Chandrika Kumaratunga they professed Federalism, yet during President Mahinda Rajapaksa’s tenure they sided with the unitary state belief and even opposed the 13th Amendment to the constitution. I on the other hand do not care about party policies, because in Sri Lanka no party is 100 per cent good; there is no supreme party. Therefore, I have changed parties, while maintaining my policies. The only policy I have changed over the years is in terms of the economy. I once believed in a Socialist Economy, however today I consider this to be impractical. I now support a strong and reasonable, private-sector dominated Open Economy.
What has been your experience as the Minister of Health? This is a very difficult portfolio to hold.
Since the 1951 Free Health Policy, Sri Lanka has offered free health services. However, problems persisted in the system and the people suffered, especially due to the lack of facilities. Another significant issue was that, although the service was deemed to be free, the public were expected to pay for certain facilities due to shortages. In addition, certain significant health problems were not being considered.
In Sri Lanka, 75 per cent succumb to non-communicable diseases (NCD), which includes heart disease, cancer and diabetes. For example, when I assumed office, the allocation of funds per cancer patient was 1.5 million rupees. When I asked what happens to the patient after the 1.5-million-rupee cap, no one could provide an answer, as essentially the patient dies due to a lack of treatment. I immediately removed the fund restriction and introduced a policy where cancer patients receive cover for treatment throughout their life. Today, there are some patients who have received treatments amounting to 45 million rupees, and they continue to live. During the previous Government, President Maithripala Sirisena who was the then subject Minister wanted to increase the fund cap to 2.5 million rupees, however provisions were not made. They were only spending 1,300 million rupees on cancer medication per year at 280,000 rupees per drug. Today, we purchase cancer medication for 144,000 rupees. Despite the reduction in the price by half, the Ministry spends 4,800 million rupees on cancer medication. If I did not work towards halving the price of the medication, currently the Ministry would be incurring a cost of 9,600 million rupees. Today, there are good medications to treat cancer, which enable the people to live for a longer time.
A similar issue was concerning patients with heart problems, another major cause of Sri Lankan mortality. Once a patient is admitted to hospital with a myocardial infarction, after testing they are advised to have cardiac stents placed. Previously, a cardiac stent was priced at 350,000 rupees, which many Sri Lankans could not afford. The price for those receiving multiple cardiac stents would be exorbitant. Those waiting in line to purchase stents would have received a shock when they had to foot the bill and many would have never been able to afford the procedure. According to a Medical Audit by Prof Sudarshini Galappatti only three per cent of stents were being placed in state hospitals as 97 per cent of patients could not afford this. I have now introduced free stents for everyone, all of which are being imported from the US. According to Dr Gotabaya Ranasinghe, Cardiologist anyone admitted to a New York Hospital for a cardiac stent placement, would receive the same stents the Government is currently importing. While previously, 50-60 stents were placed a month, today 800-900 cardiac stents are being placed. This is the difference; these are the benefits the people have received. Once a journalist thanked me over the phone as he had required a cardiac stent and was able to go through with the procedure as the stents were provided for free. In addition, he informed me that another patient in his ward, who had been advised to receive a stent placement three years ago but could not afford it, had just completed the procedure as the stents were now offered to the public free-of-charge. Many have only recently learned that cardiac stents are being provided for free in the state hospitals, because the media has not provided adequate publicity.
I Have Now Introduced Free Stents For Everyone, All Of Which Are Being Imported From The US.
A drug called Tenecteplase has been invented, and if administered within two hours to a patient suffering from a myocardial infarction the survival rate is high. The patient would even be able to get up from bed that very day. Only the ECG readings need to be checked while the Tenecteplase is administered. Cardiologists in the country, met me and requested for the drug to be imported to Sri Lanka. Agreeing to them, the next day I met the company producing the drugs and inquired on the cost. At first they quoted 125,000 rupees per vial. I informed them to provide me a reasonable price before I stipulate the price for them and assured that I would purchase 10,000 vials. They then quoted 55,000 rupees per vial. Recently, another tender was approved by the Cabinet for an order of 13,000 vials of Tenecteplase. Although our media does not highlight these achievements, the March 2018 British Medical Journal had written an Editorial stating that the introduction of Tenecteplase and the free-of-charge stents has made a revolution in the cardiothoracic field in Sri Lanka.
A recent Medical Audit revealed that while previously when six patients were admitted with myocardial infarction, five passed away; today when six patients are admitted with myocardial infarction five patients will survive. When I announced this at Kalmunai Hospital, the Cardiologists said, “No Sir, after introducing free stents and Tenecteplase, no patient has died upon admission to Kalmunai Hospital.”
Previously, 1.2 million Sri Lankans were going blind every year as they could not afford cataract lenses that cost 60,000 rupees a pair. I have instructed that cataract lenses be provided free-of-charge and these lenses are also imported from the US. My policy is not to introduce low price devices, because it is for the poor. Based on this policy, the technical evaluation committee has been instructed to only import the best into the country.
Another problem that came to my attention was that many state hospitals complained they could not perform all the blood tests required due to a massive demand. As a result, they referred these tests to private laboratories. This had become a huge business in Sri Lanka, therefore I banned the referral of patients to external laboratories. They then requested automated analysers, which we took measures to introduce to every hospital with a laboratory. An Automated analyser costs around 15 million rupees, and we distributed 2,600 million rupees worth of analysers to all state laboratories in 2016. Within 30 seconds the machine provides 16 test reports, which meant no one could complain that the laboratory was too busy or congested. This has become a huge relief to the public who would have otherwise had to spend 4,000 to 10,000 rupees on these tests. Whenever a hospital cannot perform a test, we request the patient to visit the private sector and the state pays the bill. I have allocated all Directors of the state hospitals ten million rupees each, which is a fund that is maintained continuously. If the Director spends two million rupees on patients, then this is immediately replenished. The Director of the National Hospital has been allocated 50 million rupees to make urgent medical purchases. If there is any shortage, then the Directors can directly make a purchase through Osu Sala.
Today Sri Lankans Are Able To Obtain Real Free Health In Sri Lanka. The WHO Has Recognised And Complimented Our System. In The 2017 World Bank Report, We Have Been Commended As Having The Best Pro-Poor Health Service, Which Is Both Effective And Efficient.
The shortage of pharmaceuticals was another issue that plagued the health system. When I took office, there was a shortage of 44 to 79 drugs everyday. Conversely, the value of expired drugs in Sri Lanka was 350 million rupees and I realised the orders for medication were not being balanced adequately. We worked with ICTA (Information and Communication Technology Agency) for six months to develop a software, which would provide real time data on the pharmaceutical status in all hospitals. The system was first introduced to the Central Government Systems and we have now extended it to the Provincial Councils as well. The Directors can access the information daily and if there is an immediate shortage, they can check for the nearest hospital with availability and obtain it. Placing the order and handover is done online, while transportation will be handled by the RD. Therefore, there are no longer any shortages in hospitals. If there is a shortage, then that will be due to the inefficiency of the Director of the hospital. The Director also has the power to place an order with Osu Sala, which will immediately be supplied and the Ministry will later make the payments to Osu Sala.
Today Sri Lankans are able to obtain real free health in Sri Lanka. The WHO has recognised and complimented our system. In the 2017 World Bank report, we have been commended as having the best Pro-Poor Health Service, which is both effective and efficient. The report has commented on everything, including action taken against tobacco – a 90 per cent tax accounting for the highest tobacco tax in the world. Last year cigarette consumption had reduced by one billion sticks, which means 100 million packets. Some say that in retrospect beedi smoking has increased, it is a farce. Cigarette smokers are addicted to nicotine. In beedi, which is made from another leaf, there is no nicotine. No one can satisfy their nicotine needs from another non-nicotine leaf. Many say our measures will promote the illegal cigarettes trade, this is something the Government will need to curtail and must be done by the Customs and Police.
We have also placed controls on sugary drinks. I enforced the traffic light system, where the ‘green patch’ indicates beverages with less than 2g per 100cc, the ‘amber patch’ denotes 2g to 11g and the ‘red patch’ indicates over 11g of sugar per 100cc. This programme was introduced with limited publicity, and we have seen a significant decrease in ‘red patch’ drinks since. The supermarkets informed me that the youth always check the patch before they purchase beverages today. The two main multinationals operating in Sri Lanka had to reduce the quantity of sugar in their products by ten per cent to obtain ‘amber patches’ in order to improve sales. The second step was the implementation of the sugar tax – 50 cents per gram of sugar. For example, one beverage bottle may contain eight grams of sugar, while the daily consumption of sugar should not exceed four grams. Hence, the people were doubling the consumption of sugar, which was leading to diabetes. When I enforced the tax system, the prices of sugary beverages rose to such an extent that the companies had to introduce non-sugary beverages. Our campaign has been successful.
The world’s main challenge today is non-communicable diseases (NCD). Globally, 70 per cent of hospital deaths are due to NCD. In Sri Lanka, this statistic is over 70 per cent. To overcome NCD, we have to strengthen universal health coverage to encompass the entire population. There must be a free health service available for those who cannot afford health care. Because of our Free Health Policy, Sri Lanka is one of the best countries in terms of Universal Health Coverage. The other objective is to prevent diseases at the primary level. It is for this reason that I set up 846 Healthy Lifestyle Centres and 906 Well-Women Centres monitored by the MoH around the country. Although advice is given, the public does not have a way of checking on their health, as hospitals are only meant for treatment. These centres offer free health check ups. Healthy Lifestyle Centres check the BMI, blood pressure, blood sugar levels and blood cholesterol levels, and if something is detected they are referred to the nearest hospital. The Well-Women Clinics check for breast and cervical cancer, the two predominant cancers affecting women. If we can diagnose patients early, everyone will survive. The WHO visited these clinics and commended the programme, stating that it is a good example for the world. Even Prime Minister Narendra Modi has started introducing a similar programme in India, through his Provincial Health Ministers. Similarly, Latin American, Asian and African countries have also adopted this concept.
The WHO And World Bank Have Appreciated Our Achievements And Initiatives. That Is Why I Was Invited To Address The Annual Session Of The World Bank In 2017. This Was The First Time That A Health Minister Has Been Invited To Address The Summit In The Entire History Of The World Bank, As They Usually Invite Finance Ministers Or Foreign Ministers.
Although the clinics have been set up, many do not visit them. For this reason, we plan to appoint a family physician per population of 10,000. It will be their responsibility to ensure that all the patients are screened and they will be paid according to how they achieve these objectives. The family physicians will need to perform screenings once a year to start with and eventually twice a year. When the health of the country’s entire population is checked and they are advised on how to live healthy, then we can reduce NCDs. Our target is to reduce NCDs by 25 per cent.
The WHO and World Bank have appreciated our achievements and initiatives. That is why I was invited to address the annual session of the World Bank in 2017. This was the first time that a Health Minister has been invited to address the summit in the entire history of the World Bank, as they usually invite Finance Ministers or Foreign Ministers. After my one-hour presentation, they were convinced, and the Vice President of the World Bank requested another one-to-one discussion with me on my next visit to Europe. Thereafter, I met him on the sidelines of the World Health Assembly along with Dr Deepika Attygalle, the World Bank’s representative in Sri Lanka. After I left, the Vice President had informed Dr Attygalle that he had never met a Minister with such a vision in his entire career and that he would do all he can to support us. Thereafter, he secured me a World Bank facility of 200 million US dollars. Similarly, JICA of the Japanese Government has donated 15 billion rupees, while the Asian Bank has provided another ten billion rupees. My challenge now is to spend the money appropriately on our projects. The World Bank funds must be allocated over five years, which accounts for 500 million rupees a month. Considering the challenges and red tape in the public service, the funds must be allocated and utilised appropriately and quickly, or else it will be sent back to the World Bank. From this month, we will be commencing programmes countrywide including providing facilities for hospitals and on educating the people.
UNICEF said that this year Sri Lanka is now on par with the US and Kuwait in terms of health factors, especially in terms of maternal and infant mortality rates. Although they are 15 times richer than us, we have maintained similar standards. The London Guardian had said that the US must be ashamed that their Health Factors are equal to a middle income country such as Sri Lanka. At the Commonwealth Health Ministers Meeting, Madam Graca Machel, Nelson Mandela’s wife, praised Sri Lanka thrice in her speech. She stated that the economy is not a criterion to have a good health service and that Sri Lanka is the glaring example for that. There are countries that are 50 times richer than Sri Lanka yet the do not have the same health facilities. Our data is even better than in certain states of the US. The entire world is looking towards our health system and are referring to Sri Lankan health services in their reports. Many South East Asian reports have pages filled with comments on Sri Lanka, where they finally conclude that the achievements are due to robust political leadership. They add that the multinationals of tobacco, sugary beverages and pharmaceuticals will one day stand up against the Minister, but the WHO Head Office, regional office and WHO Sri Lanka office will use all their strength to support the Minister.
What motivated your stringent campaigns against tobacco and sugar consumption?
There is no point in spending great amounts of money on treatment, when the best policy is prevention. If you allow smoking, then the country eventually spends millions of rupees to treat smokers for diseases such as lung cancer. We have to educate the people and take action to prevent them from smoking and consuming sugary beverages, among other habits that are bad for the body. Even enforcing certain action against these products creates awareness. After bans and taxes are in place, then the public discusses the measures and will investigate the reasons behind the move.
I Have Decided To Increase Sri Lanka’s Manufacturing Capacity. Previously, The SPC’s Manufacturing Capacity Was Only Two Billion Capsules And Tablets. We Have Increased This Number To Four Billion With New Production Plants From Japan And Believe This Will Help Us Cater To The Demand From Hospitals.
We are providing tobacco farmers alternative agricultural crops. At present, around 30 per cent of tobacco farmers have opted for other crops and new cultivations.
You have spoken about the importance granting permission for medicinal cannabis. Could you elaborate on this?
Cannabis was banned in Sri Lanka by the British to promote tobacco. At the time they introduced tobacco, Sri Lankans were not interested due to the use of cannabis. Today, the British have lifted the ban in the UK and similarly the ban was lifted in Canada as well. They have now found that this is an important medication for mental disorders, especially for depression and other neurological disorders. In fact, with cannabis there is an effect only if you smoke it. If you use it for pharmaceuticals or as a beverage there is no such affect, and this finding has resulted in the lifting of the ban on cannabis for medical purposes. Many countries cannot grow cannabis because of their climate, especially due to their winters. If we produce cannabis, there is a big market to tap into, such as the pharmaceutical manufacturers in Europe. Some economists say that we may be able to solve our budget deficit through this industry. I have proposed the commencement of a 100-acre cannabis plantation for medical purposes to be managed by the armed forces to ensure the cannabis does not fall into the wrong hands. Cannabis and opium are used in indigenous medicine in Sri Lanka. When I came into office, opium was not available and with great difficulty I negotiated with the Indian Government and acquired opium for indigenous herbal medicine.
What about pharmaceutical production in Sri Lanka?
One of the recommendations of the National Drugs Policy introduced by Professor Senaka Bibile was to issue a Maximum Retail Price (MRP) to limit the price markup on the medicine. The second was for the import and distribution of medication to be taken over by the Government. This was suited for the closed economy at that time, however it cannot be implemented in today’s open economy. Thirdly, he wanted all medication to be produced in Sri Lanka.
We have improved the State Pharmaceutical Corporation, and the SPMC’s revenue last year was 32 billion rupees; the highest in its entire history. There was a profit of over 1.9 billion rupees and I have therefore mandated a 50 per cent increase in the salaries of all employees. Though the pharmaceutical industry has not been nationalised, we have ensured that the Government corporation is on par and able to compete with private medical suppliers. Though Prof Bibile established the SPC, he could not place controls on the prices of medicine and commence production in Sri Lanka. This was instead achieved during the UNP Government of the 1980s under Dr Gladys Jayawardene. She set up the first SPC Manufacturing Corporation. Likewise, I have decided to increase Sri Lanka’s manufacturing capacity. Previously, the SPC’s manufacturing capacity was only two billion capsules and tablets. We have increased this number to four billion with new production plants from Japan and believe this will help us cater to the demand from hospitals.
We have also invited foreign and Sri Lankan investors to invest in the pharmaceutical production industry in Sri Lanka and have promised them a ten year buy-back guarantee. Those who partner with the Government in a joint-partnership will receive a 15-years buy-back guarantee. As such, 46 companies have already signed on and three factories have started production. Another two will commence production before the end of the year. When these producers supply medication, their cost is at times one-tenth of the Maximum Retail Price stipulated by us. For example, a drug with a MRP of 63 rupees, is now supplied by them for 61 cents. Therefore, in the future the prices of medication will decrease further. Eventually, the Government will have many benefits. From the three factories that are currently producing medication, the Government receives a saving of seven billion rupees. Other benefits include Sri Lankan producers adhering to international manufacturing principles that will result in the further decrease of prices.
The First Year After I Set The MRP For Medicine The Pharmaceutical Companies In Sri Lanka Complained, However They Are Now Silent Because They Have Seen That The Volumes Have Increased. Finally, The People Have Also Benefited As Their Bills For Medication Have Reduced By 4.4 Billion Rupees.
The recent medical audit indicates three benefits for the people. Previously, patients could not consume medication daily as they could not afford to do so, which resulted in bad health as well as a lack of treatment. However, they can do so today. Consultants say that patients now request the best drugs to be prescribed as they are affordable. The quality of the drugs market has improved. Initially, those who opposed me said companies would be forced to close and editorials were even written stating that I was disrupting the market. Many warned that good quality drug agents would leave the country. None of this has come to pass, and not a single company has left the country. The companies have instead gained; as despite profit margins being low, the market has improved by two, three or in some instances six times. Patients insist on quality medicine today as these are now affordable. Drugs for gastritis, asthma, high blood pressure and cardiology have all been manufactured in Europe. The first year after I set the MRP for medicine the pharmaceutical companies in Sri Lanka complained, however they are now silent because they have seen that the volumes have increased. Finally, the people have also benefited as their bills for medication have reduced by 4.4 billion rupees.
Presently, all medicine manufacturers supply to the Government through the buy-back guarantee. The second stage will see them provide supplies to the private health sector. Certain producers have built plants that will be able to tap into the medicine export market because even the US prefers countries such as Sri Lanka to produce the medication, since the production costs are less.
Should Sri Lanka introduce national health insurance?
A national insurance scheme is something that we should introduce at some point in time. This will decrease congestion in the state hospitals. However, the problem is that even private hospitals are congested. Therefore, without establishing more hospitals, it is not practical to introduce a national health insurance scheme. As a result, we have negotiated with Russia to establish a large hospital in Sri Lanka. Another UK hospital will be constructed in Galle. After four to five hospitals have been established in Sri Lanka, we can introduce an insurance scheme where patients will be able to seek private sector health services. Such a scheme will be in the Government’s best interest because while the Government spends more money on services due to the lethargic public service, the private sector performs those same services for only a fraction of the cost.
Could you tell us about your new position at the WHO?
There are many who speak out of turn as they do not have an understanding on how these positions are appointed. Dr Razia Pendse, WHO representative to Sri Lanka who spoke at the meeting when I was appointed to this position explained it quite well. In 2016, I was appointed the President of the South-East Asian region, when the WHO South-East Asian Session was held in Sri Lanka. This is a post that is automatically given to the hosting country. In 2017, the South-East Asian Region nominated me to the Executive Board. It was a personal nomination for me, Rajitha Senaratne, Minister of Health, Sri Lanka. I have been appointed for the next three years. There are only 34 members in the Executive Board, from the 194 member countries. Similar to any other organisation, there are different positions in the Executive Board, and from the 34 members the office bearers are elected. They unanimously elected me as one of the four Vice Chairmen. Even the WHO rep clarified that the Chairman and four Vice Chairmen form the bureau of the WHO. The bureau makes all decisions for the sake of health for the entire world. The Director General and Deputy Director General of the WHO decide on administration, finance and among other matter, the running of the WHO. This appointment is a first for Sri Lanka.
…From The 34 Members The Office Bearers Are Elected. They Unanimously Elected Me As One Of The Four Vice Chairmen. Even The WHO Rep Clarified That The Chairman And Four Vice Chairmen Form The Bureau Of The WHO. The Bureau Makes All Decisions For The Sake Of Health For The Entire World.
Previously, Nimal Siripala de Silva was appointed to Chair a WHO session. However, the post that I have been appointed to is in the Executive Board.
Members of the WHO have witnessed the difference. They invited me to address, chair or co-chair many of the side events of the annual session. I chaired the Malaria sub event and co-chaired the diabetes conference with the European Union Minister. Indeed, when I attended the commissioner’s meetings, the WHO had no policy on sugar. They never state that sugar causes diabetes due to the pressure of the industry, especially by the US. They are never allowed to promote action against sugar-based products to prevent diabetes. At this session, there was a commissioner who wanted a policy against sugar and I supported her as co-chair. Eventually, she became frustrated with the opposition and left the session, however I continued to debate until they included sugar as a cause for diabetes and promoted action against sugar-based food and beverages.
In another session, there were concerns as the benefits of breast feeding was not promoted in the WHO norms, despite public knowledge that breast milk is superior to any formula. This was due to pressure from the milk food industry. There was a side-event chaired by Thailand, who was influenced by the US. While other countries were pressing for it, the US did not allow breast feeding to be allowed into the norms. It was stated that it could be included into the norms with a consensus and that there was no voting in the WHO. A few people then requested me to speak against it, and after seeking permission I addressed the gathering. I stated that no one needs to be a health professional to know that breast feeding is the best. It is a fact accepted worldwide and I questioned as to why it could not be adopted by the WHO norms, especially as all members, except one, was for it. Then I cited an incident in the assembly the previous day, where a US-sponsored resolution had been introduced against providing health facilities to those in Gaza. It was defeated and even Sri Lanka voted against the resolution. Citing this incident, I questioned how consensus was not required in the assembly, yet was required at a side event. I further questioned how there could be no voting, when we have voted against a resolution yesterday. I even cited how for the first time in the history of the WHO, the Director General was appointed through an election. After that I left the session, the US had withdrawn the motion and breast feeding had been adopted to the WHO norms. Similarly, a lot can be achieved at world assemblies if you are prepared to speak up.
As Sri Lanka is recognised for its good health systems, I was appointed Vice Chairman of the WHO. Even at the Commonwealth Health Ministers Meeting, Madame Graca Machel and Patricia Scotland, the General Secretary of the Commonwealth, both spoke of Sri Lanka and commended our health services. British Minister Jeremy Hunt told me that I was the star at the WHO. That is the recognition we have received within the WHO. Most of the Ministers ask me how I implemented policies against tobacco and the sugar-based beverages, and stood up to the pharmaceutical companies. They ask whether there was external pressure or intimidation. They are scared to take such decisions in their countries due to pressure.
However, the Pharmaceutical Policy was introduced in Sri Lanka by Prof Bibile in 1971, although it was implemented in 2016, 45 years later. Every year, the SPC commemorated Prof Bibile, however until now, his policies could not be implemented due to external pressure.
Despite so much work being done, why are the people not aware?
That is a mistake we made. When we made ‘Good Governance’ our theme, we decided to not focus on publicity. This is alright in developed countries, however in countries such as Sri Lanka, if there is no publicity, the public assumes the Government has not done anything. We did not advertise in print or electronic media, nor did we place banners and posters. We just followed through with our plans, and now we realise that the people are not aware of many initiatives by the Ministries that have been taking place during the two years. It is also detrimental, because when the people are not aware of the facilities available such as the free health facilities, they are misled into paying for those services or to purchase the pharmaceuticals from elsewhere.
Politics Means Policies. We Must Appeal To The People With Our Ideology And Open A Dialogue On Policies That Will Be Good For The Country’s Economy, Foreign Affairs, Education And Health.
As a result, we have decided to launch a publicity campaign to make the public aware of the health services available. The Government also plans to launch a similar public awareness campaign.
What is your overall perception of politics in Sri Lanka?
There are only a few real politicians in Sri Lanka. Back in the day politicians entered the field with an ideology. They had a purpose and it was educated professionals who joined politics. Today, politics has become a career not a service, where the reigns are passed from the father to the son. Politicians today are always thinking about their next post. In the past, it was not thought to be a career and as a result there was greater political dialogue. Today, discussions are focused on personal problems. Today the professionals do not want to join politics, and when my friends seek advise on whether to enter, I warn them against it. I too would have never entered politics in the present context. It may have been right or wrong, but when I entered politics there was an ideology. I had a leaning towards socialism, therefore I entered the field for those views. We had no vision to enter Parliament because socialists were never interested in entering Parliament. It was merely said to be a stage until the revolution. Until 1994, I did not really think about contesting elections, but I was a part of campaigns throughout the country.
Because of my policies, my son also has a personal ideology, which is the reason why he wanted to contest the elections from another district. He won although he never used my name for any poster or signage. He never introduced himself as Rajitha Senaratne’s son. Many pressed him to do so, however he did not give in. Even the Prime Minister says, “Chathura spoke politics while the others didn’t and that is why he won”.
Politics means policies. We must appeal to the people with our ideology and open a dialogue on policies that will be good for the country’s economy, foreign affairs, education and health. We must consider social measures that will uplift the people, develop the economy, face economic challenges and move towards better foreign relations. After we signed the Free Trade Agreement with Singapore, there has been agitation in various sectors. A FTA is a big deal for any country and results in great benefits. However, it became an issue in Sri Lanka because this concerned another country. That is the island mentality, where many assume this island is the world, which is not so. We must break away from that thinking. The world is a global village and we are one of the villages. We cannot achieve anything in isolation. We must work together with other countries.
You are a senior and key member of the present Government. The younger generation is hesitant to enter politics. What can be done?
The future of politics looks bleak as the educated and knowledgeable younger generation do not enter the field. This is the 21st century. Yet, for a country that has had free education since the 1940s, there are many politicians presently in Parliament without the minimum Ordinary Level examination qualification. In retrospect, the 13 members of the Chinese Communist Party Standing Committee were all political school graduates in the past. Today, only one of the 13 is a political school graduate, as the others are professionals in different sectors such as engineers, accountants and lawyers. They are educated and are dedicated towards developing the country. Professionals enter the government in China and practice what they know and what they have learnt. How many professionals enter Sri Lankan politics?
We must make a revolutionary change in Sri Lankan politics, or else the country will be heading towards a disaster. Many politicians speak and behave in an unprofessional manner because they do not have or understand the purpose for which they entered politics. They do not have a vision. We must appeal to the people and start the dialogue from within the masses. The media has a huge role to play, especially in terms of starting the discussions. We must motivate good people to enter politics. Many are scared to enter politics as in terms of modern elections it is all about money. However, in the past a school teacher such as Wijeyananda Dahanayake could enter the Parliament. M S Thaymis, a peon at the General Post office could enter politics. A labourer working in the Kahatagasdigiliya graphite mine entered politics from the Dodangaslanda Seat, while a Beedi worker was elected in Balangoda. In the past a different strata of people with an ideology was represented in Parliament.
A FTA Is A Big Deal For Any Country And Results In Great Benefits. However, It Became An Issue In Sri Lanka… That Is The Island Mentality, Where Many Assume This Island Is The World, Which Is Not So. We Must Break Away From That Thinking. The World Is A Global Village And We Are One Of The Villages. We Cannot Achieve Anything In Isolation. We Must Work Together With Other Countries.
Are we capitalising on opportunities available to Sri Lanka?
We are not capitalising on all the opportunities because there is so much of objection. People assume their opposition is a form of nationalism; but that is not the case. Anyone who is against the development of the country is not nationalistic. Other countries are using the opportunities and they are bypassing us. For example, once the Maldives economy was solely based on exporting dry fish to Sri Lanka, yet today they are way ahead of us. Bangladesh, created in 1973, has surpassed us. Sri Lanka must develop as a country and enter into the world arena. We are doing well in certain areas, but not in terms of the economy and development.
What can we expect from you in the future?
We must have a strong Government with a strong ideology. Government policy should not deviate due to various issues and pressures. A strong policy should be the cardinal principle of the Government. If we promise something and have been elected based on that promise, then if it is for the betterment of the country, it should be implemented. Lee Kuan Yew and Mahathir Mohamad were successful because they stood by their policies and ideologies. Politicians and Parliamentarians must have discipline.
Where are we heading in terms of the National Question?
The present situation is better than the condition before 2015. Today, Muslims do not have any issues in terms of their beliefs such as Halal and can make decisions for themselves. The setting is peaceful. In the North, the people have the freedom to protest and campaign against the Government. I am pleased to see that they are able to express their freedom and voice after 40 to 50 years. In the past the Army and Police intervened and stifled democratic demonstrations, even before the war, which is what eventually led to the armed insurrection. Yet, today people are able to use their right to free speech and to protest. However, we have not done enough for the Sri Lankans in the North. There are many matters to be settled and we must enact a new Constitution that will provide an answer to the National Question once and for all.
There Are Many Matters To Be Settled And We Must Enact A New Constitution That Will Provide An Answer To The National Question Once And For All. The Main Political Party Representing The Tamils And The Tamil Leadership Are Reasonable Today. We Must Use This Time To The Maximum, Before We Lose Another Golden Opportunity.
The main political party representing the Tamils and the Tamil leadership are reasonable today. We must use this time to the maximum, before we lose another golden opportunity. The North was a warring arena for 30 years and there was no development.Therefore, we must expedite infrastructure development in terms of housing, roads, water, electricity as well as improve health and education. I was in Jaffna recently and met C V Vigneshwaran who appreciated the initiatives taken in the North by the Ministry of Health. He is not just like any Tamil politician, he is not even aligned with the TNA. All the Tamil politicians including M K Sivajilingam attended my functions, because they also feel that we are reasonable. Through Global Funds, we have renovated around 65 hospitals in the North. We are in the process of building a Cancer Hospital, Cardiothoracic Unit, Accident Services Unit, Pediatric Hospital in the North, among other facilities. It is only then that they will feel like they are part of one country.
We must ensure that the minorities feel equal to the Sinhalese. Then they will take part in the national development because they will feel that this is their country. We must promote that mentality, or else the country can never be developed. After we unite as members of one family we can then even invite the diaspora to serve in Sri Lanka for at least two years, paying them as much as we can. From scientists, to engineers, doctors and consultants; many talented Sri Lankans are overseas. They spearhead large-scale hospitals in Europe. The Indians established Apollo Hospital after inviting Indians in Westerns countries to return home and serve their country. Therefore, we too must create that environment of unity within Sri Lanka.
