PRESIDENTIAL ADDRESS

Dr. Kumara Wickremasinghe

The Sri Lankan history reveals many examples of medical practices performed by ancient kings as physicians. King Ravana was believed to be an eminent physician who treated many disease conditions and King Buddadasa of Anuradhapura in the 4th century was a famous physician treating both humans and animals. Medical literature such as "Sarartha Sangrahaya” written by King Buddadasa as well as the ruins of well- established hospital complexes at Mihinthale and Alahana Piriwena in Polonnaruwa proves the strong, and established, healthcare system in ancient Sri Lanka.

After practicing Indigenous Medicine for centuries and several other systems such as Ayurveda, Unani, and Siddha in Sri Lanka, western medicine was introduced to this island by the conquering Western nations. There is not much evidence of the Portuguese being involved in improving the health system of the country. During the Dutch period (1640 – 1796) hospitals were established for patient care. 

During their rule from 1815 to 1948, the British expanded and established a healthcare system on the island. They worked through the Principal Civil Medical Officer (PCMO) up to 1856 appointed by the governor. In the year 1856, the Civil Medical Department was established with the responsibility of providing medical care for the  general population. The first rural dispensary was established by then-Governor Sir William Henry Gregory in 1872. In 1925, the post of PCMO was replaced by the Director of Medical and Sanitary Services. The concept of primary health care was first introduced at Kalutara with the assistance of Rockerfeller Foundation during this time. Most importantly, the undergraduate medical education was commenced in 1870 by establishing the Colombo Medical School.

Over the time Sri Lanka developed a well- established island wide healthcare system with Tertiary, secondarily and primary care hospitals and MOH officers covering whole country. The establishment of Provincial councils following the 13th amendment to the constitution in 1987 was a major reform as it devolved the provisions of healthcare to provincial councils. 

History of College of Medical Administrators of Sri Lanka 

In 1974, the Association of Medical Administrators was formed to look after the interests of government medical administrators. In 1992, it was converted to College of Medical Administrators of Sri Lanka with the participation of 46 medical Administrators. The college took the leading role of developing a standard and structured post-graduate training in Medical Administration, and a board of Study in Medical Administration was established in 1994.

Current Healthcare Landscape of the Country Healthcare is one of today’s most dynamic and evolving fields, with a wide range of opportunities and challenges. Due to the relentless efforts of multiple health staff categories as a team for well over a century, Sri Lanka has achieved an enviable health status. The present health indicators provide a perfect example of this fact making our healthcare delivery system a model for other developing countries. We have strengthened our skilled human resources, invested in our infrastructure and inventories, and achieved remarkable success in both the preventive and curative health sectors despite internal conflicts, and economic constraints. Medical Administrators, with the support of the policymakers took the leading role in transforming the Sri Lankan health system successfully by identifying the health needs of the people in the past few decades. They were able to grasp the health-seeking behaviours, attitudes, and expectations of the people of the country which have changed dramatically over the past few decades. Also, they were able to introduce evidence-based management interventions, especially technology-driven medical information management, health resource management, multi-disciplinary approach (e.g. One Health), etc. to provide cost-effective, best possible care for the needy.

Health in 5th Industrial Revolution

Industry 5.0, also known as the Fifth Industrial Revolution, is a new and emerging phase of industrialization that sees humans working alongside advanced technology and A.I. Thus, with medical advancements the life expectancy of people will further increase with a rise in the aging population. During this revolution, mainly due to the effects of life style changes, we are experiencing in high incidence of chronic NCDs such as Diabetes mellitus, Hypertension, and Psychiatric disorders, and Injuries which have already become the most common cause of hospital admissions. Although we have managed to eliminate Polio, Malaria, and Mother-to-child transmission of HIV and Syphilis from the country, we are still struggling to control other communicable diseases such as Tuberculosis and Dengue.

According to the World Economic Forum Insight Report in 2024, the percentage of GDP required for healthcare is rising worldwide. Further, the report highlights that there is a significant shortage of healthcare workers throughout the world and may reach shortage of 10 million by 2030. This will mostly affect the Low and Middle-Income Countries in the world including Sri Lanka where the situation will be even worsened with the economic downfall and shortage of skilled human health resources due to migration. 

With these external and internal challenges, our vision to successfully achieve Universal Health Coverage, the establishment of strong primary care service, strengthening of clinical governance in healthcare, and equity in resource distribution has become challenging
to all medical administrators. Martin Luther King Jr once said that “Our very survival depends on our ability to stay awake, to adjust to new ideas, to remain vigilant, and
to face the challenge of change". Therefore, this is the best time to strengthen the transformation of healthcare by managing “change" professionally and the efforts can be led by the medical administrators in the
upcoming years,

What is Transforming Healthcare?

Transforming Healthcare refers to the process
of implementing significant changes, innovations, and advancements within the healthcare system to improve patient outcomes, increase efficiency, enhance accessibility, and reduce costs. The Healthcare transformation involves various aspects such as including technology integration, organizational restructuring, policy reforms, and shifts in healthcare delivery models. Our responsibility as the college is to guide medical administrators to spearhead this transformation.
Healthcare transformation is `built on 3 pillars:
As Warren Bennis said " Leadership is the capacity to translate vision into reality". Therefore, as the leaders of the Healthcare
lead this transformation.
Since 1993, the college has been instrumental in capacity building by developing highly competent Medical Administrators. So far, 341 MSc-qualified Medical Administration have been produced by the PGIM and among them 130 were able to fulfil the MD qualification with 69 board- certified consultants in Medical Administration. The next step is to develop medical administrators as highly specialized consultants in fields like, Health Economics, Healthcare Policy Development and Planning, Medical Procurement, Human Resource Management, Research and Biostatistics, Project Management, Disaster Management, Hospital Design and Architecture.

United Nations introduced Sustainable Development Goals in which goal 3 focused on Health. Specifically, Goal 3.8 is focused on achieving Universal Health Coverage which has 3 aspects, Access, Service Availability, and Financial Risk Protection.

Achieving Equity in access is a vital part of UHC. This is directly related to the Primary healthcare reforms improving utilization, capacity building, and developing of Primary Healthcare.
Quality Healthcare Services in promotive, preventive, curative, palliative, and rehabilitative health are one of the main aspects of Universal Health Coverage. Though We have achieved a lot in the preventive and curative sectors, we must pay more attention to strengthening the palliative and rehabilitative care services.
health financing has become one of the greatest challenges in the recent past. “Financial Risk Protection” is mandatory in achieving Universal Health Coverage. In Sri Lanka, we are experiencing Ever-increasing out-of-pocket expenditures and, a lower GDP growth rate. With current problems, we have also observed more people included in social safety net.
In this context, we have put more emphasis not only on equity in recourse mobilization but also on initiating “Health Financing Reforms”. Ladies and Gentlemen, more than ever we need to foster leadership to achieve our UHC targets and transform Sri Lankan healthcare. “Professionalism” among healthcare professionals has the utmost importance in transforming healthcare. It is defined as the “High standard that you expect from a person who is well-trained in a particular job”. Higher standards are not only categorized as technical knowledge but also as developing soft skills and attitudes.
College is already in the process of improving the professionalism among its members in many ways and the “Lead the way “program is one such activity to fulfill this requirement. It’s the duty of my council to foster professional development among health eaders to transform healthcare.
We are in a resource-limited environment with constraints in physical, human, and technological resources that affect effective healthcare delivery. Therefore, one of the key concerns in transforming healthcare is achieving Efficiency.

So, our guidance in focusing on allocative efficiency through the distribution of goods and services in an equitable manner, and to provide leadership to avoid maldistribution is important.
Automation in our work processes and integration of our digital health solutions will be the key to reducing duplication in ordering investigations and prescribing drugs. Networking of facilities, and electronic forward and back referrals integrated with National Electronic Health Records will not only
improve efficiency but also be helpful in rational decision-making.
Data-driven decision-making in management is the need of the time to utilize our resources efficiently. This will not only improve our allocative efficiency but also will significantly increase our productive efficiency as well. Ladies and Gentlemen, our healthcare system has achieved commendable success stories, but there is always room to improve to full potential. Some of the countries in our
region have shown that leadership, professionalism, and efficiency have led the transformation of healthcare successfully.

If we carefully analyse the Universal Health Coverage Index from 2000 to 2021, In 2000 Thailand had 43 points and Sri Lanka had 44. In 2021 Thailand has
progressed to 82 points and Sri Lanka has progressed to 67 points.I believe we have the foundation and the potential to reach greater
hights. Every government spends a significant portion of the National Budget on the

Health sector to enhance the Prosperity of the
Nation.
With our competent medical administrators with their competent teams, Transforming Healthcare is not a dream but an achievable reality.
Transforming Health to face the challenges in the 21st century is the key to achieving Universal Health Coverage, Sustainable Development Goals and to achieve overall development as a country. Our success is the success of the country. We as the Sri Lanka College of Medical Administrators, aiming to transform healthcare by nurturing leadership, professionalism, efficiency and bridging partnerships with other professional colleges and stakeholders to tackle the challenges of
the 21st century.

Let us make a healthier nation.
Let us all get together and transform healthcare by fostering leadership, professionalism, and efficiency.

Thank you.