GMOA Annual Report 2011/2012

Government Medical Officers Association

TU No: 291Room No.10

Organization of Professional Associations Building Complex No.275/75,Prof.Stanley Wijesundara Mawatha

Colombo 07

Tel: 0112580886 / 0112503586 / 0714999555 Fax: 4518668 / 2503586

Web: www.gmoa.lk

E Mail: [email protected]

[email protected]

GMOA

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ForewordThe GMOA has a proud history of 82 years and has maintained the highest standards as a responsible trade union as well as a prominent professional body over the decades. Even though our primary objective is to safeguard the rights and privileges of our members, most issues taken up by the GMOA have long term benefits to patients and to the healthcare delivery system of Sri Lanka.

Health service in Sri Lanka has reached internationally comparable standards. The health indices of the country are a testimony to the above, keeping in mind that over 90% of residential patient care is delivered by the state sector. The credential as one of the most cost effective health sectors in the world was achieved by Sri Lanka due to retention of highly skilled human resources in the state sector. GMOA has set an example to the other professionals by retaining more than 90% of professionals in the government sector.

Our membership consists of intellectuals and academics. Therefore GMOA acts on merits of an issue and not for popularity. This rational unbiased approach has led others to consider our membership as an eccentric group. However all the outcomes we have achieved both improve working conditions of doctors, while concurrently enhancing patient care services.

Going beyond the horizon of the medical sphere, we pioneered the development of the National Wage Policy. The expertise and confidence we gained while handling this issue was used to contribute towards national interests. GMOA took the lead in developing national policies while maintaining the stability professionals both financially and academically.

As a Trade Union, our primary objective is to safeguard the rights and privileges of our members. We had many salary achievements and made significant strides in improving members welfare. At the same time as a professional organization we handled an unprecedented number of professional issues of long term national significance during the past year. We firmly believe that our contributions will not only produce benefits to our members but also uphold and safeguard rights of patients, in the best interest of the country.

We salute and sincerely thank our 16 000 strong membership who stood strong against all adversities directed against us to safeguard the GMOA and the dignity of the medical profession. May your devotion and perseverance guide the GMOA in the years to come.

Thank you.

Dr. Anuruddha Padeniya (President - GMOA)Dr. Chandika Epitakaduwa (Secretary - GMOA)

Executive SummaryDuring the 1990s the GMOA approached many professional issues with a sense of vibrancy, despite lacking a proper long-term vision. Nevertheless, the efforts taken to withstand external pressures towards politicization should be appreciated. Since the year 2000, the GMOA embraced a more responsible role as a trade union, to increase capacity building of the medical profession and to provide insights to many professional issues.

GMOA election and its background

In July 2011, the present executive committee of the GMOA was elected with an unprecedented majority. The dormancy as a trade union in the preceding 3 years and the frustration by the membership due to endless political intrusions led to this historical victory of the present GMOA. The membership looked up to us to bring an end to this deteriorating trend and begin a new course towards improving the standards of the medical profession.

Initial phase

The present executive committee worked very hard to satisfy these demands and restore the GMOA to its current status. Within the first two months of taking office, we were able to eliminate political interference in transfers and other activities creating a setting in which our membership could work in dignity.

Once we stabilized the GMOA, we focused on neglected priorities of the membership. However, we regret to note that valuable physical and intellectual resources were seized from the GMOA office. This made our path much more difficult and extra effort was needed to retrieve those valuable resources of the GMOA by approaching numerous other institutions.

Subsequently we had the opportunity to function with a far-sighted vision, with our principal objective to achieve financial stability of the medical profession. Since July 2011 we have successfully addressed more than 6 salary issues and 8 critical professional issues.

Financial stability of Medical Profession

Since the year 2003, GMOA started addressing salary issue with the rationale of using scientific principles of salary structuring. We re-started the process after 3 dormant years. Despite the various political harassments and intimidations we could successfully address 6 salary issues. One can appreciate the time line of these outcomes to judge the strategic approach of GMOA.

Policy issues

Many professional issues of national significance were dealt with by the GMOA during the past year, which expanded our capacity beyond traditional trade unionism of the past decade.

The influx of unqualified foreign doctors, has threatened the quality of health care delivery. Foreign medical practitioners without necessary qualifications are already practicing in the private sector as Specialists exploiting the deficiencies of our health regulatory mechanism. The CEPA & SATIS agreements would only open the door for more Indian doctors to practise without proper evaluation. The best strategy to face this threat is to strengthen the regulatory frame work. As such the GMOA initiated the development of an evaluation procedure for foreign doctors culminating in the establishment of a Specialist Registry at the SLMC.

The ill-conceived Private Medical College at Malabe was functioning smoothly with the highest political backing at the time of our election. GMOA membership was divided on the issue, and protecting our unity was also a priority. We approached the issue strategically based on safeguarding standards of medical profession and education in Sri Lanka. We initially published a report highlighting the deficiencies of Medical College at Malabe and later it was ratified by a panel appointed by Ministry of Health to inquire in to PMC at Malabe. We


launched an awareness campaign highlighting the deficiencies and currently PMC at Malabe is defunct and on its natural course of death.

The Service Minute was a neglected piece of unwritten law since its inception in 1991. We shed light into this important issue, despite activities of sabotage from fractions with vested interests to destroy our unity. Through this, corrections in the salary anomalies and promotion anomalies of Grade Medical Officers and Specialist Medical Officers were initiated.

We focused on the lack of transparency and stagnant transfer procedures which caused many difficulties and frustration to our membership. With much effort we were able to computerize the transfers, thus enabling them to be transparent, systematic and effective.

Out of the welfare activities taken up in this year it is noteworthy to mention that schooling of doctors children, which was a cause of deep concern for the membership was addressed by issuance of letters by the Secretary to the Ministry of Education, to all 280 doctors who sought admission to popular schools.

PGIM issues were also dealt with favourable outcomes. Political interferences which threatened the independence of the SLMC were neutralized by the GMOA by bringing together all stakeholders of the medical profession.

Facing Intimidation

We endured a well-funded and organized external and internal campaigns operating against us, at their level best. When we took office, all important documents including salary commission reports and submissions had been taken away from us. GMOA office staff had resigned and all soft and hard assets were either deleted or seized from the GMOA.

All forms of media including Facebook and rumours were used to defame the current GMOA President. Politicians were persuaded to attack Dr. Anuruddha Padeniya, Prof. Lalitha Mendis, Dr. Nihal Nonis & other independent medical professionals.

Nevertheless we were able to withstand these obstacles and make unprecedented achievements for members and the profession within the past year. We will continue to march forward in the future to uphold the dignity, financial stability of the profession as a trade union and a responsible professional association in the future.

Editors

Executive Committee 2011-2012President Dr. A.B. Padeniya

Vice President Dr. S.A.S. Karunathilake Dr. S.U.W. Wadanamby

Secretary Dr. E.D.G.C. Epitakaduwa Asst. Secret. Dr. A.M.N. Ariyarathne Dr. U.M. Gunasekara Dr. K.C.P. Gunathilake Dr. S.S. Marasinghe

Treasurer Dr. K H.D. MilroyEditor Dr. W.M.P. WarnasuriyaAsst. Editor Dr. C.T.K. FernandoNom.td Member Dr. D.T.D. De Silva

TrusteesDr. Nimal RathnasenaDr. Saman AbeywardenaDr. Paba PalihawadanaDr. Prasanna DasanayakeDr. Lalantha Ranasinghe

General CommitteeDr. M.D. AjithDr. A.K.A.S.K. AnandaDr. M.S. AzeezDr. S.W.K.M.B. BulankulamaDr. D.T.D. De SilvaDr. H.R.M. HuseeirDr. H.R.K.T. DhammikaDr. T.D.B. IllangasingheDr. W.M.L.D. JinadasaDr. I.L.K. JayarathneDr. S.H. KolombageDr. D.Y. PiyadigamaDr. A.L. RanasingheDr. B. Sai NiranjanDr. W.I.N. WijesooriyaDr. D.M. EpaDr. A.M. JayasiriDr. M.W. KumaraDr. S.U.C. RanawakaDr. K. Wickramanayaka

Transfer Board

Specialist Transfer Board

Dr. Saman WadanambyDr. S.A.S. Karunathilake

Dr. Lalith PereraDr. B.G.N. Rathnasena

Dr. Harsha SathischandraDr. Kumudini RanathungaDr. Saman Abeywardane

Dr. Prasanna DassanayakaDr. S.M. Arnold

Dr. Channa WedamethriDr. Upul Vidanagama

Dr. Lalith GamageDr. Priyantha Madawala

Dr. Anidu PathiranaDr. Eresha Jasinghe

Grade Medical Officers Transfer Board

Dr. Parakrama WarnasuriyaDr. Nalin Ariyarathne

Dr. Lasantha JinadasaDr. Kanchana Bulankulame

Dr. Sainiranjan BalakrishnanDr. Naveen de Soysa

Dr. A. LathaharanDr. Thimothe Wickramasekara

Dr. S.A. VithanageDr. Nalinda HerathDr. Vipula Indralal

Dr. Nath WijesooriyaDr. Palitha Rajapaksha

Office StaffAdministrative Officer

Mr. P.L. Gunasinghe

Finance AssistantMiss. Sashika Mallawarachchi

Administrative AssistantsMiss. C.U. Thomas

Miss. Achini MuthaiahMiss. H.A.P.B.D. Subashinie

Office AssistantMr. H.G. Ran


GMOA Branch UnionsAkkaraipattuAmpara DBUAmpara GHAnuradhapura THAwissawella BHBadulla PH Balangoda BH Hambantota DGH Batticaloa GH Bibile BHBlood BankCheddikulam BHChilaw GH CI MaharagamaColombo Municipal CouncilColombo DBUCastle Street Hospital for WomenColombo South Teaching HospitalDambadeniya BHDambulla BH Dehiattakandiya BH Dickoya BHDiyatalawa BH De-Soyza Maternity HomeEheliyagoda DHKarapitiya TH Embilipitiya BH Eye HospitalMatara GH Gampaha DPDHS Gampaha GH Gampola BH Galle DBU Kamburupitiya BHHomagama BH Horana BH Infectious Diseases HospitalJaffna THKahawatta BHKalmunai AMH (South)Kalmunai North BH Kalmunai RegionalKalutara DBUKalutara DGH Matara DBUKandy TH Kantale BH Balapitiya BHKarawanella BH Kegalle DBUKegalle GH Kilinochchi DGHKuliyapitiya BH Kurunegala DBUKurunegala TH Lady Ridgeway Teaching HospitalMadirigiriya BHElpitiya BH

Mahaoya BH Mahiyanganaya BH

Mannar GH Marawila BH

Matale GH Hambantota DBUMahamodara TH

Mawanella BH Mental Hospital Angoda

Monaragala DBUMonaragala DGH

Medical Research InstituteMullaitivu

Mulleriyawa BHNational Institute of Health Service Kalutara

Nawalapitiya DGHNegombo DGH

National Hospital of Sri LankaNikaweratiya BH Nuwara Eliya GH

Panadura BH Peradeniya TH

Point Pedro BHPolonnaruwa GH

Polonnaruwa DBU Pottuvil BH

Primary Healthcare Services Puttalam Peripheral

Puttalam BH Ragama TH

Ratnapura DBURatnapura PGH

Rikillagaskada BHSirimavo Bandaranayake

Specialised Chlidren's Hospital Sri Jayawardanapura GH

Tangalle BH Thambuttegama BH

Trincomalee GH Vavunia GH

Warakapola BHWathupitwela BH

Welisara Chest Hospital

Table of ContentsFinancial Stability of Medical Officers 13

Telecommunication Allowance14Research Allowance16Exemption of Disturbance, Availability and Transport Allowance from Taxation 19Exemption of Extra Duty Allowance from Taxation 19Revision of Disturbances Availability & Transport Allowance 20Revision of Extra Duty Allowance21

Service Minute22Preliminary Grade Abolition 22Correction of Salary Increment Anomaly of Grade II Medical Officers 22New Promotion Scheme for Grade Medical Officers 23Salary Anomaly Correction for Specialist Medical Officers 24Grade Promotions for Post Graduate Trainees 24

Professional Issues 25SLMC Issues 26Malabe Private Medical College Issue30Code of Conduct for police when dealing with Clinicians 33

Health Regulations and National Health Policy34Evaluation of Foreign Specialists and Establishment of Specialist Registry35Elimination of Illegal Medical Practice37

Medical Service39Saturday - Official Holiday for Doctors 39Correction of Saturday Duty Hours 40

Members Welfare41Schooling Issue41Establishment of an Insurance Scheme for Intern Medical Officers 41Etisalat GMOA Internet Package with free dongle42Upgraded Bank of Ceylon Loan Scheme42Special Loan Scheme for Medical Officers from Peoples Bank- No upper limit for Housing Loans 42Special Sri Lanka Telecom Package 43Reduction of Hyundai local handling charges 43

Medical Education44Issues of Post Graduate Training44Distribution of BNFs to Medical Institutions 48

Dignity49Policy on providing health coverage for Politicians 49Trade Union Actions 49Branch Union Issues 50Anti GMOA Activities 51Newsletters 53GMOA Publications 55

Annexures56

1.Financial Stability of Medical OfficersFinancial stability of a profession is essential to maintain high standards and productivity. It is a necessity to retain highly skilled professionals in the country to deliver patient care of high quality as well as to ensure deployment that safeguards equity.

GMOA first proposed a National Wage Policy in 2003, which was developed and approved in 2006 by the 2006/06 circular. This categorized Public servants into several strata and provided the basis for granting salary increments without getting chain reactions from other groups. Unfortunately this aspect was neglected from 2009-2010. We reactivated the GMOA to achieve this goal despite resistance from both internal and external fractions who do not understand the values of addressing these issues on a scientific basis.

During the past year we addressed:1. Basic Salary 2. Allowances

1. Basic Salary

We approached financial stability based on a scientific salary guiding principle - salary compression ratio. Basic salary of public officials had not been upgraded since 2006. GMOA worked with the vision of achieving 1:12 Salary Compression Ratio, which is the next step of the National Wage Policy under Public Administration Circular 2006/06. According to these principles we persisted towards achieving Rs.200,000.00 for a Specialist and Rs.150,000.00 for a Medical Officer.

We had productive negotiations with Ministry of Health, National Salary and Cadre Commission and the Ministry of Finance and Planning who were convinced by our case. GMOA presented the proposal to His Excellency the President who agreed with its principles and requested to develop a consensus among all trade unions and professions for its final implementations.

GMOA is negotiating with other trade unions at present to further refine the proposal and build consensus.

2. Allowances

While negotiating for basic salary increments, we focused on increasing the take home salary of Medical officers so that practically 1:12 ratio is reached.

Accordingly 6 strategic allowances, which were neglected in previous years, were addressed during the past year. Medical Officers are included in the Senior Level of the National Wage Policy of PA Circular 2006/06. As such we were entitled to a Telecommunication Allowance and a Research Allowance, which were privileges of Senior Level Public Officers.

The following allowances were introduced and revisions were done:1. Introduction of Telecommunication Allowance 2. Introduction of Research Allowance3. Exemption of Disturbances, Availability and Transport Allowance from Taxation4. Exemption of Extra Duty from Taxation5. Revision of Exemption of Disturbances, Availability and Transport Allowance6. Revision of Extra Duty Allowance

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1. Telecommunication AllowanceNational Wage Policy was introduced by Public Administration Circular 2006/06 under which Medical Officers were categorized as Senior Level Public Officers. Senior Level Public Officers were granted a Telecommunication Allowance by Treasury circular No.446 issued on 01.09.2010 to which Medical officers were also entitled. However Telecommunication Allowance was not implemented till September 2011 when the current Ex-Co addressed it.

Problems were noticed in implementing the Telecommunication Allowance in the Provincial sector and for Postgraduate Trainees, which we promptly addressed through issuance of new circulars. Telecommunication Allowance was fully implemented after a long and complex process in which 21 circulars were issued in the process. Eventually we were able to fix the Telecommunication Allowance with the salary after negotiations with the government.

Initial Implementation of Telecommunication Allowance

Registration procedure to apply for the Telecommunication Allowance was made simple and direct by the GMOA.Subsequently payments were implemented at the branch union level. Active Branch unions implemented the allowance efficiently for their members.Payments were implemented in September 2012; exactly one year after the issuance of the Treasury Circular.

Implementation in provincial sector

The initial Circular dated 13.05.2011 on the Telecommunication Allowance did not address the Provincial Health Sector. As a result Telecommunication Allowance was not paid to doctors of Provincial Hospitals.To address this issue GMOA obtained a Ministry of Health Circular dated 8.3.2012 by Secretary of Health. GMOA also addressed all the governors and facilitated urgent payment of the allowance.

Implementation for Post Graduate trainees

Although PG trainees were eligible for the Telecommunication allowance there was no proper mechanism to pay it.As such GMOA developed a mechanism to pay the allowance to PG trainees with Ministry of Health Circular dated 14.03.2012.With the implementation of Telecommunication Allowance for Provincial Sector and PG Trainees, finally GMOA set up the legal framework to achieve the Telecommunication Allowance for the entire membership.

Fixed Telecommunication Allowance

GMOA negotiated with the government to get the Telecommunication Allowance fixed and added to the salary. As such Ministry of Health Circular 01-24/2012 dated 16.05.2012 was issued giving Medical Officers 2 options:i. Doctors could draw the maximum claim limit by submitting bills to fulfill the requirements as per Circular- Health Ministry/CA/191 dated 08/03/2012.ii. Doctors who do not wish to submit bills can claim 2/3 of maximum limit as a fixed allowance added to the salary. Doctors who are having official telephones can claim 1/3 of maximum limit as a fixed allowance.

(Please refer Annexure 1 - Circulars authorizing Telephone Allowance for PG Trainees, Provincial Sector doctors and Fixed Telephone Allowance.)


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Medical Officers could fill and submit a simple application to the head of their respective institutions and claim the allowance.

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Extract of the circular issued more than 1 year ago for all categories in the Senior Level

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2. Research AllowancePublic Officers categorized under Senior Level via Public Administration Circular 2006/06 were eligible for a Research Allowance worth 25% of the basic salary according to 2011 budget proposals; a privilege earlier granted only to University Lecturers. As such Medical Officers were eligible to claim Rs.7500.00 upwards and Consultants could claim Rs.11000.00 upwards as Research Allowance.

Research Allowance is calculated directly as 25% of the basic salary. Therefore the allowance increases every year with annual salary increments. As such the actual annual salary increment is also increased by 25%.

Previously the only way to gain a salary increment was to get a Grade promotion either by seniority or by completing a diploma and going through the fast tract. With the implementation of the Research Allowance, a larger salary increment can be achieved with less effort and time.

Once the proposal is submitted the allowance is granted for 24 consecutive months. If the research is published in an accepted forum allowance will be given for life. Many Branch unions successfully organized Research Workshops together with the Mother Union to help their members to gain the Research Allowance.

Process of obtaining the Research Allowance

A unit has been established at the Education, Training and Research Unit (ET & R) of the Ministry of Health to coordinate the implementation of Research Allowance.

Five doctors can get together and form a research team and select a suitable research topic. The research proposal should be written according to guidelines specified by the Secretary, Ministry of Health.

The project proposal has to be presented to the Director ET & R unit along with the following documents which can be obtained from www.gmoa.lk or from ET & R unit of Ministry of Health. The documents are:

1. Application form duly filled and authenticated by the Head of the Institution.2. Certified copies of NIC, SLMC Registration Certificate & salary slip of the previous

month. Submit your research proposal to the local ethics review committee or to the SLMA ethics

review committee and obtain ethical approval. Once the ethics approval letter is issued hand over a copy to the ET & R unit for processing. ET & R unit will send the research proposal to the Technical Review Committee appointed by

the Ministry of Health. The committee comprises of consultants of various specialties. The technical review committee will send their comments on the proposal back to ET & R unit.

The process is complete once the relevant documents are submitted, ethical approval is granted and Technical Review Committee adjustments are made.

The Director, ET & R will submit the document to Director General of Health Services for approval. Once the approval is granted you will be eligible for Research Allowance

We have initiated forming ethical review committees in all Teaching and Provincial Hospitals as per Guidelines issued by Forum of Ethics Review Committees, Sri Lanka. Guidelines are available at ET & R Unit, Ministry of Health


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Research Allowance Granted - 25% Salary Increase

Research Proposal Suppor;ng Documents ET & R

Technical Review

CommiEeeDGHS

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My No. DMS/A/8/21Department of Management Services,General Treasury, Colombo 01.10.03.2011.

All Secretaries to the Ministries,

Payment of Research Allowances as per the Budget Proposals 2011 In accordance with the budget proposals 2011, a monthly research allowance at the rate of twenty ve percent (25%) of the basic salary excluding allowances could be paid to University Lecturers and Senior Level Ocers engaged in research work in the public sector, subject to the following provisions. (This allowance does not entail any right to the pension or to any other statutory allowance).

1. Ocers En;tled to the AllowanceI. Lecturers and the senior level members of the academic sta of the universiUes who are in the permanent cadre.II."Senior Level Ocers" in accordance with the deniUon sUpulated in the Public AdministraUon Circular No. 06/2006 or

ocers in the Government CorporaUons and Statutory Boards who have completed at least 10 years of permanent service in "Academic and Research Services" or in a higher post according to the Management Services Circular No.30.

2. MethodologyI. A proposal including the nature, Ume frame, and methodology of the research should be submi[ed to the Research

Management Council/Commi[ee menUoned in Para 04 and the approval of the said Council/ Commi[ee for the research proposal should be obtained by the ocers enUtled to the research allowance as per Para 02.

II.The research allowance can be obtained with eect from 01.01.2011 subsequent to the submission of the interim research report relevant to the said proposal to the Research Management Council/Commi[ee within six (06) months and having obtained the approval thereof.

III.ConUnuity of granUng the research allowance at the end of two years will depend on the saUsfacUon of the Council /Commi[ee with regard to publicaUon of the nal research report in an InternaUonally or NaUonally Accepted ScienUc PublicaUon and/ or submission of the nal research report to a relevant Symposium within the period of two years.

3. Research ManagementI. Research proposals of University Lecturers - Research Commi[ees accepted by the Senate of the relevant University.II.Research proposals of the ocers serving in the eld of agriculture in the Public Service, Government CorporaUons and

Statutory Boards - Sri Lanka Council for Agricultural Research Policy (CARP).III.Research proposals submi[ed by the ocers related to other elds - The Research Supervision Commi[ee established

under the Ministry of Technology and Research comprised of the following ocers or the Sub Commi[ees appointed by the said Commi[ee as required.

Mrs. Dhara WijayUlake - Secretary to the Ministry of Technology and Research Doctor T.R.C. Ruberu - Secretary to the Ministry of Health Dr. R.H.S. Samaratunga - Secretary to the Ministry of Environment Mrs. Malani Pieris - Secretary to the Ministry of PlantaUon Industries Mr.Thilak Collure - Secretary to the Ministry of Industry and Commerce Dr.Saman Kelegama - ExceuUve Director, InsUtute of Policy Studies Mr. B. Wijayaratne - Director, Sri Lanka InsUtute of Development AdministraUon

4.I. Research allowance shall not be paid in respect of research studies conducted prior to 28.02.2011.II. Research expenses should not be incurred from the provisions granted to the insUtuUons from the Consolidated Fund.III.The research allowance should he incurred from the Expenditure Head No.1003 and in relaUon to Government

CorporaUons and Statutory Boards, this research allowance should be borne from the relevant Expenditure Heads of salaries and other remuneraUons of each insUtuUon.

IV.The research work expected by this Circular should not impede the duUes of the permanent post.

5. This Circular is issued with the concurrence of the Ministry of Public AdministraUon and Home Aairs, Ministry of Higher EducaUon, Ministry of Agriculture and Ministry of Technology and Research.

Sgd.P.B. JayasundaraSecretary to the Treasury and the Ministry of Finance and Planning

Extract of the Management Services Circular No: 45 (Please refer Annexure 2)

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Research Workshops

GMOA pioneered research promotion among the membership. An unprecedented number of research workshops were held around the country by GMOA for the benefit of the membership.

Workshops were conducted in the following hospitals / health offices:

23.01.2012 Lady Ridgeway Hospital 01.02.2012 Matara General Hospital 10.02.2012 Wathupitiwala General Hospital 16.02.2012 Nindaur District Hospital 24.02.2012 Kandy Teaching Hospital27.02.2012 Elpitiya Base Hospital01.03.2012 Homagama Base Hospital 02.03.2012 Ampara General Hospital06.03.2012 Jaffna Teaching Hospital 08.03.2012 Karapitiya Teaching Hospital12.03.2012 Tricomalee General Hospital 16.03.2012 National Blood Center 21.03.2012 Nawalapitiya Base Hospital27.03.2012 Batticaloa Teaching Hospital 29.03.2012 Ratnapura General Hospital 02.04.2012 Avissawella Base Hospital 08.05.2012 Colombo South Teaching Hospital09.05.2012 Kurunegala Teaching Hospital 23.05.2012 Gampola Base Hospital30.05.2012 Dambulla Base Hospital31.05.2012 Anuradhapura Teaching Hospital05.06.2012 Kegalle District General Hospital12.06.2012 Gampaha District General Hospital13.06.2012 Sri Lanka Medical Association 21.06.2012 Panadura Base Hospital27.06.2012 Matale Base Hospital 07.07.2012 Kalutara General Hospital15.07.2012 Badulla General Hospital16.07.2012 Mahiyangana Base Hospital04.08.2012 Nuwara-Eliya Base Hospital06.09.2012 Kilinochchi Base Hospital 11.12.2012 Kurunegala RDHS Office


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Certificates were issued to all participants who successfully completed the workshop

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3. Exemption of Disturbance, Availability and Transport Allowance from Taxation

Government introduced the PAYEE taxation scheme under which government servants salary was subjected to taxation; a critical policy change of the government.

Accordingly, by July 2011 Medical Officers salary was also subjected to taxation. However, Extra duty, Availability and Transport are essential to maintain emergency services and essential patient care. Therefore those components of the service cant be taxed.

GMOA highlighted the issue to relevant authorities and requested the Exemption of Disturbances Availability and Transport (DAT) Allowance and Extra Duty Allowance from taxation. In response to the efforts of the GMOA, the Commissioner General of the Department of Inland Revenue agreed to exempt DAT Allowance from taxation.

4. Exemption of Extra Duty Allowance from TaxationConcurrently Extra duty allowance was also exempted from taxation by the Department of Inland Revenue. Accordingly Secretary to Minister of Health has issued a letter to withhold taxation. As a result most of the Medical Officers are currently out of the Tax range and gain full benefits of the revised DAT and Extra duty allowances.

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5. Revision of Disturbances Availability & Transport Allowance

Disturbances & Availability Allowance was introduced in 1992 as Rs.2000.00. The transport component to it was added in 1994 to make Disturbance, Availability and Transport Allowance Rs.5000.00

However, Revision of this allowance was neglected from 1994-2007 - Over 14 years. In 2007, GMOA made a submission demanding revision of DAT allowance to 70000.00. Then government principally agreed to Increase DAT allowance up to Rs.29,000.00 But due to the war situation only Rs.10,000.00 was granted.

Revision of DAT allowance was again neglected over last 3 years. The current GMOA demanded the revision of DAT allowance to the agreed amount of Rs.29000.00. Subsequently DAT allowance was increased up to Rs.15,000.00.


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6. Revision of Extra Duty Allowance

Extra-duty (ED) is calculated according to the basic salary. However, Government hasnt increased basic salaries of public officials since 2006.

Revisions for Extra duty rates were proposed in 2007 for the existing basic salary. Since Extra duty is calculated according to the basic salary and not parallel to cost of living, extra duty rates proposed in 2007 are still valid.

However, extra duty revisions proposed in 2007 were only partially implemented and were not addressed during past three years.

Current GMOA achieved full implementation of increments to Extra duty payments proposed in 2007 by Ministry of Health Circular No 02-56/2012 dated 27.04.2012. GMOA has proposed further increases of Extra duty rates, deriving maximum amount from the current basic salary.

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Grade 2007 2008-2011 2012 May

No revision Revised

Preliminary 210 210 300

Grade II 280 280 325

Grade I 310 310 370

Deputy Administra;ve 350 350 390

Senior Administra;ve 380 380 450

Deputy Director General 380 380 450

Specialist 380 380 450

ED for 120 hours for a Grade II MO

* All payments are in Rupees per hour

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2.Service MinuteService Minute of medical professionals was first formulated in 1991, 21 years ago. After a lapse of 15 years this was readdressed by the 2006/6 circular. Many years have passed since then without any progress on the service minute of Medical Officers.There are three categories of Medical Officers; Grade Medical Officers, Medical Administrators and Specialist Medical Officers.

Addressing the service minute is a challenging task as any new development should be beneficial for all 3 categories without curtailing any group. Understanding the sensitivity of the issue, many politically motivated groups made attempts to sabotage the development of the service minute and create friction among the three groups in order to divide the GMOA.

Despite many sabotage activities GMOA made following achievements:

1. Preliminary Grade Abolition2. Correction of Salary Increment Anomaly of Grade II Medical Officers3. New Promotion Scheme for Grade Medical Officers4. Salary Anomaly Correction for Specialist Medical Officers5. Grade Promotions for Post Graduate Trainees

1. Preliminary Grade AbolitionUnder 06/2006 circular a new promotion scheme for government service was introduced by the National Wage Policy, categorizing public servants into grades III, II and I. But promotion scheme of Medical Officers was different to other sectors putting doctors at a disadvantage.

Medical Officers were recruited in to Preliminary Grade and are promoted to Grades II and I. Dental Surgeons were directly recruited to Grade II.

We addressed this issue and were able to achieve the following:

Abolition of Preliminary Grade and eliminate two years that are spent in that level.Recruitment of Medical Officers to Grade II which would be considered in parallel with Grade III of 06/2006.Initial salary step of Medical Officers to be increased and made equal to Present Grade II initial salary step of Rs.28095.00.

(Please refer Annexure 2 Letter from the DGHS to the Secretary of Health regarding abolition of the Preliminary Grade)

2. Correction of Salary Increment Anomaly of Grade II Medical Officers

According to Public Administration Circular 06/2006 Grade Medical Officers fall into SL 2 category. As such Grade Medical Officers are eligible to get a higher initial salary, a higher salary increment and a higher ending salary than public servants belonging to categories below them.

But SL 2 category got a lower annual salary increment than SL 1 which was below them. This also resulted in Grade II Medical Officers getting a lower ending salary than SL 1. In addition MT 8 category, which comprises of other Health Sector categories who are placed lower than


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Grade II Medical Officers, were getting an annual salary increment higher than Grade II Medical Officers.

Current Ex Co addressed this unfair discrepancy against Grade II Medical Officers with the salary commission. We increased the annual increment of Grade II Medical Officers from Rs.650.00 to Rs.790.00.This also placed the SL 2 category above the SL 1 category with regards to their ending salaries correcting the anomaly.

(Please refer Annexure 3- Letter from the DGHS to the Secretary of Health regarding salary anomaly of Grade Medical Officers)

3. New Promotion Scheme for Grade Medical OfficersMedical Officers promotions are governed by the relevant Service minutes. There were three stages in the promotion scheme: Preliminary Grade, Grade II and Grade I. Previously, Medical officers were recruited to the service as Preliminary Grade Medical Officers. After completion of 2 years in Preliminary Grade and E Bar examination they were promoted to Grade II. Grade II Medical Officers were promoted to Grade I in 16 years as an Average Performer or in 10 years as an Exceptional Performer via fast tract.

We were able to convince amendments to the promotion scheme that will allow us to gain promotions faster and increased salaries accordingly. Now,Medical Officers are recruited to the service as Grade II Medical Officers.Grade II Medical Officers are promoted to Grade I in 10 years as an Average Performer or in 6 years as an Exceptional Performer.Grade I Medical Officers are promoted to Senior Grade in 7 years as an Average Performer or in 4 years as an Exceptional Performer.

(Please refer Annexure 5 for the letter from the DGHS to the Secretary of Health regarding new promotion scheme of Grade Medical Officers)

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4. Salary Anomaly Correction for Specialist Medical Officers

In 2006/06 circular, salary compression ratio was restricted at 1:4. As such Specialists who belong to SL3 scale could not keep the salary scale proportions maintained in the 1991 service minute.

Therefore we have proposed to rectify this anomaly by placing Specialist Medical Officers in SF salary scale. This proposal is still under negotiations.

5. Grade Promotions for Post Graduate TraineesPreviously Post Graduate Trainees who did not proceed with training after completing the Part I of MD/MS examinations were not entitled for any promotion or other benefit for their achievements at the part I examination.

GMOA addressed this issue in the service minute and got an amendment to reward them. As such now Medical Officers who obtain post graduate qualifications are promoted to Grade I after 6 years of service as Grade II Medical Officers.


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3.Professional IssuesDuring the past year GMOA handled several critical professional issues with national significance expanding our scope beyond that of an ordinary trade union.

They are:

SLMC Issues

Sri Lanka Medical Council is the statutory organization responsible for upholding the standards of medical practice and medical education in Sri Lanka. During the past year SLMC faced tremendous political pressure leading to far-reaching consequences on standards of medical practice and medical education.

GMOA united all professional colleges to formulate the Senate of Medical Profession, making it the decision making body for the medical profession. Therefore under that protection, SLMC is functioning independently now.

Malabe Private Medical College Issue

Malabe so called "medical college" started in 2009 without BOI approval, approval from the Ministry of Health, a Teaching Hospital for clinical training, a permanent academic staff, clear entry criteria for students and satisfactory management and financial arrangements. However, it was functioning smoothly without any objection until last year.

GMOA made a comprehensive report to expose its true situation and spearheaded a massive awareness campaign to defend standards of Medical Education and the profession.Due to our efforts the Ministry of Health appointed a committee to look into this matter which highlighted many of the above shortcomings and endorsed our report. As such Malabe PMC is now defunct and on its natural course of death.

Code of Conduct for police when dealing with CliniciansPolice intervention in clinical practice lead to harassment of doctors due to the absence of a code of conduct for police officers. This matter was taken up by the GMOA with IGP to develop a code of conduct for police officers when intervening in clinical activities.

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1. SLMC IssuesSri Lanka Medical Council is the statutory organization responsible for upholding standards of medical practice and medical education in Sri Lanka. In the recent past SLMC faced several critical issues with major implications on maintaining standards of medical practice and medical education.

Sri Lanka Medical Council faced tremendous political pressure during last year. This escalated to the level of challenging the very existence of SLMC, wherein it would fail to safeguard the interests of the public and the medical professionals.

GMOA analyzed the situation and summoned a consensus meeting with all professional colleges to strengthen the unity of the medical profession and maintain the integrity of SLMC. The forum of all the colleges was termed the Senate of the Medical Profession" and it was made the decision making body for our profession with consensus of all stakeholders.

Therefore under that protection SLMC is functioning independently in spite of a politically motivated president.

We addressed following issues faced by SLMC during the past year:

1. Intimidation of SLMC by politicians2. Assault on the Registrar of the SLMC3. Resignation of President/ SLMC and pending appointment of a controversial

personality as President/ SLMC.4. Efforts to transform SLMC as a Government Enterprise5. Attempt by AMPs with fraudulent six month Russian degrees to gain registration as

Medical Officers under section 29 of the medical ordinance6. Establishment of Private Medical schools without following the SLMC guidelines7. Issues of the foreign doctors practicing as specialists in Sri Lanka without due

qualifications 8. Establishment of a Specialist Registry in the SLMC9. Status of the ERPM examination

(Please refer Annexure 10- the minutes of the meeting to reach consensus within medical professional organizations.)

1. Intimidation of SLMC by politicians

Autonomy of SLMC is of paramount importance to safeguard medical profession and education. The recent outbursts by the Minister of Higher Education and the threats to dissolve SLMC were condemned unanimously by the Senate of the Medical Profession.


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2. Assault on the Registrar of the SLMC.

The shameful and politically motivated attack on Dr. N.J.Nonis, Registrar, SLMC, was unanimously condemned by the house. It was highlighted as an unwarranted hazard to professionals engaged in their rightful duty.

3. Resignation of President/ SLMC and pending appointment of a controversial personality as President/ SLMC.

Traditionally presidency of SLMC has been held by an eminent medical professional who is highly respected in the medical field. Therefore, the sudden resignation of Prof Lalitha Mendis from SLMC presidency due to political pressure and the controversial appointment of Prof. Carlo Fonseka, who has close political affiliations, were viewed as detrimental to the progress of medical profession.

The house unanimously urged Prof. Lalitha Mendis to stay on till the end of her tenure and President/ SLMAagreed to communicate this proposal to His Excellency the President.

4. Efforts to transform SLMC to a Government EnterpriseAccording to the Medical Ordinance, SLMC is a body corporate which could not be categorized as an Enterprise. SLMC is a financially independent organization and there are provisions to monitor its finances adequately under the current set up. Despite these provisions attempts were made by the government to categorize SLMC as a government enterprise. The house condemned this move as both unlawful and unnecessary.

5. Attempt by AMPs with fraudulent six month Russian degrees to gain registration as Medical Officers under section 29 of the medical ordinance.

Apothecaries are registered under section 41 of the medical ordinance. With political support AMPs made arrangements to obtain medical degrees from St. Petersburg University, Russia which was confined only to three years, instead of the usual six years. Ministry of Health granted paid leave to follow the medical curriculum. However, Apothecaries conducted fulltime private practice during this period of paid leave without attending the

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course. At the end of three years, they produced a degree certificate which indicated that an entire six year curriculum was followed in three years.

GMOA demanded Ministry of Health to hold an inquiry where claims of AMPs were found to be fabricated. Police department also concluded the certificate was fraudulent and reported to the Supreme Court where the court ordered the SLMC to reject the fraudulent medical degree certificates.

Despite these facts apothecaries were trying to get the SLMC registration as medical doctors under section 29. The house agreed that these efforts and false claims by Apothecaries need to be addressed and challenged.

6. Establishment of Private Medical schools without following the SLMC guidelines

In 2009, a business enterprise by the name of South Asian Institute of Technology and Management (SAITM) began offering a medical degree program which culminates in to a degree granted by the Nizhny Novgorod State Medical Academy of Russia.

SAITM had requested the SLMC to recognize their program which the SLMC had rightfully rejected citing the gross shortcomings of the institute. SAITM didnt have BOI approval, approval from the Ministry of Health, a Teaching Hospital for clinical training, a permanent academic staff, clear entry criteria for students or satisfactory management and financial arrangements.The SLMC informed the public through media with repeated paid advertisements that SAITM is not approved by the SLMC. However, the institution continued to recruit students and function under the patronage of few influential health administrators and politicians.

GMOA had objected to this institution citing the above mentioned shortcomings as well as the gross injustice caused to the students of the local state education system. The first report ill-conceived Private Medical Faculty at Malabe was published in 2010.

But a gazette notification was published in August 2011 by the Ministry of Higher Education granting SAITM the degree awarding status despite its gross shortcomings.

The GMOA threatened an Island wide trade union action against the move and as a result of the efforts by GMOA a 5 member committee was appointed by the minister of health to give a comprehensive report on SAITM. The panel report verified the above deficiencies and discrepancies.

7. Issues of the foreign doctors practicing as specialists in Sri Lanka without due qualifications.

The house concluded that a clear protocol should be formulated for recruiting foreign doctors to practice in Sri Lanka and that registration should take place under the scrutiny of SLMC after an independent assessment of qualifications.

8. Establishment of a Specialist Registry in the SLMC

Importance of establishing a specialist registry to Sri Lanka under SLMC was also highlighted. Consensus was reached to make regulations under current Ordinance empowering SLMC to register specialists.

9. Status of the ERPM examination

In the past ERPM examination was held by the SLMC and foreign medical graduates with degrees from SLMC recognized foreign universities were eligible to sit for the exam.


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ERPM examination was changed in 2005 after a group of 54 candidates who had failed the ERPM examination from 1999, filed a fundamental rights case against SLMC claiming that the exam was too tough and is even tougher than the state university final examinations. A Supreme Court settlement was reached and the UGC was asked to supply the common MCQ papers used for the final examination of the state universities for the Examination. The failure rate increased further during the following two years.

Therefore another Supreme Court case was filed later requesting the exam to be handed back to SLMC. The 54 candidates who were still unable to pass the exam tried to reduce the pass mark to 40% using personal influence. Among their demands were; Reducing the pass mark to 40%, Eliminating negative marks, Eliminating the community medicine and forensic medicine papers, Appointment of a superior body to (SLMC) monitor examination and SLMC members should not be a part of it.

The SLMC and the members of the SLMC including the president and the registrar were personally subjected to lot of personal harassment during the recent past because of this protracted legal tug-of-war.

However, the SLMC and the entire medical profession is firm on the stand that the pass mark should not be changed and the standard of the licensing examination should not be lowered at any cost. Furthermore, SLMC is the unequivocal authority in deciding the standard of medical education and service provided to the public.

Taking into consideration of the above issues Senate of the Medical Profession agreed upon the following:

1. To request His Excellency the President to re appoint Prof. Lalitha Mendis as President / SLMC

2. To request an appointment with His Excellency to discuss the matter further.3. This gathering represents the entire medical profession in Sri Lanka, and we should take

prudent steps to safeguard the dignity of the profession.4. Demand the adherence to prescribed standards of medical education from all institutions

disregarding whether they are foreign or local medical faculties.5. Maintain the standards of ERPM examination equivalent to Final MBBS examination.6. To finalize specialist registry 7. To finalize policy to deal with employing foreign medical professionals in Sri Lanka 8. In a matter of controversy this gathering will be the final decision making body for the

profession and thus called the Senate of the Medical profession and this will gather to discuss the progress in the future too.

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2. Malabe Private Medical College Issue Establishing Private Medical Colleges (PMC) raises great concerns over the standards of Education and Healthcare of a country. Therefore they are strictly regulated worldwide. Malabe so called "medical college" started in 2009 and was functioning smoothly without any objection or scrutiny until 2011. SAITM was about to take over Base Hospital Homagama for clinical training. SAITM Private Medical College had many deficiencies including the following:

1. No Approval from relevant institutions

Any fee-levying institution of higher medical education should comply with standards stipulated by Sri Lanka Medical Council (SLMC) and the law of the country. Such an institution should at least possess the following before inception:

No approval of Sri Lanka Medical Council (SLMC)According to the Medical Ordinance a medical institute needs recognition of SLMC before it recruits students. However SAITM fraudulently recruited students via advertisements claiming to have approval of SLMC. Subsequently SLMC published several newspaper advertisements countering their claims. (Annex- I, II, III, IV)Even if Malabe PMC is recognized in the future, present students will not be eligible to obtain SLMC recognition.

No approval of Board of InvestmentBOI has not approved setting up of a medical institute at Malabe. Approval has been given only for a Management Institute; as mentioned in the name South Asian Institute of Technology and Management.

No approval of Ministry of Health At the time approval was sought to set up South Asian Institute of Technology and Management (SAITM), Board of Investment (BOI) has clearly stated that Ministry of Health approval should be obtained before Health Sciences are taught.

Up to date South Asian Institute of Technology and Management has not obtained approval from Ministry of Health to teach Health Sciences.

No approval of Ministry of Higher Education University Grants Commission has sent three teams to evaluate medical school of SAITM; none of them recommended granting degree awarding status.

However a gazette notification was published by the Ministry of Higher Education granting SAITM degree awarding status, "Subject to the conditions specified in the schedule". The schedule consisted of 7 conditions with several sub-conditions. Most of these conditions have not been fulfilled, although the 1 year deadline granted to SAITM has elapsed. (Annex VI)

The medical school at Malabe cannot have any legal status if it has not fulfilled all conditions laid down in the gazette notification. The degree awarding status can be granted only on the recommendation of the specified authority (In this case University Grants Commission) according to the procedure laid down in the University Act. As such university act has also been violated. (Annex VIIb)

However South Asian Institute of Technology and Management (SAITM) has failed to fulfill the above, which are essential to establish a private medical college.


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2. Lack of Standards

According to guidelines stipulated by Sri Lanka Medical Council, any fee levying institution of higher medical education should fulfill the following criteria. An institution that does not meet any one of these absolute criteria will not be approved by SLMC. Dedicated hospital for clinical activities with minimum of 100 beds each in General Medicine,

General Surgery, Paediatrics, Obstetrics and Gynecology. All Heads of Departments and at least 70% of the academic staff should be permanent,

fulltime staff members of the institution. The course should spread over five calendar years excluding the time spent on any

preparatory courses. The institution should maintain Professorial Units (University Clinical Teaching Units) in the

main clinical subjects with a dedicated academic staff as clinical teachers. The institution should have an identified community for field based training in liaison with the

public health service providers of the area (Eg: MOH Municipal or Urban council)

Majority of doctors who work as lecturers at Malabe PMC are foreign graduates with only a basic degree which is grossly inadequate to become a member of an academic staff of a university. Out of them, the majority including the director of the institute are failures at the ACT 16 examination, which is the fundamental requirement to practice as a doctor in Sri Lanka.

The institute lacks essential departments required for a medical school and some departments are under visiting professors, which is grossly unsatisfactory.

SAITM medical school has recruited students for the past 4 years. In state medical faculties formal clinical training for students starts in the 2nd year of the curriculum with exposure to the clinical setting from the very first year. Though it was advertised by SAITM that clinical training will be provided at private hospitals, no clinical training is provided up to now. SAITM medical school still doesnt have a teaching hospital for clinical training which is a prerequisite to start a medical school in every country.

As such Malabe PMC has not fulfilled the minimum standards required of a medical school.

3. Financial and Educational Fraud

Financial fraud

Dr. Nevile Fernando is over 70 years old and according to Companies Act No.7-2007 sentence 210, any person who has reached 70 years of age or more cant be appointed as a director of private or public company. This regulation brings in to question the very presence of Dr. Fernando as the main investor.

Unlike any state higher educational programme SAITM recruits 2 batches per year. Students are charged 6.5 million each prior to any formal education.

All recognized private universities worldwide require a bank guarantee from the institution depending on the number of students to ensure that the university will not default on students. SAITM doesnt have any guarantee from any financial institution for financial security of students.

Obscured financial state of SAITM medical school raises serious concerns that it is an unsustainable financial scam similar to Sakvithi.

Educational Fraud

From its commencement in 2009, Sri Lanka Medical Council informed Dr. Neville Fernando, Chairman of SAITM, that SLMC recognizes only the six year medical course conducted by Nizhny Novgorod State Medical Academy (NNSMA) and not any other programme in Sri Lanka or elsewhere that is linked with NNSMA.

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However SAITM fraudulently recruited students for a twinning programme with NNSMA, advertising that it has the approval of SLMC which is a violation of section 128 of the University Act. (Annexure 8 Extract of the letter from President of SLMC to Dr. Neville Fernando)

A twinning programme is where a part of medical education is done locally and the rest in a foreign country. Twinning programmes are not accepted by SLMC. There is no evidence that Nizhny Novgorod State Medical Academy has approved such a twinning programme.

As highlighted above SAITM neither has a fulltime academic staff or a hospital as it claimed to have at the time of recruiting students.

A five member committee was appointed by Hon. Minister of Health to inquire in to Malabe medical school. It made further recommendations (Annex V) which SAITM has failed to implement.

GMOA made a comprehensive report to expose its true situation effectively and voiced our concerns. That was the turning point for the Malabe PMCs downfall. (Available at www.gmoa.lk.) (Please refer Annexure 9 Report on the ill conceived Private Medical College at Malabe)

GMOA highlighted the fraudulent nature of the institution branding Malabe PMC as Sakvithi PMC. We spearheaded a massive and very effective awareness campaign. Eg: Derana TV 360 programme (Available on youtube) Upon our request, the Ministry of Health appointed a committee to look into this matter which concluded the same and endorsed our report.

Following this, all doctors who had their children admitted to Malabe PMC had withdrawn their children.

Recently, Urban Development Authority fined SAITM Rs. 29 million for not complying with acceptable approvals further exposing its lack of credibility.

Malabe so called "medical college" is completely defunct now and on its natural course of death.


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Report on theIll-conceived

Private Medical Collegeat Malabe

(South Asian Ins@tute of Technology andManagement SAITM)

Compiled ByDr Anuruddha Padeniya et al

Government Medical Ocers AssociaUon

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3. Code of Conduct for police when dealing with Clinicians

In the past, incidents of Police intervention in clinical practice led to harassment of doctors. Recently, based on an allegation made by a female patient against one of our Branch Secretaries, he was arrested and kept behind bars for 14 days.

This matter was taken up by the GMOA with Inspector General of Police. As a result a code of conduct for police officers in clinical matters was introduced to uphold the law while safeguarding dignity of Medical Profession and professionals.

The Code of Conduct Includes:

When a doctor makes a complaint about any harassment during the process of carrying out duties, the OIC or HQI of police should record the complaint and should immediately inform the ASP and SP of the region.

Investigations on the complaint should be started and maintained by the ASP personally. The ASP should inform the Senior Deputy Inspector General Administration immediately

about the complaint. If a patient dies in hospital and a statement has to be recorded from the Specialist Medical

Officer, who treated the patient, all records have to be produced to the Solicitor General for advice beforehand. A report has to be sent to the Solicitor General by the police asking for advice regarding the matter. Statements cant be recorded from Specialist Medical Officers without obtaining advice from the Solicitor General.

If a patient dies and a complaint is made that death had occurred due to medical negligence, the doctor cant be taken in to custody. Approval from Solicitor General should be obtained before questioning and taking into custody.

Now doctors can carry out duties without any inappropriate police interference.

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4.Health Regulations and National Health Policy

GMOA pioneered formulation of national health policy and health regulations during the past year. Countering the threat posed to the rights of our patients and qualified Sri Lankan doctors by substandard foreign medical practitioners and illegal medical practitioners were the main targets of our efforts.

Evaluation of Foreign Specialists and Establishment of Specialist Registry

There is no evaluation process for foreign doctors, prior to registration, under the current provisions of the Medical Ordinance. As such many substandard foreign medical practitioners get temporary registration and work as ' Specialists' in the private sector.

Government has already signed SAARC Agreement for Trade-In Services (SATIS) together with eight South Asian Nations and Comprehensive Economic Partnership Agreement (CEPA) with India is pending. Above agreements would allow foreign medical practitioners to freely come and practice in Sri Lanka without any registration or evaluation, threatening the long held standards of the Sri Lankan health sector.

To address this issue GMOA proposed the establishment of a formal procedure for evaluating foreign specialist registration and the formation of a Specialists Registry for Sri Lanka. After months of work and contributions from many stakeholders, it is in the process of legislation.

Elimination of Illegal Medical Practice

There are as many as 40000 illegal medical practitioners in the country, twice the number of legal practitioners. Illegal medical practice is a criminal offence punishable via the penal code. Yet under the current regulations punishment for quacks is grossly inadequate. Hence measures taken to eradicate illegal medical practice were unsuccessful in the past. GMOA as the first strategic step initiated an awareness campaign in 2001. Thereafter in 2008, GMOA collaborated with Attorney Generals Department and the Police Department to conduct a census on quacks to formulate a future plan of action.

After a lapse of 3 years, current GMOA readdressed the issue and proposed a minimum 5 years of imprisonment for Quacks which was approved by Ministry of Health.

Employment of substandard medical practitioners as specialists and as assistant specialists in the private health care sector has led to many issues in the recent past. Currently there is no policy on employing foreign specialists. A proper evaluation process to assess the qualifications and skills level of foreign specialists is not established.

Currently foreign specialists are registered under the provision provided by the section 67A of Medical Ordinance. Initially the applicant submits his/her CV along with supporting documents and a letter of sponsorship by the prospective local employer, to the Director General of Health Services (DGHS). The DGHS submits the credentials of the applicant to the relevant professional bodies for evaluation and obtain their recommendations to register the applicant as a specialist in Sri Lanka. Alternatively the DGHS has the sole authority to appoint a committee to evaluate the application form and give its recommendations without the concurrence of the relevant professional body (according to Section 67A). Other than the DGHS, the Secretary of Health or a Dean of a Medical Faculty can make recommendations to the SLMC regarding the suitability of an applicant to function as a specialist.


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1. Evaluation of Foreign Specialists and Establishment of Specialist Registry

Employment of substandard medical practitioners as specialists and as assistant specialists in the private health care sector has led to many issues in the recent past. Currently there is no policy on employing foreign specialists. A proper evaluation process to assess the qualifications and skills level of foreign specialists is not established.

Currently foreign specialists are registered under the provision provided by the section 67A of Medical Ordinance. Initially the applicant submits his/her CV along with supporting documents and a letter of sponsorship by the prospective local employer, to the Director General of Health Services (DGHS). The DGHS submits the credentials of the applicant to the relevant professional bodies for evaluation and obtain their recommendations to register the applicant as a specialist in Sri Lanka. Alternatively the DGHS has the sole authority to appoint a committee to evaluate the application form and give its recommendations without the concurrence of the relevant professional body (according to Section 67A). Other than the DGHS, the Secretary of Health or a Dean of a Medical Faculty can make recommendations to the SLMC regarding the suitability of an applicant to function as a specialist.

Current Registration Procedure Foreign Medical Professionals into the Private Sector

They are registered under the provision provided by the section 67A of Medical Ordinance. The applicant should submit his/her CV along with supporting documents and the letter of

sponsorship by the prospective local employer to the DGHS. The DGHS will submit the credentials of the applicant to the relevant college for evaluation

and obtain their recommendations to register the applicant as a specialist in Sri Lanka. Alternatively, according to Section 67A the DGHS has the sole authority to appoint a

committee to evaluate the application form and give its recommendations without the concurrence of the relevant professional body.

Other than DGHS, the Secretary of Health or a Dean of a medical faculty can recommend the SLMC regarding the suitability of the applicant to function as a specialist.

There is no specialist registry in Sri Lanka and as a result many unqualified doctors practice as specialists in private hospitals. There are concerns about poor standards in the registration process using ad hoc decisions, which has come under heavy criticism for lack of transparency.

Above deficiencies led to incidents of gross violation of patients rights. Many patients who were mismanaged were transferred to NHSL with major complications while the foreign doctors fled the country. This also incurred a massive extra cost to the government health sector. At the same time foreign doctors without due qualifications practicing as specialists was a violation of rights of highly qualified Sri Lankan doctors. This situation is bound to worsen with the implementation of Comprehensive Economic Partnership Agreement (CEPA) and SAARC Agreement on Trade-In Services (SATIS)

agreements. SATIS agreement has already been signed by 8 South Asian countries while CEPA agreement is pending between India and Sri Lanka. These agreements would pave a legal

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pathway for foreign, especially Indian, doctors to come to Sri Lanka and practice without any evaluation of their qualifications. This would allow a massive influx of substandard Indian doctors to overrun the Sri Lankan health system and its long maintained standards. Realizing the prevalent issues and potentially devastating implications in the future, we initiated the process of strengthening the health regulatory structure of Sri Lanka to counter above threats. GMOA organized a workshop on 18/11/2011 involving all the stakeholders to discuss the issues through their perspectives and to get their opinion to develop a policy to provide a long lasting solution for above issues.

The Brainstorming session was conducted to arrive at a consensus among all stakeholders with the eventual objectives of:

Establishing a Specialist Registry in the SLMC by incorporating it into the Medical Ordinance. Establishing a draft policy document for the registration of foreign medical professionals in Sri

Lanka. At the end of this brainstorming session it was concluded that the report should be circulated among all professional organizations with draft proposals in order to obtain feedbacks.All professional colleges were requested to identify the specialties under their purview and recognize the qualifications to be included in the specialist registry. Majority of Professional organizations responded positively and corrections were made accordingly. All agreed that this is a urgent necessity for the country with the implementation of Comprehensive Economic Partnership Agreement (CEPA) and SAARC Agreement on Trade In Services (SATIS).

The Final consensus workshop was held on 10/05/2012 at the Health Ministry Auditorium chaired by the DGHS with the objectives of:

Acknowledgement of Specialist qualifications presented by the respective colleges and professional bodies.

Formation of Specialist registry and its inclusion criteria. Discussion and corrections in the draft proposal of registering foreign specialists.

Accordingly a finalized proposal for Evaluation of Foreign specialists was formulated and is in the process of legislation. (Please refer Annexure 6 Final draft proposal & Minutes of Consensus meetings to establish a mechanism of Specialist Registration and Specialist Registry.)


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2. Elimination of Illegal Medical PracticeMedical Practitioners who are registered under one of the three legally established medical councils are legal medical practitioners. About 20000 medical practitioners are registered under the following medical councils: 1. Western Medical Practitioners (MBBS) Under No.26 of the Medical Ordnance 19272. Ayurvedic Medical Practitioners in Sri Lanka Under No.31 of the Ayurvedic Ordinance

19613. Homeopathic Medical Practitioners in Sri Lanka Under No.07 of the Homeopathic

ordinance in 1970

A person who pretends, professionally or publicly, to skill, knowledge or qualifications he or she does not possess is called a quack. Several groups of quacks have been identified.

1. Individuals practicing medicine without registration at a medical council. Persons with no qualification whatsoever Persons involved in the health sector who are not doctors- Nurses, Pharmacists

2. Persons with registration under one of the above legitimate categories but practice outside their field of expertise. Eg: Ayrvedic doctors practicing Western Medicine.

Illegal medical practice is a criminal offence punishable via the penal code.

Violation of Patients and Doctors Rights by Quacks

Patients autonomy is violated by quacks, who mislead innocent patients with false qualifications. Patients are often misdiagnosed and ill-treated by quacks. They present to hospitals with complications of diseases which puts their lives at risk. Patients who have been mismanaged by quacks are eventually treated in the state sector incurring a large extra cost to the free health system.

Presence of quacks is detrimental to health promotion and adversely affects our long maintained health standards and health indices. Presence of Quacks, who are unqualified and have no registration, is a violation of the rights of highly qualified medical professionals who practice legally.

GMOA fight against illegal Medical Practice

As a responsible professional organization, GMOA firmly believes that proper qualifications are mandatory to deliver medical care and has strategically fought to eliminate quacks over the past decade.

2001 - Awareness CampaignGMOA initiated actions against illegal medical practitioners in 2001 with an awareness campaign targeting the public and the Police.

2008 Collaboration with Attorney Generals Department and Police Department

GMOA held several discussions with the Attorney General who directed us to the Inspector General of Police for further action. Deputy Inspector General Mr. Gamini Nawaratne was appointed by the IGP to formulate a plan to address illegal medical practice.

Accordingly, workshops were organized for police officers on How to conduct court cases against illegal medical practitioners and Hazards made to the public health by illegal medical practice.

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Subsequently GMOA organized a joint press conference with the Police Department on 28th April 2008 on the progress made and future actions.

A Police circular was issued by Mr. Gamini Nawaratne to all police stations, to collect information and maintain a database on individuals who practice medicine within each division.

The DIG personally followed up the progress made by Director, Crime Unit and monthly reports were produced to the DIG.

GMOA requested all the branch unions to collect data about quacks practicing in their areas and to forward them along with further suggestions to eliminate quacks.

These measures revealed that 40 000 persons practice medicine illegally in Sri Lanka, twice the number of legal practitioners.

2011- 2012 Proposals to eliminate quacks

In a subsequent meeting held on 25.04.2008 with the Secretary of Health and Police Department, GMOA proposed to form an umbrella organization comprising of all three Medical Councils and other stakeholders including Police and Attorney Generals Department to streamline the process.

It was identified that quacks could be apprehended on the following grounds.

1. Through Medical Ordinance.2. Forgery/ impersonation of a doctor can be dealt with through the Penal Code.3. Cosmetic Devices and Drugs Act, under which Medical Officers of Health and Police

officers enforce law against quacks. Ayurvedic and Homeopathic practitioners who prescribe and store western medicines can be apprehended through this act.

However legal punishment for illegal medical practice is a trivial fine which is grossly inadequate. Even when found guilty at courts, quacks return to their practice after paying the fine, usually in the same area.

Accordingly GMOA Proposed:

1. A minimum of 5 year imprisonment for illegal medical practice was proposed by GMOA and was approved by Ministry of Health.

2. Strictly implement Cosmetic Devices and Drugs Act, under which it is illegal for persons who are not registered western medical practitioners to possess and prescribe western medicines.


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5.Medical Service1. Saturday - Official Holiday for DoctorsA healthy lifestyle with quality time for family commitments and recreation is internationally recognized as an essential requirement to maintain high quality work performance. Therefore most countries have adopted policies to provide mandatory vacations for professionals, especially ones involved in essential and high risk sectors like medicine and piloting. A high quality weekend is essential to maintain efficient work performance during working days. Medical officers have historically sacrificed their family commitments and personal interests in ensuring high quality patient care in an equitable way for all citizens. Most of our members are burdened by an overwhelming number of patients throughout day and night. Further, doctors provide an all island service which requires them to work in peripheries far away from homes. Strained lifestyles of doctors have adverse effects on doctors lives and compromises quality of patient care. In order to address this issue,

GMOA framed a submission in 2007, to develop a mechanism to relieve doctors from duties on Saturdays.

GMOA presented the proposed system to His Excellency the President, who agreed to the proposed in principle. However at the time, some officials of the Ministry of Health resisted the demand by highlighting the risk of reduction in quantity of work. As such GMOA planned a pilot study to prove its feasibility.

Pilot study was first initiated in BH/Negombo and Cancer Hospital - Maharagama. Unfortunately, the past GMOA failed to submit a formal report of outcome of the pilot study. As such GMOA could not expand the implementation island wide.

Present EX-CO planned a new pilot study covering the entire North Western Province. Despite internal resistances, GMOA successfully negotiated the implementation of the pilot study with Ministry of Health and the provincial administration.

The Study was conducted in government health institutions in the North Central Province with the participation of all medical officers.

On subsequent follow up, Ministry of Health, provincial authorities, and medical administrators expressed their satisfaction over the outcome of the study.

As such Saturday off for all doctors island wide will be implemented in the next few months. With its implementation all doctors, especially doctors working in peripheries, can enjoy a quality and meaningful weekend.

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(Please refer Annexure 7 - the extract of the feasibility study performed by

GMOA regarding Saturday off)

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2. Correction of Saturday Duty Hours Medical Officers performed duties 34 hours of per week in the past. This comprised of 6 hours per day on week days and 4 hours on Saturday. However a Public Administration Circular issued in 2008 i n c r e a s e d M e d i c a l Officers weekly work hours to 36hours; 6 h o u r s p e r d a y o n w e e k d a y s a n d Saturdays. As a result Medical Officers were a l s o d e p r i v e d f ro m claiming Extra Duty on Saturdays.

GMOA corrected this anomaly by reinstating the previous, duty hours of 34 hours per week. Saturday work duration was adjusted back to 4 h o u r s a n d a l l o w e d Medical Officers to claim extra 2 hours of Extra Duty per week.


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6.Members Welfare1. Schooling IssueDoctors are the highest products of our free education system. As such doctors value education of their children above all others. However, schooling of children of doctors has over the years been a critical issue without a sustainable solution.Medical service is unique from other sectors of government service in many ways. Medical Officers are transferred every four years to maintain equity of care for patients of all areas. As such doctors move from one residence to another frequently. Doctors reside close to the hospital to fulfill service obligations. Proximity to schools is usually cant be fulfilled. Post Graduate Trainees undergo mandatory foreign training to ensure quality of service.

All above features are service obligations required to ensure delivery of high quality health care efficiently in an equitable manner throughout the country.

However above measures hinder prospects of gaining admission to a good school for doctors children. Circulars on school admissions dont address issues of transferring doctors and post graduate trainees.They disqualify doctors from applying for school admission in the chief occupant category, pose difficulties in arranging documents necessary for admission and discriminate against foreign trainees among many other issues. At the same time many other government servant categories enjoy privileges with regards to schooling of children that are not available to Medical Officers.

Many doctors were contemplating leaving the government service to private sector or to go abroad to provide better education for their children.

Therefore,2003 - GMOA requested the Ministry of Education to reserve a quota for kids of doctors. 2005 - A cabinet memorandum was issued allowing lateral entry to schools for doctors children following transfers. This cabinet decision was implemented till 2008 by incorporating it in to Grade 1 school admission circular.

During last two years, including circular 2011/18 issued by Ministry of Education for year 2012 didnt include this decision. As such many of our members were unable to find good schools for their children.

As such the GMOA acted to safeguard schooling of children of doctors. We made submissions to His Excellency and to relevant Ministries highlighting the issue. As a result letters were issued to ALL 280 doctors by Ministry of Education assuring popular schools in respective areas which is a 100% success.

2. Establishment of an Insurance Scheme for Intern Medical Officers

Internship period is an essential requirement to be fulfilled after completing 5 years of medical faculty education to be eligible for SLMC registration. After completion of the internship, intern medical officers are recruited to the medical service by public services commission. As such

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intern medical officers dont fall under the Ministry of Health and are not considered as permanent staff. Therefore they are granted only a monthly allowance, not a salary.

They are not covered by government insurance schemes which other government servants enjoy such as Agrahara. The tragic consequences of the lack of an insurance system were highlighted with the death of intern medical officer Dr. Hasitha Prasanjith Ranasinghe due to Dengue Haemorrhagic Fever at the age of 28 years.

Considering the above GMOA proposed an insurance scheme for intern medical officers for the respective 1 year period which would give comprehensive coverage for medical problems and accidents faced by interns. Such a scheme would only incur an estimated cost of Rs. 4 million per year to provide coverage for over a 1000 intern medical officers per year and Ministry of Health has responded favorably for the proposal. GMOA expects to implement the proposed Insurance Scheme for Intern Medical Officers in the near future.

3. Etisalat GMOA Internet Package with free dongleGMOA came to an agreement with Etisalat to offer a special Internet package for Medical Officers with 4GB and 10GB packages at concession rates. The Dongle is provided free of charge.

4. Upgraded Bank of Ceylon Loan SchemeGMOA negotiated with Bank of Ceylon to arrange a flexible loan package for doctors. As a result the BOC/GMOA credit Package was upgraded. Now loan can be paid in seven years (previously 5 years) and the credit limit has been increased for medical officers of all grades.

5. Special Loan Scheme for Medical Officers from Peoples Bank- No upper limit for Housing Loans


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6. Special Sri Lanka Telecom PackageGMOA negotiated with Sri Lanka Telecom to gain a special Telephone and Internet package with free special entertainment offers exclusively for GMOA members. This package is designed for the telecommunication allowance.

7. Reduction of Hyundai local handling chargesGMOA negotiated with Hyundai to reduce local handling charges of vehicles by Rs.300 000.00 to buffer the effects of increasing vehicle prices and devaluation of the rupee.

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7.Medical Education1. Issues of Post Graduate Training1. Duty leave for Diploma in Family Medicine (DFM) online course

DFM online is a 2 year weekend course with clinical sessions. Previously personal leave had to be obtained to complete the requirements of DFM as official duty leave was not granted for its sessions. However it is impossible for a medical officer to obtain 49 leaves per year. Therefore candidates had to shift duty times and face many difficulties to make time for the sessions.

As such the current Ex Co addressed the issue and gained duty leave for all 98 days of clinical sessions and 2 more weeks of study leave before exams.

This benefit also applies for MSc Toxicology and other online courses.

2. Restoration of MD Medicine Part I intake

PGIM restricted the number of MD Medicine Part I intake to 37 candidates per year, which is half of the number of trainees recruited previously, for unknown reasons.

GMOA addressed the issue with PGIM and made arrangements to have two intakes per year like previously and to continue the policy till an apparent excess of trainees is identified.


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3. Introduction of MSc Human Nutrition

Ministry of Health was planning to recruit 40 holders of Animal Nutrition BSc to practice as human nutritionists. GMOA intervened and withheld the recruitment. However there werent enough human nutritionists in Sri Lanka to fulfill the demands of the Ministry and there was no postgraduate study programme for human nutrition.

As such together with the Ministry and PGIM, GMOA initiated the MSc Nutrition programme for medical officers. We further reserved above 40 posts in the Ministry of Health for Medical Officers qualifying as Human Nutritionists.

4. Recruitment of Private Candidates for PGIM courses

Private sector candidates were recruited for PGIM courses via a quota system in the past. Sinc