The journey towards recognising and protecting patients’ rights in Sri Lanka, which spans more than three decades, has reached another significant milestone with the patients’ rights charter being presented to Parliament in August.
The move follows years of advocacy and several attempts to establish a formal framework safeguarding the rights of patients.
The process dates back to 1995, when the Ethics Committee of the Sri Lanka Medical Association issued its Declaration on Health.
In 2023, a subcommittee of Parliament’s Sectoral Oversight Committee on Health was established to formulate a Charter for Ensuring Patients’ Safety and Well-being. The final draft was presented to Parliament in June 2024 and subsequently approved by the Sectoral Oversight Committee on Health in July 2024.
In May 2024, then Health Minister Dr. Ramesh Pathirana noted that the ministry had received nearly 700 complaints in the preceding year and announced that a patients’ rights charter was being advanced through Parliament, with the possibility of eventual legislation.
Sri Lanka Medical Association (SLMA) Council member Dr. Vinya Ariyaratne, who served as its President in 2023, said that the association had been among the first professional bodies to formally raise the need to safeguard people’s right to health, beginning with its 1995 Declaration on Health.
“Since then, there have been various attempts to make it at least a charter, if not part of the Constitution at some point. The formal process started in the 2000s,” he said.
He noted that different Sectoral Oversight Committees on Health subsequently took up the issue under different governments, recognising the need for a charter of patients’ rights.
Dr. Ariyaratne further stated that during the Ranil Wickremesinghe presidency, the final draft was presented to Parliament just before it was dissolved, bringing an end to that chapter. He noted that the draft had been the result of an extensive consultative process involving civil society organisations and a wide range of professional bodies.
“It was an extremely consultative process, and there were certain clauses that were not acceptable to some stakeholders, but a consensus document was eventually reached.”
The National People’s Power (NPP) Government’s manifesto had pledged to make the charter law if elected, Dr. Ariyaratne said. Accordingly, advocacy has continued over the past two years to advance the process.
The Sectoral Oversight Committee revisited the previous draft and sought the views of various professional organisations before agreeing on a revised version. This revised draft was presented in early August by Sectoral Oversight Committee on Health, Media, and Women’s Empowerment Chairperson, MP Dr. Nihal Abeysinghe, who indicated that it would be introduced as an act of Parliament.
Speaking to The Sunday Morning on Thursday (13), Dr. Abeysinghe said that they hoped to make the patients’ rights charter into a law by 2027 and complete the process.
He pointed out that the charter’s journey had spanned three successive Parliaments, with the draft being near completion under then MP Mayantha Dissanayake during the ninth Parliament.
“With the 10th Parliament, as the Chairperson of the Sectoral Oversight Committee on Health, Media, and Women’s Empowerment, I took over [the process]. We have consulted the Ministry of Health, various professional colleges, and the World Health Organization (WHO). I have now presented it to Parliament and proposed that it come back as an act.”
The immediate roadmap involves dispatching the framework to key stakeholders. “Next week, we’ll be sending it to the President, Prime Minister, Health Minister, Health Ministry Secretary, and the ministry team. We then have to prepare the act and bring it back to Parliament, after which the regulations have to be prepared. Once the regulations are ready, we can implement it.”
Dr. Abeysinghe explained that the timeline for completion depended on the drafting speed of the ministry, which had to prepare the act. He expressed determination to pass the legislation before the current parliamentary term ended.
“We are trying our best to pass it soon because this is the third successive Parliament handling the matter. My determination is to finish as early as possible and get it implemented before our term is over,” Dr. Abeysinghe said, adding that no new regulatory body would be needed to implement the charter.
“Once the act is passed in Parliament, we will prepare the regulations along with the ministry. Based on these regulations, it will be implemented.”
The implementation strategy relies on existing administrative structures. “We only need to prepare the regulations, which will be done by the Ministry of Health, supported by the Sectoral Oversight Committee. Once the regulations are approved, the Health Ministry can implement it through a mechanism. The ministry’s planning unit has to take responsibility and it may appoint a small unit to monitor implementation.”
In order to ensure seamless integration across the country’s healthcare system, plans are in place to pilot the framework in select hospitals.
“We have to prepare hospitals and health institutions to accommodate the principles we have laid down in the charter. We will be discussing with them how to implement it. We may undertake some modelling in certain hospitals to see how it works throughout the country,” Dr. Abeysinghe explained.
According to Dr. Ariyaratne, Sri Lanka’s long-standing free universal healthcare system meant that the issue of healthcare as a rights-based approach had not traditionally been at the centre of public discussion, given the system’s equitable nature.
“The right to health is not a fundamental right in our Constitution. At some point, we wish to see this right included as a fundamental right in the Constitution,” he said, noting that the existing system had contributed to achieving health outcomes far beyond the country’s national income.
Low maternal and infant mortality rates and high life expectancy, he said, had been supported not only by free healthcare but also by policies such as free education and nutrition subsidies.
“Regardless, people considered it as part of the State’s responsibility, but not really as a right of the people to access healthcare. However, in recent years, we have seen violations of patients’ rights as well as medical errors, which are of course common in other countries as well. In order to have more accountability and also a better standard of care for people, a patients’ charter has been in discussion for more than 30 years now.”
Dr. Ariyaratne stressed that the inclusive nature of the process was one of the charter’s key strengths and said Sri Lanka should not retreat from establishing a more rights-based healthcare system.
“There is no turning back, and it’s very good for the health system also to recognise the global trend of being concerned about patients’ rights and move towards a more rights-based system in Sri Lanka.
“We are very happy since it’s a good start to ensure patients’ rights, as we see constant complaints of patients’ rights being violated. For me personally as a public health professional, this is a landmark achievement.”
Among the rights he believes the charter could strengthen are access to information, obtaining a second medical opinion, and being informed about treatment options.
“If there’s an omission on the part of the healthcare system, there’s currently no grievance mechanism. There are also issues like access to a second opinion. If a patient consults another specialist for a second opinion, this is not always entertained properly. Patients are also not adequately informed about options available to them. These rights have not been sufficiently emphasised,” he explained, noting that once the patients’ charter was in place, healthcare providers would be bound to uphold these rights.
The long delay in adopting a patients’ charter has also been linked to concerns among medical professionals about potential legal consequences.
Dr. Ariyaratne acknowledged that doctors had expressed fears that a formal charter could expose them to increased litigation, particularly when working in resource-constrained environments.
“There are certain serious concerns. For example, doctors are worried that they will face litigation once there is a patients’ charter. I can understand that concern, being a doctor myself. The overwhelming majority of doctors are not violating ethical principles or the law; they are making significant sacrifices while performing in a low-resource environment.”
He said there was a concern that doctors could be unfairly held accountable if something was not done in the best interest of the patient within a resource-constrained setting.
Another concern is the possibility of defensive medicine, where doctors order additional tests or procedures primarily to protect themselves against potential litigation. He noted that this could cost more to the system or to the patient, and also cause delays.
Dr. Ariyaratne pointed to the United States as an example where medical negligence litigation had become an industry, although he noted that this was not the case in Sri Lanka yet.
Nevertheless, he believes these concerns can be addressed. “The benefits to the healthcare system and to the people outweigh some of these challenges, and there can be safeguards for doctors as well,” he said.
Dr. Abeysinghe too expressed similar sentiments. “This will be a people-friendly charter because we are not going against health workers,” he said.
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