The Commissioner, 

The Human Rights Commission of Sri Lanka's (HRCSL)

No. 14, R. A. De Mel Mawatha,

 Colombo 4,

Sri Lanka. 

Dear Sir/Madam

Requesting Intervention for Fair Working Hours for Government Doctors in Sri Lanka

We, the undersigned Government Medical Officers employed under the Ministry of Health, Sri Lanka, hold various designations within the curative and preventive sectors of public health. As members of the All-Island Service, we are required to transfer to a new station every four years based on seniority. Our designation and station change according to the published vacancy list during the annual transfer application process. Consequently, every medical officer has the potential to work in a unit with patient admissions, leading to significant challenges related to social and family commitments, job satisfaction, and the risk of litigation. These challenges stem primarily from the absence of standardized weekly working hours, which are not aligned with those of the countries whose clinical management guidelines we follow.

According to the circulars and guidelines issued by the Ministry of Health, Sri Lanka, the current on-call duty structure requires medical officers to work from 8:00 AM to 12:00 noon in the ward, remain on-call for the unit from 12:00 noon to 2:00 PM, resume ward duty from 2:00 PM to 4:00 PM, and then remain on-call for the unit from 4:00 PM until 8:00 AM the following day. Additionally, the medical officer who was on-call the previous day is required to continue working from 8:00 AM to 4:00 PM the next day, resulting in a continuous duty period of approximately 32 hours.

Typically, a unit consists of three to four doctors, although some divisional hospitals have only two or three doctors. This requires each doctor to undertake on-call duties once every two, three, or four days. During night on-call shifts, medical officers frequently receive multiple calls after midnight, leading to severe sleep deprivation. Despite this, there is no provision for a rest period or a day off following the completion of an on-call shift. Doctors who perform on-call duties in Sri Lankan hospitals often find it resembles shift work rather than traditional on-call duty. This is due to the necessity of admitting patients beyond the available bed capacity in the ward and the lack of a standard time frame for completing each admission, including history-taking, examination, and relevant medical or surgical interventions. Furthermore, because patients are not admitted according to the available bed capacity in the ward, the number of admissions remains unpredictable, and medical officers are required to attend to all admitted patients, regardless of workload constraints. This often leads to fatigue and sleep deprivation, negatively impacting both the well-being of doctors and the quality of patient care. Exhausted medical officers face a higher risk of making errors, encountering conflicts with patients, and facing potential legal consequences.

Female doctors with young children or lactating infants face additional hardships due to these extended working hours, which adversely affect their family life, personal commitments, and the  rights of their infants.

Furthermore, government doctors are not provided with a housing allowance, making it difficult for them to afford secure and comfortable accommodation near the hospital within their salary. Rental costs in urban areas have risen significantly recently due to high inflation in Sri Lanka, as evidenced by classified websites such as Ikman.lk. Consequently, many doctors are compelled to commute long distances using public transportation, as they do not receive transport facilities similar to those provided to other senior-level government officers. Additionally, the DAT allowance has not been updated in line with the high inflation rate in Sri Lanka.

According to the job description of Medical Officers and Senior House Officers issued by ministry of Health, Sri Lanka (link attached herewith), the number of working hours per week is not specified. This is a significant injustice to doctors in Sri Lanka.

Additionally, some heads of institutions are misinterpreting or misusing the Establishment Code, Chapter XXVIII (Administrative Procedure), General Clause 1.2, which states that “heads of departments are not restricted to employing subordinates only during general office hours when their services are required beyond those hours.”

Therefore, we kindly request your esteemed office to intervene and address the following matters in discussion with the Ministry of Health, Sri Lanka, and also with the Sri Lanka Medical Council, in relation to international standards of patient care guidelines.

1.    Establish a standardized number of compulsory working hours per week for doctors in alignment with international standards.

2.    Clarify the application of the Establishment Code, Chapter XXVIII (Administrative Procedure), General Clause 1.2, which states that the head of an institution may require employees to work beyond normal working hours. However, the total working hours, including work beyond normal working hours, should not exceed the standard weekly working hours.

3.    Ensure that, if working beyond the standard weekly hours is necessary, verbal consent is obtained from the relevant medical officer.

4.    Allocate a standardized time frame for each clinic and OPD patient, consistent with the practices of countries whose medical guidelines and management plans we follow. This will facilitate proper history-taking, relevant system examination, prescribing medications, providing medical advice, and, if necessary, writing referrals for opinions from different medical specialties to ensure better patient care and improve job satisfaction.

5.    Paying for on-call hours is considered shift duty due to the necessity of admitting patients beyond the available bed capacity in the ward.

Thank you 

Sincerely 

Attachments:-

MO/SHO Job description link (Published by ministry of health Sri Lanka)

https://www.health.gov.lk/wp-content/uploads/2022/08/JD_SHO-MO.pdf

Establishment Code,

https://pubad.gov.lk/web/index.php?option=com_content&view=article&id=45&Itemid=192&lang=en