Repeated strikes and trade union actions, and threat of such actions by doctors and other medical staff exposes the fragility of Sri Lanka’s public healthcare system—not only in terms of resources but also in its mechanisms for resolving disputes. While demands for fair pay and better working conditions are legitimate, the recurring paralysis of public hospitals raises an uncomfortable question: who protects the patients when the system breaks down?

In a country where the majority of the population relies exclusively on public healthcare, even a single day of disruption can translate into life-threatening consequences for thousands. The time has come to move beyond ad hoc negotiations and establish a formal, fair, and transparent dispute resolution mechanism—one that recognizes the rights of health professionals while ensuring uninterrupted access to care for those who can least afford alternatives. A recent dispute arose last month (October 2025) when doctors threatened strike action over what they described as irregular transfers but was fortunately averted at the last moment through talks involving the Minister of Health, Ministry officials and the General Medical Officers Association (GMOA).

The escalation to strike action always leaves public hospitals understaffed, clinics unattended, and surgeries postponed. While  governments urge restraint on the part of the doctors and others, healthcare workers argue that previous promises have been broken. Between these two narratives lies the suffering of ordinary citizens—patients who depend entirely on state hospitals for everything from dialysis to maternity care.

For the urban middle class, a strike may mean inconvenience. For rural or low-income patients, it can be catastrophic. Every strike exposes the harsh inequities within Sri Lanka’s health system: patients travelling long distances from Polonnaruwa or Monaragala for scheduled clinics find closed doors; cancer patients awaiting chemotherapy are told to return in a week; parents with sick children spend hours in queues, uncertain whether a doctor will appear.

Television footage of crowded corridors and desperate families has become an almost ritual feature of health sector unrest. The stories are personal and painful—a diabetic mother unable to obtain insulin, a heart patient turned away on the morning of surgery, a child’s test results delayed because laboratory technicians joined the strike. These are not mere anecdotes; they represent a recurring humanitarian crisis that strikes at the moral legitimacy of both unions and the state.

This is why healthcare cannot be treated like any other sector of industrial relations. It involves human lives, not just numbers or contracts. Every shutdown leaves lasting scars on the trust between the public and the medical profession. Once that trust erodes, rebuilding it becomes far more difficult than adjusting a salary scale.

Sri Lanka has experienced multiple rounds of strikes in the health sector over the past two decades—often triggered by pay disputes, transfer policies, or professional rivalries between categories of health workers. Each time, the pattern is the same: protests escalate, the government scrambles to negotiate, and temporary solutions are patched together. Once calm returns, so does complacency—until the next crisis erupts.

This cycle of reaction and repetition points to the absence of a durable institutional mechanism for handling conflict. Instead of relying on ministerial discretion or political mediation, Sri Lanka urgently needs a dispute resolution framework or a standing process that can preempt industrial action through structured dialogue, transparency, and binding arbitration.

Before any union in the Health Sector declares a strike, all parties must be required to participate in a neutral mediation process. This could be facilitated by an independent panel comprising representatives from the Human Rights Commission of Sri Lanka (HRCSL), the Public Service Commission, and respected medical professionals. If mediation fails, the dispute should proceed to  arbitration, ensuring that no grievance is left unresolved due to political stalemate.

 A permanent Health Sector Dispute Resolution Council, legislatively mandated and independently funded, could be another option that can serve as a lasting solution.

Sudden strike action should be prohibited in essential services like healthcare. Trade unions must give adequate notice—preferably 14 days—before launching industrial action. This allows hospitals to activate contingency plans, transfer critical patients, and inform the public in advance, reducing panic and uncertainty.

Even during a strike, essential services must remain functional. Emergency wards, intensive care units, maternity sections, and cancer clinics should operate under a “minimum service” agreement. Such provisions exist in many countries, recognizing the ethical and professional obligation of healthcare workers to prevent loss of life, regardless of labor disputes.

Much of the current mistrust arises from confusion over government data and pay structures. Clear, public disclosure of remuneration packages, tax implications, and allowances would help prevent misinformation. Regular briefings from both sides would ensure that the public remains informed and that negotiations are conducted in good faith.

Whenever disputes occur or are likely to offer the government too must demonstrate consistency and credibility. Chronic underfunding of the health sector, bureaucratic inefficiency, and the slow pace of implementing promised reforms have over the years  eroded confidence. A culture of delayed responses and ad hoc decision-making only invites confrontation.

Both parties must accept that the public health system is not just a workplace—it is a lifeline. Its stability is a shared moral duty that transcends political affiliations or professional hierarchies.

Establishing a dispute resolution framework is not merely a procedural reform—it is a step toward institutional maturity. It signals that Sri Lanka is ready to treat its public health system as a cornerstone of national security and human development, not as a bargaining chip in periodic power struggles.

Civil society, professional colleges, and human rights institutions can play a pivotal role in shaping this framework. Their participation would lend credibility and safeguard the process from political manipulation. 

Sri Lanka’s healthcare workers deserve national gratitude for their dedication—especially during crises like the COVID-19 pandemic. Their right to fair wages and dignified conditions is unquestionable. But that right must coexist with the public’s right to uninterrupted access to healthcare.

A transparent, rules-based dispute resolution system would ensure that both are protected. It would replace confrontation with consultation, suspicion with clarity, and instability with trust. For a nation still recovering economically and socially, this is not just a health sector reform—it is a moral and governance imperative