Arogya Centres are at the heart of Sri Lanka’s planned healthcare reform, as debate grows over hospital access, family doctors and patient referrals.
Arogya Centres have moved to the centre of a national healthcare debate after President Anura Kumara Dissanayake outlined plans to change how Sri Lankans access hospitals.
“We are changing the healthcare system. We are changing the culture of going to hospitals whenever one feels like it. We are establishing centres that provide a family doctor. Without a recommendation from that doctor, one cannot go to a large hospital…”
President Dissanayake made the remarks at a rally in Beruwala last Sunday, Sept. 6.
His comments immediately triggered questions over the government’s planned “Arogya Centres (Health Centres) 1000” programme. Different views soon emerged over what the proposed system would mean for patients.
On social media, some criticised the President’s remarks and opposed the proposed changes. Others defended the concept, arguing that similar referral-based systems operate in developed countries.
Against that backdrop, BBC Sinhala examined the issue from several angles.
What exactly did the President say?
President Dissanayake spoke about reforms he expects to introduce across several sectors. However, his comments on healthcare attracted particular attention.
“We are changing the healthcare system. We are changing the culture of going to hospitals whenever one feels like it. We are establishing centres that provide a family doctor. Without a recommendation from that doctor, one cannot go to a large hospital,” the President said.
He continued:
“Now, whether they go to the market, they go to the hospital; whether they come to a junction, they go to the hospital. That cannot continue. To go to a large hospital, one must have a recommendation from one’s own doctor.”
According to the President, approximately 80 million people receive treatment annually from outpatient departments in the state and private sectors.
“The population is 22 million. Eighty million people get medicine from hospitals annually. That means each person goes seven or eight times. Why? There is no standard, no recommendation. The patient decides where they need to go,” he said.
The President argued that a doctor, rather than the patient, should decide which level of medical care or specialist a person needs.
To support that approach, he said the government plans to establish “Arogya Centres 1000” in the coming year.
“There will be a primary doctor. Only with that doctor’s recommendation can the patient go further up.
“If they are told to take some herbal porridge and rest, they should go home and rest, take the medicine, not go [to the hospital]. Even if they bring all the medicines, they don’t drink them all, right? That’s the same. They give for three days, don’t they?” the President said.
He described the existing pattern as “waste and a crime.”
Arogya Centres already appeared in the policy platform
The concept is also reflected in President Dissanayake’s 2024 presidential election policy statement.
Under the “Primary Care” section of the chapter titled “A Healthy Life – A Healthy People,” the policy states that a family doctor and health staff would serve populations of between 5,000 and 10,000.
It also proposes a structured system of care.
Under that model, institutions such as base hospitals would function as primary care institutions. General hospitals would operate at secondary level, while teaching hospitals would provide tertiary care.
The policy also refers to establishing satellite clinics where specialist consultants could visit communities served by family medicine units.
In addition, it proposes facilities for psychological, speech, audio, occupational and community physiotherapy services.
Sajith Premadasa questions President’s change in position
Opposition Leader Sajith Premadasa raised the issue in Parliament on Monday, Sept. 8.
He argued that the President’s latest remarks conflict with statements he made while in opposition.
“The current President said when he was in opposition that health is a fundamental right. That fundamental right must be strengthened. If they cannot provide a bed when one goes to the hospital, one can sue the government. I am saying this using his own words.
“Then he says today that he is changing the healthcare system. One cannot go to the hospital whenever one feels like it. One cannot go to the hospital when going to the market. One cannot go to the hospital when coming to a junction. He said it was a fundamental right when in opposition. Now he says you can’t go whenever you want,” Premadasa said.
The Opposition Leader suggested that the government’s decision may have resulted from what he described as the “severe collapse of the health system, the severe drug shortage in the country, and the shortage of equipment in hospitals.”
“Instead of making various decisions for the country when they are unable to work, the government’s responsibility is to implement in power what they said when they were in opposition regarding health policies,” he added.
‘Four or five doctor visits a year are not harmful’
Ravi Kumudesh, President of the Health Professional Officers’ Association, also responded to the President’s remarks.
In a statement, Kumudesh stressed that primary healthcare reform should not turn into a mechanism that restricts patients from accessing healthcare.
He argued that policymakers should not simply conclude that people are overusing medical services.
Instead, he said the country should create a health system where patients can reach the correct service, at the correct place and at the correct time.
According to the statement, international data indicates that a person visiting a doctor “four or five times a year cannot be considered abnormal or harmful behaviour to the health system.”
Kumudesh also noted that frequent healthcare visits can sometimes reflect responsible health behaviour.
“People with diabetes, high blood pressure, heart disease, and other chronic conditions need regular follow-ups. Pregnant mothers and children need scheduled healthcare services. There is also a need to engage with healthcare repeatedly for medication adjustments, reviewing test results, early detection of diseases, and preventing complications,” the statement said.
He therefore argued that simply counting annual visits to hospitals or doctors and describing that number as excessive healthcare use would be unscientific.
Kumudesh also said that if patients must visit base hospitals, general hospitals or teaching hospitals for conditions that primary healthcare could manage, the problem may lie within the healthcare delivery system rather than with patients.
“The problem is in the healthcare delivery system,” he said.
Accordingly, he argued that the system should focus on reducing unnecessary readmissions, preventable hospitalisations and referrals to higher-level hospitals for patients who could receive care at primary level.
What is the Arogya Centre concept?
Deputy Minister of Health Dr. Hansaka Wijemuni described the Arogya concept as the next stage of Sri Lanka’s healthcare system during a special discussion with BBC Sinhala.
“We have identified a number of deficiencies in our health system. The method we are using to address those deficiencies is these Arogya Centres,” he said.
The Deputy Minister identified several challenges facing the health sector.
Among them are the rapid rise in non-communicable diseases, people being unaware that they have such illnesses, and patients with diagnosed conditions failing to control them effectively.
He said the programme therefore aims to strengthen disease prevention at community level.
It also seeks to identify illnesses earlier and provide support before complications become more severe.
Providing support for patients with complications to maintain their quality of life through palliative care is another objective, he said.
Dr. Wijemuni also said the government intends to register all patients through Arogya Centres.
“We hope to give everyone a digital identity as soon as possible, as well as a health identity. The health identity will be given through the Arogya Centre in their village,” he explained.
How will the system work?
According to the Deputy Health Minister, 39 Arogya Centres are already operating as pilot projects across Sri Lanka.
However, he said meaningful results would become clearer only after a “large number” of centres operate in each district.
“There is a clustering system in this. That means there is a grouping. After grouping and identifying the main hospitals in those clusters, there is a system to provide the necessary facilities from those main hospitals to these clusters.
“There is also a system for referring patients from smaller hospitals to larger hospitals, and a system for referring patients back from larger hospitals to lower-level hospitals.
“This is actually linked to the next step, the next level of our hospital system. So this cannot be discussed separately from the Arogya concept. This is one part of the forward journey we have planned for the health sector,” he said.
Dr. Wijemuni said the project has been operating since September 2025.
However, he stressed that the reform would not abolish existing outpatient departments, private hospitals or dispensaries around the country.
“None of these existing services will be reduced, and we will improve all of them further. That means we will improve the rural hospital system as well, and we will also improve the secondary and tertiary level hospital systems. But there were some services that we could not provide from all these hospitals. It is to cover those services that we are hoping to achieve through this,” he said.
That clarification is important because the President’s remarks had created concern that access to larger hospitals could simply be restricted.
The Deputy Minister’s explanation suggests that the government instead intends to build a referral structure around existing healthcare services.
How will Arogya Centres be funded?
So far, the government has not allocated additional funding specifically for the 39 centres currently operating.
However, the Health Ministry expects additional budgetary allocations as the programme expands.
“We are currently operating only 39 centres. So far, we have been able to manage this within the funds already allocated to the health sector.
“But in the future, we hope to increase this number to 1000. That means within another year, we plan to increase this to 300, and then reach the target of 1000.
“When we reach that target, we will need to allocate a separate amount of money from next year’s budget for this purpose. Such a need has not arisen so far,” Dr. Wijemuni explained.
The funding question will therefore become more significant as the pilot programme moves towards national expansion.
Are there enough doctors and healthcare workers?
The Deputy Minister also acknowledged that Sri Lanka currently does not have enough doctors and healthcare workers to fully implement the programme.
As a result, the government plans further recruitment.
“We need a considerable number of doctors. Similarly, we need to recruit other staff as well. We have requested approval from the Ministry of Finance for that.
“Therefore, we hope to recruit in the future. For that reason, the cadre of doctors we need will also increase through this,” he said.
The debate over the Arogya Centres therefore involves more than whether patients visit hospitals too often.
It also raises wider questions over primary healthcare, referral systems, chronic disease management, staffing, funding and whether patients will continue to receive timely access to care.
The government says existing services will remain and improve while the Arogya network expands.
Critics, meanwhile, continue to question whether reform could eventually restrict access or place new barriers between patients and hospitals.
How Sri Lanka manages that balance will determine whether the new system strengthens primary healthcare without undermining public confidence in access to medical treatment.
