By Asiri Fernando/The Morning
Colombo, May 24L The Suwa Seriya ambulance service, a critical medical service provider for the masses, is struggling to sustain its services due to poor pay, skilled migration, and difficulties in repair and maintenance of its fleet of 322 ambulances.
The service, established in 2018 with Indian funding and technical assistance, has brought pre-hospital care to a wide cross-section of the community which could not afford an ambulance before. Today, the service finds over 50 of its 322 ambulances out of operation due to repair and staffing issues.
According to Suwa Seriya Chairman Dumindra Ratnayaka, the foundation is struggling to replenish its ranks of Emergency Medical Technicians (EMTs) and pilots, with 400 vacancies to fill but only 50 ready to join.
In an exclusive interview with The Sunday Morning, Ratnayaka gave an overview of the issues the lifesaving service is facing, ranging from red tape and funding challenges to staffing issues.
Following are excerpts:
Q: How many ambulances does the Suwa Seriya service have in its fleet at present and how many are serviceable?
A: We have 322 ambulances. Let me explain about serviceability. Every ambulance is serviceable. As of now we have 56 which are out of service and there are two reasons for that.
Firstly, other than the 25 new ambulances we received recently, all other ambulances in the fleet are in need of repairs. The rest of the fleet requires repair because, during the Covid-19 pandemic, the ambulance fleet was used extensively with minimum basic maintenance. Such prolonged usage of vehicles with minimum basic maintenance takes a toll.
Further, during the Covid period, strong chemicals were used to clean the ambulances during the early stages due to a lack of understanding about the illness. Once a patient was moved in an ambulance, hospitals used strong chemicals to clean it. This caused corrosion of the ambulances and some of the installed medical equipment.
Then came 2022, Covid decreased, and we found ourselves focused on sourcing fuel to run our ambulances; again, no repairs were done. Then in 2023, when we lined up a plan to repair the fleet, address the corrosion, and repair any critical/noncritical mechanical issue, Suwa Seriya couldn’t get the full budget we asked for. The Government could not allocate the full budget we sought.
Q: With a budget shortfall, Suwa Seriya tried to raise funds on its own. How did that work out? What is the status of the fleet now?
A: We reached out to the private sector through ‘Adopt an Ambulance’ and we raised Rs. 750 million. We went ahead with the private fundraising because the Government had approved a budget which was $ 1 billion lower than what we had asked for.
We had four key tasks in mind to accomplish with the Rs. 750 million raised. Firstly, to repair ambulances. Secondly, repair or replace medical equipment which was not in good condition. Thirdly, we wanted to buy the staff new uniforms, as they had not got new uniforms for three years. Fourthly, to recommence our training, which was halted during the Covid period.
We began to repair our fleet and we also got 25 new vehicles which the Government had received during the Covid period. These are Toyota vehicles, which needed to be fitted with the kit required to convert them into ambulances and the Treasury funded the conversion. Just a van with no equipment isn’t an ambulance.
These 25 were outfitted as pre-hospital care ambulances, which are very different from the basic ambulances which are used to transfer patients from one hospital to another. We got the funding for that and we added them to the fleet. We had 297 ambulances prior to that; with the addition of the new 25, we could move 25 which were in need of repair offline to do so.
Initially, repairs were going slower than expected because of restrictions on importing spare parts, etc. Then there was the dollar shortage, which impacted the import of spare parts. Subsequently, the repair process is still not going at the speed we want it to due to a shortage in mechanics and technicians, many of whom have migrated. Repairs are happening but at a slower pace.
Under ‘Adopt an Ambulance,’ we asked corporates to provide us with Rs. 5 million to maintain an ambulance from the fleet. We have offered them branding on the ambulance as an option.
Q: Aside from the technical difficulties in sustaining the fleet, are there issues with the staff?
A: Yes. Since 2020, we have also been losing staff. Initially, we lost a small group of staff due to fears about Covid; it was in the early days of the pandemic when it was not well understood – people were scared and did not know how to deal with it. We can provide the best training and all the Personal Protective Equipment (PPE), but they are the people who take the risk, so we lost a group there.
Then came 2022; we were not allowed to replace the numbers we had lost as the Government had a freeze on recruitment. Then in 2023, we got some approval to start recruitment. Even then we were not given proper approval and the foundation’s Board took a strong decision to recruit and to continue with the service. We had to hire.
We also lost a number of staff members during the economic crisis, with inflation soaring but not the salaries of Government servants. Because we are funded by the Government, we also have to pay our staff based on what is stipulated in the Government structure. Many of our EMTs have migrated to other countries, where they are paid far better.
The other reason we have several ambulances ‘offline’ is the shortage in staff to man all the available vehicles.
Q: How much are Suwa Seriya staff paid? What is their basic salary?
The base wage is Rs. 35,000. An EMT will earn Rs. 15,000 which comes as allowances, which includes the Rs. 10,000 increment given by the Government for those in the State sector during the last Budget. Based on the hours they work, they make anything between Rs. 60,000 and 70,000 a month. You need to deduct EPF and ETF from that, so the take-home is something close to Rs. 55,000-65,000 a month.
Many of the Suwa Seriya staff work from where they are assigned or stationed; most have to work outstation, away from home and have to spend on boarding, food, and travel, which leaves little or nothing left of their salaries at the end of the month. This is also considering the work commitments we as an organisation demand of them. It is very different to what a nurse does.
They are like paramedics – they rush to a location, assess the situation, and act with what they have; it is a demanding and exhausting job. They deserve a better salary. We call our ambulance drivers pilots because they are far more than drivers. They are also trained in basic medical treatment and they assist our EMTs. Our pilots get a lower salary. Even with overtime, our pilots make less than Rs. 50,000 per month, so we have been losing them.
Many EMTs migrate overseas since they get paid much better. If they go to Australia or New Zealand, for example, they can work as caregivers and earn more than Rs. 700,000-800,000 per month. If they go to Israel, they may earn Rs. 500,000-650,000 per month.
Q: At present, what is the staff shortfall?
A: At present we have vacancies for nearly 400 EMTs and pilots. Ideally, we need about three staff per ambulance – two EMTs and one pilot. At minimum, we need 2.5 to operate the service effectively. Now, we are down to 1.8, so we are an ambulance service which is offline due to the lack of staff. If we assume all ambulances in the fleet are in perfect condition and in operational order, still nearly 40 of them will be offline due to the lack of staff.
We have used this time to push repairs on 40 such vehicles while they are offline, but in reality it means fewer ambulances for active duty. We take around 1,000 people to hospital on average per day. That is about three patients per ambulance. Obviously, that is not a flat rate; it is an average across a day.
During peak periods, we now have to check availability and inform the caller about the expected time for an ambulance to arrive, because we don’t have enough of them online. We check and dispatch the fastest arrival. Having more ambulances is not necessarily the solution; we also need to have and retain the staff needed to operate them around the clock. The bottleneck is staff.
Q: How is the recruitment process going?
After much advertising, we had 700 applicants, but only 200 fit our requirement. We had a written and physical examination for our recruits, but out of the 200 who fit the bill, only 45 turned up for the exams. When we inquired from those who didn’t turn up for the exams, they said that the salary which was offered was not enough. That is the reality.
Q: Since the salaries are paid by the State, is there anything that can be done to improve the pay offered?
A: We have asked the Government for a pay increase for the staff. We have been set up by an act of Parliament. The Board of the foundation has the authority to set the salaries. Unfortunately, since the State is the provider of funding, that authority is overridden by the regulations of the State, so we can’t offer our staff any salary we want. If we had funding from the State and other sources, we would have been able to do something.
When you talk about salaries, we need to have a continuous revenue stream to provide them. We are in the process of discussing the matter with the Asian Development Bank (ADB), to study if other mechanisms of funding can be incorporated to suit our country.
Q: Has the State approved your budget for this year?
A: Yes, it was approved. For 2024, Rs. 3.9 billion was approved, plus Rs. 500 million which is part of corporate funding, which will come via the Finance Ministry as part of tax relief. That amount is sufficient to keep things going with the current salary scales.
Q: Do these challenges affect the response time?
A: It is challenging to maintain the low response times we had before. However, we do all we can to coordinate with the resources we have and provide this service to those in need.
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