It’s time to talk about Trump’s mental health

By Eugene Robinson Opinion writer August 21

How unstable and divorced from reality is President Trump? We’ve reached the point where the nation has the right and the need to know.

We’re not accustomed to asking such questions about our presidents. We don’t know how to even begin inquiring into a president’s mental health, so we rationalize aberrant behavior as being part of some subtle strategy. We say that Trump is cleverly playing to his base, or employing the “madman theory” of foreign relations, or simply being unpredictable to gain an advantage by keeping everyone off balance.

But if Trump were really playing three-dimensional chess, presumably he’d be getting things done. His approval ratings would be rising rather than falling. Allies in Congress would be expressing admiration rather than increasing dismay.

Sen. Bob Corker (R-Tenn.) hit a nerve Thursday when he said that Trump “has not yet been able to demonstrate the stability nor some of the competence” needed in a president. That indictment was significant because Corker, who chairs the Foreign Relations Committee, is a respected Capitol Hill veteran who chooses his words carefully — and who thus far has been willing to give Trump a chance. Corker said he feared that “our nation is going to go through great peril” and called for “radical change” at the White House.

Democrats have been slightly more plain-spoken. Rep. Adam B. Schiff told CNN on Sunday that “I certainly think that there’s an issue with the president’s capability.” And fellow California Rep. Jackie Speier tweeted last week that Trump “is showing signs of erratic behavior and mental instability that place the country in grave danger.”

After President Trump's most recent rhetoric about Charlottesville inflamed even more criticism, a handful of GOP lawmakers, including Sens. Bob Corker (R-Tenn.) and Lindsey Graham (R-S.C.), are criticizing Trump directly, while others stay silent. (Jenny Starrs/The Washington Post)

Speier went so far as to call for action under the 25th Amendment, which allows the vice president and the Cabinet to relieve the president of his “powers and duties” if he is unable to discharge them.

Trump’s performance last week following the Charlottesville incident was indeed alarming, the problem being not just what he said but how he said it. After initially blaming the violence — which led to the death of 32-year-old Heather Heyer — on “many sides,” Trump reversed course and specifically condemned neo-Nazis and the Ku Klux Klan — but looked like the reluctant star of a hostage video. Then the next day, Trump went back to blaming “both sides” in what can only be called an angry, red-faced rant.

We should assume that the ugliness we heard from Trump about Charlottesville reflects his true feelings. And we can conclude that he failed to grasp how jarring those sentiments would sound to most Americans’ ears.

Anyone can have a bad day. But according to many published reports, Trump often erupts into rage — especially when he sees something he doesn’t like on the cable news shows he is said to watch compulsively.

In his Twitter postings, he increasingly lashes out in ways that are counterproductive. I can see some method behind his incessant ranting about “fake news,” which may actually help him with his political base. But why attack Senate Majority Leader Mitch McConnell (R-Ky.) whose help the president needs if he is to get legislation passed or nominees approved? Why campaign against Sen. Jeff Flake (R-Ariz.), who has been a frequent critic but ended up supporting Trump on health care? Is Trump unable to imagine how other GOP senators — whose votes he needs if he is to get anything done — are going to react?

I have spoken with people who have known Trump for decades and who say he has changed. He exhibits less self-awareness, these longtime acquaintances say, and less capacity for sustained focus.

Indeed, it is instructive to compare television interviews of Trump recorded years ago with those conducted now. To this layman’s eyes and ears, there seems to have been deterioration.

I am not professionally qualified to assess the president’s mental health; psychiatrists and psychologists who have the proper credentials and experience to do so are silenced by ethical rules.
The stakes are so high, however, that the officials who work alongside Trump and observe him closely bear a tremendous responsibility. There is a huge difference between sounding as unhinged as North Korea’s Kim Jong Un and actually being that unstable.

President Donald Trump’s reluctance to condemn bigotry suggests he does not want to heal the wounds of racism and white supremacy. Fred Hiatt, head of The Washington Post editorial board, says Americans still have reason to hope. (Adriana Usero, Kate Woodsome/The Washington Post)

It is of some comfort that Trump is surrounded by levelheaded military men — Defense Secretary Jim Mattis, national security adviser H.R. McMaster and Chief of Staff John Kelly — who are unlikely to do anything rash. But no one elected them.

It is uncomfortable to talk about the president’s mental health. But at this point it is irresponsible not to.

Read more from Eugene Robinson’s archive, follow him on Twitter or subscribe to his updates on Facebook. You can also join him Tuesdays at 1 p.m. for a live Q&A.

Hunt vs. Hawking: who’s right about the NHS?

by Georgina Lee and Martin Williams

The health secretary, Jeremy Hunt, clashed with Professor Stephen Hawking over the weekend about the NHS.

The exchange saw claims and counter-claims scattered across the pages of the weekend papers, with each accusing the other of ignoring evidence.

So, who’s right? FactCheck looks at the four biggest points of contention between the pair.

NHS privatisation

Professor Hawking said in a Guardian article on Friday that “the balance of power in the UK is with private healthcare companies”.

Mr Hunt replied via an article in the Telegraph the following day. “As for use of the private sector, well last year it was 7.7 per cent of NHS spend – up just 0.1 per cent on the previous year,” he said.

Mr Hunt is right that 7.7 per cent of total NHS spending went to private healthcare providers in 2016-17. He’s also right that, as a proportion of NHS spending, that figure is up 0.1 per cent on the previous year. Department of Health annual accounts back him up on these claims.

But when we look at how these figures have changed over time, a different picture emerges.

Analysis of the Department’s accounts shows Mr Hunt is right that there has been only a tiny change in the overall proportion of NHS spending going to private providers in the last year.

However, he has presided over more significant increases in NHS privatisation since he became health secretary in 2012.

(We can only use figures from 2013-14 onwards because the government changed its data methods in that year).

And what about the types of care that are being privatised?

According to a 2017 report by the British Medical Association (BMA), 44 per cent of the money spent on private sector care in the NHS now goes on community health services. The BMA calculates that this represents a 271 per cent increase in privatisation of community healthcare since 2010-11.

The same report estimates that 25 per cent of NHS privatisation spending is on “general and acute care”, while just over 10 per cent goes on mental health and learning disability care.

The seven-day NHS and the weekend effect

Mr Hunt and Professor Hawking also clashed over the so-called “weekend effect” – the purported increase in mortality among patients admitted to hospital at the weekend.

The health secretary has made tackling this issue one of his main objectives, saying he wants to “deliver a 7 day NHS so we can promise NHS patients the same high quality care every day of the week”.

One of the main ways Mr Hunt has tried to achieve this is through changes to staffing, which prompted the biggest walkout in NHS history last year when junior doctors accused him of imposing unfair contracts on them.

Professor Hawking accused him of “cherry-picking” the evidence to support these controversial changes.

“[Hunt] had claimed that thousands of patients died unnecessarily because of poor hospital care at the weekend, and used this to argue that we needed to implement a seven-day NHS,” he said.
Rebuffing the accusation, Mr Hunt claimed that Professor Hawking was wrong about the lack of evidence.

He said: “You do have to make a judgement – and I based mine on the Fremantle [sic] study of 2015 because it was quite simply the most comprehensive and detailed paper ever done on the topic. No responsible health secretary could have ignored it.”

The Freemantle study in question, which was published in the British Medical Journal (BMJ), compared the outcomes of patients admitted on weekdays with those admitted at the weekend. It suggested that there is a higher mortality rate among the second group.

But the research behind it has since been questioned. Academics at Oxford University found that the “weekend effect” may be more to do with bad data than bad care.

They explained that most studies have relied on hospitals to record each patient’s experience using a code. But analysis suggests that those codes may not be wholly accurate.

For instance, the Oxford researchers found that some hospitals were recording stroke patients arriving for pre-planned follow-up appointments with the same code as emergency stroke admissions.

Pre-booked appointments are much more likely to be scheduled for a weekday. They are also far less likely to result in the patient’s death.

This could downplay the mortality rate for weekday admissions, and give the false impression that weekend rates were comparatively higher.

The Oxford academics suggested that the Freemantle study lacked “basic due diligence”, while Professor Freemantle stood by his work, saying: “I’ve been accused of being in the Government’s pocket by junior doctors, but it’s not true, I’m just a statistician.”

But the concerns do not end there. Since publishing the research, the BMJ has had to make a correction to the Freemantle study, pointing out: “One of the authors … is medical director of NHS England, [and] is a long standing proponent of improving NHS services seven days a week.”

It’s also important to remember that this is just one study. For scientists and statisticians, a fuller and more rounded understanding of any issue will generally come from a range of studies and reviews.

Indeed, one further problem for Mr Hunt is that even if the Freemantle study provided reliable evidence for the weekend effect, it does not explain why it might be happening.

How many people in the UK have private health insurance?

In his article, Professor Hawking also claimed that UK is moving towards a “US-style insurance system”. Mr Hunt tried to rebut this in a tweet by pointing out that the proportion of people with private medical insurance has gone down by 9.4 per cent since 2009.

We asked the Department for Health where this figure comes from. They haven’t got back to us, but we’ll update if they do.

In the meantime, our best estimates suggest Mr Hunt is probably right that the number of people with private medical insurance is lower now than it was eight years ago.

Research by health economists at LaingBuisson shows that in 2008, 4.35 million people had private insurance. The most recent data from 2015 shows around 4 million people were covered. That’s a drop of about 8 per cent.

But what’s not clear is whether this is a reflection of the government’s NHS policy, or whether there are wider factors at play. Indeed, the same report suggests that Brexit and recent rises in insurance premium tax are bigger problems for this industry than any changes to government health policy.

And although it hasn’t reached its 2008 peak, the number of people with private medical cover has crept back up in recent years, rising by 2.1 per cent between 2014 and 2015.

Ultimately, it’s very difficult to draw a clear link between the government’s health policy and the number of people with private medical insurance.

More money, doctors and nurses than ever?

Mr Hunt tweeted: “NHS under Cons has seen more money, more docs and more nurses than ever in history.”

These are claims we hear time and again.

The absolute numbers have gone up over time. However, the more revealing thing is how this compares with patient demand.

Here’s how health spending and staffing numbers have changed in comparison to the population since 2010.

Health spending in England has risen by £93.50 per person. Proportionate to the population, there are slightly more doctors, but fewer nurses.

And it’s not just overall population that matters; the proportion of older people is going up. That’s important because the NHS needs to spend more per head on older people, as this graph from the Department of Health shows.

The IFS predicts that the number of people aged 65 and over in England will increase by 9.2% between 2016 and 2021.

Furthermore, it is worth bearing in mind that even though health spending is higher than before, the rate of increase is slow compared to long run averages. Historically, UK health spending has risen by four per cent each year, in real terms.

Analysis by the IFS ahead of this year’s election showed that Conservative policy for NHS spending is well below the historic average of four per cent.

Therefore, while Mr Hunt’s claims are technically correct, they don’t give us the full story.


A Department of Health spokesperson said: “This government is committed to a world-class health service that is free at the point of use now and in the future.”

Wear and tear of joints at a glance

By Dr. Himantha Atukorale
MBBS (Colombo), MD Consultant in
Joint Disease and Rehabilitation-2017-08-22

"An old lady is struggling to stand up from a seated position. Even after standing, her grimace of pain says it all. She has unbearable knee joint soreness. The lady is fidgety with a walking stick. Her fingers are swollen over the joints, making it even more difficult to firmly grip the handle. The legs are bowed at the knees – what we call 'bow legs' is evident even from a distance."

What is the underlying cause of knee pain, and what affects the hands and other joints simultaneously to create generalized joint pain? How does the body select certain joints, damage them, and spare some of the most weight-bearing joints like the ankles?

This is a condition called osteoarthritis, which is the most common type of arthritis out of nearly a hundred different types of diseases affecting the joints. We believe that osteoarthritis is the key joint disease among Sri Lankans although nationwide surveys have never been done. Osteoarthritis is quite a common occurrence at our joint clinics. This is also known as wear and tear arthritis, although research has shown lately that it's not just that.

Who gets osteoarthritis?

The following categories of people are at risk of developing osteoarthritis: Females, people who are 40 years or above, those who have had fractures or injuries in the joints, people with a familial tendency to have osteoarthritis (hereditary), overweight people, people who do jobs that put too much strain on the joints, people with other joint diseases like rheumatoid arthritis.

How do you feel osteoarthritis?

This is important to know as not all patients might feel severe pain from within the joint. Pain is the most common symptom, especially pain that is felt immediately after prolonged periods of rest, for example, after sitting down for half an hour, and pain that becomes worse at the end of the day. It could become so severe that it might even prevent the patient from falling asleep.

Another symptom might be stiffness, which again is felt after prolonged periods of rest. Stiffness might prevent you from moving your joints properly. Some patients recalled instances where they had to put more effort in order to move that particular joint.

Swelling is also a common symptom. There are several types of swelling that we observe. Certain joints get swollen when joint fluid collects inside a small space called the joint cavity. This fluid swelling increases the pressure within the joint, and as a result the skin bulges out. There is also a bony swelling which occurs because of bone fragments called osteophytes. Unlike fluid swelling, this can be felt when the affected area is pressed.

The crackling sensation or bone grinding feeling is called crepitus. Crepitus is also felt by patients in most instances. This happens when you move your joint.

Do note that even healthy individuals might feel a bit of crepitus. Crepitus alone doesn't always mean that you have osteoarthritis.

How is osteoarthritis evaluated?

The rheumatologist will first of all test how severe the osteoarthritis is, especially in the weight-bearing joints like the hips, knees, and ankles. The evaluation includes a detailed history and a complete examination of not just the joints that are affected, but the healthy ones as well. During the examination, you might be asked to perform certain joint movements or the specialist might do them passively.

Then, sometimes, the consultant might order certain blood tests to see whether there is a bit of inflammation coming from within the joint. Inflammation is swelling related to increased blood supply to a certain part of your body. They might also order X-rays to see how well the bony architecture is preserved. Joint ultrasound scans are very useful as well.

Rarely, we order special imaging like Computerized Tomography (CT) scans and Magnetic Resonance Imaging (MRI) scans to have a more clear view of the joint damage, which is not visible on conventional images.
How can osteoarthritis be managed/treated?

Whenever I tell people who have osteoarthritis, that fifty per cent of the cure is achieved by the patient himself/herself, they shake their head in disbelief. Here in Sri Lanka, patients expect the rheumatologist to cure them 100 per cent, whereas in developed countries 'self-help' plays a major role in 'controlling' arthritis.

Most of the proven treatment strategies are patient-based ones and the rheumatologists simply guide them. It is a fact that joint protection strategies and exercise can ease off the pain completely.

There are several types of medication which help patients control the symptoms of osteoarthritis. Out of these, painkillers play a major role. Starting from ointments, paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and there are occasions where we even prescribe opioid analgesics for severe pain. Certain drugs which relax the muscles also help.

Joint injections consist of a mixture of steroids and pain relieving medication. Injections are very useful in rapidly bringing down the swelling and providing great relief.

New methods of controlling symptoms

There are more than ten different new methods of treating osteoarthritis. As I stated previously, joint protection strategies are useful in preventing further damage. We use braces/guards/splints that are worn over joints to control unwanted movement.

Again, these come in several different types and sizes. We also recommend supports to be worn with your footwear.

Muscle strengthening, if properly done, protects the joint that lies underneath. There is evidence that suggests that this might even halt the joint from getting deformed. Aerobic exercises, cycling, and swimming are very useful in treating osteoarthritis.

There is evidence that suggests that even Tai chi, which is all about gradual limb movements while maintaining body balance alleviates joint pain.

Transcutaneous electrical nerve stimulation (TENS) therapy, which involves applying an electrical impulse over the affected joints, is very popular in Western countries. Guided physiotherapy also helps reduce symptoms of osteoarthritis.

Certain nutritional supplements like glucosamine and chondroitin, which are compounds that are normally found in joint cartilage, may improve the health of damaged cartilage according to a few studies.

Weight reduction has been known to improve pain, especially in the weight-bearing joints.

Sometimes, patients with osteoarthritis need early referral to orthopaedic surgeons for joint operations. There are numerous surgical methods of treating worn out joints and the patient needs to decide what is best for him/her.

Sri Lankan government establishes phony Office on Missing Persons

By Vijith Samarasinghe -21 August 2017

Sri Lankan President Maithripala Sirisena last month signed a gazette to establish an Office on Missing Persons (OMP) so as to pretend to be delivering justice for the tens of thousands of people who disappeared during the country’s three-decade communal war and civil emergencies.

In reality, this is a desperate attempt by the government to paint itself in “democratic” colouring, while protecting and further arming the same police and military forces responsible for these crimes.
More than 20,000 people, mainly Tamils, went missing during the 26-year communal war that ended in May 2009. Tens of thousands of Sinhala youth also disappeared during the suppression of rural unrest in the 1988–1990 period. These people were abducted by the security forces or associated paramilitary death squads and killed.

After signing the gazette on July 20, Sirisena tweeted: “This marks another step forward in Sri Lanka’s path to sustained peace.” UN Secretary General António Guterres commended the government, saying the decision was “an important step for all Sri Lankans who are still looking for the truth about their loved ones.” Various media outlets and “civil society” quickly endorsed the government’s claim of a victory for democracy.

Referring to the OMP, the official leader of the parliamentary opposition, Tamil National Alliance (TNA) leader R. Sambandan, said he “wished the issue of the missing persons would be credibly dealt with to ensure relief for the families.”

All of this is false. Establishing the OMP was a key recommendation of the United Nations Human Rights Council (UNHRC) resolution in 2015 on “Promoting Reconciliation, Accountability and Human Rights in Sri Lanka.” The government supported the resolution, but took more than two years to finalise the OMP legislation.

The Office on Missing Persons (Establishment, Administration, and Discharge of Functions) Bill was introduced in parliament in May 2016 and passed in August 2016 following much internal contention. After another 10 months, the bill was finally adopted in June with an amendment proposed by the Sinhala communalist Janatha Vimukthi Peramuna (JVP), followed by Sirisena’s endorsement on July 20.

It will take weeks or months to appoint the top OMP officials. They are to be selected by the Constitutional Council and approved by the president, giving the government full control over the OMP’s investigations.

None of the UNHRC’s resolutions on war crimes in Sri Lanka had anything to do with concern for the human rights of the victims. The resolutions were initially sponsored by the US for the purpose of pressuring the former President Mahinda Rajapakse and halting his political and economic tilt toward China.
When Sirisena was installed in office in the January 2015 presidential election, as a result of a US-orchestrated regime-change operation, the content of the UNHCR resolutions was changed to help the current government cover up human rights abuses and war crimes.

As some human rights organisations have pointed out, the legislation provides “civil, criminal and administrative immunity” to individuals who cooperate with OMP to trace missing persons. In essence, this will shield those individuals from being held accountable.

The legislation also prevents any evidence provided to the OMP to trace missing persons from being used by an OMP member or official in any subsequent trial.

The government is committed to covering up the crimes behind the disappearances, for which many military and police officials are directly responsible. As soon as the bill was passed by the parliament last year, Sirisena sought to appease the military and communal forces. He said: “We only want to give redress to those who have been affected, not to punish anyone.”

The OMP’s powers include “to search for missing persons and identify appropriate mechanisms for the same” and “make recommendations to the relevant authorities towards addressing the incidence of missing persons” to protect their rights. The OMP can also “identify avenues of redress” for missing persons and relatives.

Underscoring the toothless nature of this body, Prime Minister Ranil Wickremesinghe told parliament during a debate on the bill on June 21: “The responsibility of this office is to search for missing persons and issue a certificate. There is no other power [for this office].”

The JVP fully endorsed this phony bill, saying the rights of missing persons must be protected. The amendment moved by the JVP concerned a clause that gave powers to the OMP to enter into an agreement with any person or organisation, domestic or foreign, to obtain information or technical assistance. In line with its ultra-nationalist outlook, the JVP claimed this would allow the OMP to strike agreements with foreign bodies, saying that would be harmful to the country.

Nothing has changed for the victims of the communal war in the North and East of Sri Lanka. These areas are still under military occupation, hundreds of political prisoners are still incarcerated without trial and the security forces are continuing arrests, torture and random shootings.

UN special rapporteur on human rights and counterterrorism Ben Emmerson, who completed a five-day visit to Sri Lanka in July, said torture remains “endemic and routine” in the country’s security system. Even those arrested as recently as late last year had been subjected to torture, he said, “despite a new government promising to end such practices.”

Emmerson met stern opposition from sections of the government. This included a heated argument with the Justice Minister Wijedasa Rajapakse, who is backing various Sinhala-Buddhist chauvinist groups.

Former President Rajapakse and the parliamentary group loyal to him—the Joint Opposition—are attacking the OMP on chauvinist grounds. In an open letter to chief Buddhist prelates, Rajapakse criticised both the OMP Act and a postponed Bill on “enforced disappearances” as mechanisms “to punish the members of the armed forces and the political authorities that gave leadership to the war.” This is despite Sirisena’s and Wickremesinghe’s assurances to the military that the legislation has nothing to do with punishing the perpetrators.

The bitter infighting in the Sri Lankan ruling class over democratic window-dressing, such as the OMP, points to the deep crisis within the political establishment. At the same time, amid rising class struggles against the government’s austerity program, all factions are seeking to whip up communalism to divide the working class and are bolstering the police state apparatus.

Only citizens, civil society, media and Judiciary can assure ‘Yahapalanaya’!


Tuesday, 22 August 2017 

The solemn pledge of fostering ‘Yahapalanaya’ – Good Governance – was the key political commitment that led to the regime changes of January and August 2015. Voters defied the pressures before them to rally round and vote for the realisation of a dream; a dream of enjoying sustainably the national resources, within a structure of governance that upheld peace, harmony, equity, inclusiveness, anti-corruption and rule of law as cornerstones of good governance. These good governance principles were to be the first priority of the Executive, Legislature, and the Judiciary.

The shattering of such dreams began with the bond scam of 2015. The coming to light of continuing conflicts of interests, related party transactions and the violations of the rule of law, for personal benefits and in search of political aspirations/connections have left the citizens totally disillusioned.

The news reports of Sirasa/Shakthi/MTV island wide survey under ‘Sri Lanka Free Against Corruption’ project, reflects clearly the undisputed citizen’s assessment, of the state affairs of governance then and now and the non-delivery of the promise by the ‘Yahapalanaya’ by the regime elected by the votes of citizens. The citizens’ comments clearly presents what should be done to correct the unacceptable governance regime fostered on them by the political leaders, legislators, the executive and their henchpersons. They even suggest the use of a polpiththa (a baton) to threaten and beat up errant politicians and officials.

The Good Governance Guide (http://www.goodgovernance.org.au/about-good-governance/what-is-good-governance/) describes good governance as follows:

What is good governance?

Good governance is about the processes for making and implementing decisions. It's not about making 'correct' decisions, but about the best possible process for making those decisions.

Good decision-making processes, and therefore good governance, share several characteristics. All have a positive effect on various aspects of local government including consultation policies and practices, meeting procedures, service quality protocols, councillor and officer conduct, role clarification and good working relationships.

What are the main characteristics of good governance?

Good governance is accountable: Accountability is a fundamental requirement of good governance. Local government has an obligation to report, explain and be answerable for the consequences of decisions it has made on behalf of the community it represents.

Good governance is transparent: People should be able to follow and understand the decision-making process. This means that they will be able to clearly see how and why a decision was made - what information, advice and consultation council considered, and which legislative requirements (when relevant) council followed.

Good governance follows the rule of law: This means that decisions are consistent with relevant legislation or common law and are within the powers of council. In the case of Victorian local government, relevant legislation includes the Local Government Act 1989 and other legislation such as the Public Health and Wellbeing Act 2008, and the Equal Opportunity Act 2010.

Good governance is responsive: Local government should always try to serve the needs of the entire community while balancing competing interests in a timely, appropriate and responsive manner.

Good governance is equitable and inclusive: A community's wellbeing results from all of its members feeling their interests have been considered by council in the decision-making process. This means that all groups, particularly the most vulnerable, should have opportunities to participate in the process.

Good governance is effective and efficient: Local government should implement decisions and follow processes that make the best use of the available people, resources and time to ensure the best possible results for their community.

Good governance is participatory: Anyone affected by or interested in a decision should have the opportunity to participate in the process for making that decision. This can happen in several ways - community members may be provided with information, asked for their opinion, given the opportunity to make recommendations or, in some cases, be part of the actual decision-making process.

NE houses project

A news report in the Sunday Times of 20 August states: “The Government will construct 50,000 brick and mortar type houses in the Northern and Eastern Provinces under a new project….The prospective owners will decide the kind of housing they prefer… issues related to housing in the north were a priority issue since thousands were rendered homeless – the result of the separatist war. During a visit to the north, Premier Wickremesinghe said the people in the area had told him they preferred brick-and-mortar houses and not prefabricated ones.”

The above-purported Government decision and action can be a good case study to demonstrate how to assure good governance within a third world Asian democracy and support the hypothesis that only citizens, civil society, media and Judiciary can assure ‘Yahapalanaya’!

A large number of homeless persons of the north and east, who became homeless due to the conflict and war, yet remained in that state; and outside the reach of the Government-initiated housing programs. This situation was despite the ready hand of humanitarian assistance offered by the international community led by the Indian Government, the international and local NGOs, the diaspora and philanthropists. Their needs were not being attended to with speed and their specific needs were not being met.

Unacceptable solution

Following a visit to Sri Lanka by a VIP business leader, the Minister responsible for Resettlement proposed a purported magic wand created dream of a solution, obviously made from an ivory tower looking at a mirror, with the solution fitting the needs of decision makers and their business contacts, and certainly not the impacted homeless householders. The Minister, his coterie of supporters, and even professionals and advisors, tried their utmost using various strategies and tactics, to push through a non-transparent deal, possibly tainted by conflicts of interests and related party interests.

The proposed solution was unacceptable to the homeless householders, as it did not deliver a house fitting their environmental needs and challenges, customs, traditions and living conditions desired by householders, and especially the need to preserve value intact for generations to follow. Sweeteners, offered by way of internet, TVs and furniture and fittings as added benefits, did not move the prospective householders and it only showed the margins built into the deal sufficient to finance these added benefits. The people’s needs were consistently highlighted and the deal opposed by the political leaders representing the people affected and they organised consultations, public demonstrations, appeals, and even legal action.

Continued on page 21

Continued from page 15

Civil society proposal

Civil society developed an alternative proposal which was in line with the time tested solution in form, structure and implementation process. This proposal also met all the values and needs of the impacted householders. This solution was backed up by a financing proposal from an investment bank, with funding sources entirely raised in Sri Lanka, as against the original proposal of long-term commercial loan-backed solution of the Minister.

Further, the civil society proposal mitigated the long-term foreign exchange rate led risks and their solution was designed to enhance participative decision making and oversight and above all options for significant local value addition and livelihood options for people of the region without such opportunities. Lastly, this solution was assessed as superior by technical specialists and was to cost the state approximately 60% of the costs incurred with the imported pre-fabricated structures.

The alternative proposal was attempted to be blocked on various counts, some of which were total misrepresentations and others like the lack of capacity, lack of local materials and labour were only obvious red herrings.

The impacted citizens, whenever an opportunity arose, during the visits of political leaders to the relevant areas, made their opposition to the undemocratic and unacceptable solution clearly articulated. The local people’s representatives took a principled stand and consistently articulated their opposition, expressing the voice of the people. Caring media and civil society were also relentless in their critique and advocacy.

Whilst accommodating the egos of connected politicians and possible non-transparent commitments with a partial order to the favoured foreign supplier, a partially-acceptable solution appears now ready to be progressed. The impacted persons in this solution may yet be at the mercy of local contractors, as international NGOs with expertise and commitment to assure quality outcomes and provide participatory links to the affected householders are missing as stakeholders in the proposed structure.

Essential reforms

The lesson from this case study is that, without consistent vigilance, voice of advocacy, public pressure, demonstrations, naming and shaming, ‘sathyagraha’ campaigns, holding political masters and the executive to account and voting out or recalling elected representatives (when permitted by the Constitution) leveraging collective initiatives of citizens, civil society and media (including judicial interventions where appropriate), no set of politicians and the executives will ever abide by Yahapalanaya – Good Governance – guidelines described earlier.

In order that the remaining critical promises are delivered by the political masters, the citizens, civil society and media, must next focus their attention to develop collective strategic actions, in advocating for following essential reforms:

1. By necessary Constitutional amendments

a.take away the present rights of ministers to subject the secretaries of ministries, (who are the chief accounting officer of the ministries) to issue directions and control the management of the affairs of the ministries and exercise/interfere in the supervision over the departments of Government and other institutions and engage in decisions connected with recruitment, transfers and disciplinary action of officers in the ministries

b.Permit a system of recall of legislators in line with best practices

c.Empower the Auditor General to audit all State enterprises and their subsidiaries

2. Adopt early the National Audit Bill including therein provisions empowering the Auditor General to impose surcharges on the chief accounting officers of ministries

3. Adopt Codes of Ethics and Conduct biding the Cabinet and the legislators including therein provisions covering declarations of interests and related party transactions and setting out mandatory individual collective responsibilities of the Cabinet and legislators

4. Adopt essential reforms to update and strengthen the Declaration of Assets and Liabilities Act and Bribery and Corruption Act

5. Enact a Proceeds of Crime Act with provision for unexplained wealth orders

6. Ensure all professionals and employees in the public and private sectors are bound by codes of ethics and conduct that require them to report on noncompliance with laws and regulations and give such whistle blowers full protection under the whistle blower and witness protection laws

The case study under reference must also raise amber light signals in the eyes of politicians and the executive that where the citizens, civil society and media are alert, they have little chance to ‘doosra’ the public with bad governance.

Politics is final arbiter of good governance

Minister Mangala Samaraweera pledging solidarity with pro-government civil society groups engaged in a recent protest in Colombo.

 

By Jehan Perera-August 21, 2017, 8:28 pm

There was no governmental celebration of its second year anniversary. Government leaders scarcely mentioned it. However, civil society leaders who had been in the forefront of the movement for good governance in the run up to the elections of 2015 organised a public meeting in the form of a "satyagraha" to remind the government of the promises it had made two years ago. However they also had many positive outcomes to acknowledge. Chief amongst them would be the improvement in relations between the ethnic minorities and the government and the reduction in the level of fear of the state. The 19th Amendment, which was the high point of the 100 Day programme of the new government has ensured a separation of powers between the arms of government. There has also been the passage of legislation that will have a positive impact on the polity over the longer period, such as the Right to Information Act which has the potential to make the government more transparent and accountable.

While the civil society leaders organized the public event to be an occasion to hold the government to its promises, the limelight was taken by the very politicians whom they had come to remind of the promises to be kept. Several government ministers who are leading advocates of good governance within the government attended the public event and received extensive media coverage. This was a reminder to civil society that it was the politicians more than they who had the power to make change happen directly that impact on the lives of people, for which reason the media gave them priority. The ability of civil society activists who uphold the values of good governance to work in collaboration with the politicians in power was a positive indication that their cause was not a lost cause. The readiness of ruling politicians to join the civil society platform is a legitimization of the positive role of civil society.

Despite the unmet promises and compromised nature of the government many if not most in civil society continue to seek to engage with the government. They seek this engagement because they see no alternative to the present government in terms of reaching the goals spelt out in the promises made by those who lead the government. So far the parties in opposition to the government, who would be the alternative to the government, shown no interest in the values of good governance, meeting international standards and upholding human rights. These were all violated during the period of the last government. But today the leaders of the former government will simply deny that they violated the norms and values of good governance. The Joint Opposition leaders in particular show no sense of remorse for the excesses of the past. They have also failed to come up with an alternative plan for problem solving and good governance.

THIRD YEAR

Civil society urgings to the government to deliver on its promises notwithstanding, the decisions that the government takes will be determined on political considerations. The government will endeavour to secure its voter base while seeking to weaken that of its political opponents. Unlike civil society which can, and ought to, demand that good governance promises should be kept, political leaders will not wish to go beyond what is possible and detrimental to their political interests. As the third year of the Government of National Unity formed by the coming together of the UNP and SLFP commences, the question is what can and will it do to deliver on the promises it made during the last elections. The challenges it set could have been better achieved if taken at the tide two years ago in the manner of the 19th Amendment and Right to Information Act which were developed and concretised in the early stage of the government’s tenure in office. It is generally better to do difficult things when one’s moral stature and credibility is higher rather than when it comes lower.

Initially after an election there is euphoria and hope that the new government will deliver something better for the people than they currently have. The government’s commitments in terms of solving the ethnic conflict, changing the electoral system and putting an end to sky high corruption would have been subjected to less interference had it been done earlier in the government’s term rather than later.

Recently the government has come in for criticism on account of corruption and conflict of interest issues relating to the Central Bank bond scam. The foreign minister resigned as a result. However it is unlikely that the government will go on a path of prosecuting its own members. The question is whether it will even prosecute its political opponents successfully. In a similar manner where constitutional reform is concerned the government cannot seek to go beyond the unitary state or the present formulation of Buddhism as having the foremost place if it wishes to stay on in power.

Unfortunately, the promises made by the government are harder to deliver on now. The most disappointing failure of the government has been with regard to putting an end to the ethnic conflict and proceeding from a divided past to a shared future. The government of national unity has presented just this opportunity. Both the UNP and SLFP during their previous tenures of government have come up with solutions to the ethnic conflict based on the principles of power sharing and devolution of power. The problem has been that what each of these parties is able to propose when in power, they have been even more prepared to denounce when they are in the opposition. On this occasion when they are together, there is every potential for them to propose a joint solution through negotiations between the Tamil representatives and those from the government.

WASTED OPPORTUNITY

Given the history of the ethnic conflict, and the urgency in finding a solution to it, a special effort is required in this regard. It would be a wasted opportunity if the Government of National Unity is unable to work out a workable solution to the ethnic conflict as well as to issues of day-to-day concern to the ethnic minorities, especially to the people of the North and East, such as the return of land from military control, and the finding of missing persons. The leaderships of the ethnic minority parties, in particular the TNA, which represents the majority of Tamil people of the North and East, have gone out of their way to be trustful and accommodative of the government and its concerns. The failure of the government to deliver on its promises to them is pushing them into a disadvantageous position with regard to retaining the support of their electorates.

The TNA has recently started to openly lobby the international community to get them to pressurize the government to deliver on its promises. They are being pushed to this position because their collaboration with the government is not yielding the results they expected. The government’s slow pace in tackling the problems of war affected people is severely impacting on the confidence that the Tamil people have in the government. Although the government passed the law regarding the setting up of an Office of Missing Persons, it has still not operationalised it, although a year has passed since the law was first passed in parliament. It appears that the government’s reluctance stems for concerns by some section of the polity who are afraid of the truths of the past emerging.

The growing disillusionment of the Tamil people with the TNA for its support of the government can lead them to consider other alternatives. At the recently held cooperative society elections in Jaffna, the EPDP prevailed in some areas, including the prestigious Nallur area, which is a warning to the TNA that it is not only political rights but also improvements on the ground that people are seeking. The EPDP’s consistent strength over the past two decades has been its commitment to solving problems of people on the ground. The problem for the TNA which focuses on obtaining political rights for the Tamil people is that it has not been successful while on the ground the people feel that they are not benefiting from the government’s development programmes. The decision of the government to build 50,000 brick houses after months of protest against the earlier decision to build steel-prefabricated houses could redeem the situation to some extent. Delivering benefits to people on the ground will need to be the government’s path of survival as well as that of its political allies.

Like Drought Parched Earth: The Painful Injuries Sustained By Tea Pluckers

MAATRAM on 08/22/2017

Editor’s Note: The following is a translation of a photo essay produced by Maatram‘s editor, Selvaraja Rajasegar.

“I apply castor oil to my fingers and hold them over the fire. That is the medicine. For two days, I can pluck tea. After that, the pain comes back. So I treat my fingers again with castor oil” said tea plucker Perumal Danalechchumy, forty-nine years old.

Danalechchumy has five children; three of them go to school, and the other two work in Colombo. She was sixteen years old when she began plucking tea. Her fingers resemble the drought-parched earth – filled with cracks. The tea stains her hands, like blood.

View the full story, produced on Adobe Spark, here, or below:

2017 marks 150 years of tea production in Sri Lanka. To mark this anniversary, there have been several celebratory events and activities, including a Global Tea Party, an International Tea Convention and a charity auction organised by a variety of stakeholders including the Ceylon Tea Traders Association, the Sri Lanka Tea Board, the Tourist Board and tea companies. While these events have received wide coverage, there is little mention of the tea plantation workers, without whose contribution the industry would not exist.

With this in mind, Groundviews launched a series of audiovisual stories aimed at raising awareness on the difficulties faced by estate workers and the changes in the industry (or lack thereof) over the past 150 years.

To view the rest of the content for this series, click here. 

Can President’s new economic council end SLFP obstructionism?

The dissenting SLFP MPs and ministers are not exactly interested in the pros and cons of the leasing of the Hambantota Port to the Chinese or the joint-venture with India to develop the Trincomalee Port

2017-08-22

President Maithripala Sirisena has decided to set up a National Economic Council (NEC) which will become the apex body tasked to formulate and implement the government’s economic and development policy. The new venture is in part an attempt by the President to claw back some control of the economic policy, which was hitherto under the purview of Prime Minister Ranil Wickremesinghe and his economic advisers. However, the plus side is that it would inject a degree of certainty to the government’s policy and mitigate the effects of the obstructionist tactics resorted to by the SLFP partner in the yahapalana government.  

What has left the government dilly dallying on many of the major development projects is not so much the opposition by the joint opposition, but obstructionism by the government’s own junior partner, the SLFP, whose opposition is neither principled nor fact-driven. Rather, it is driven by calculated political opportunism. It is also an overt pretest by the SLFP members against the UNP which had sidelined them in the decision-making process and thus depriving them of perks generally associated with being part of the government.   

"Proposing amendments to the already signed and sealed Hambantota Port deal was not just ridiculous it also sent wrong signals to the prospective investors"

The dissenting SLFP MPs and ministers are not exactly interested in the pros and cons of the leasing of the Hambantota Port to the Chinese or the joint-venture with India to develop the Trincomalee Port. They are bitter about the fact that they cannot get government jobs and contracts for their henchmen. To rub it in, their counterparts in the UNP are filling government jobs with their stooges. This unfair status quo which is a life and death matter in their re-election prospects is dissuading the SLFP junior partner from wholeheartedly supporting any government decision.   

To make matters worse, the President until recently kept away from economic matters. The absence of a clear party line created by that vacuum provided further incentive to the SLFP’s less than cooperative attitude. Also, that the President himself was sending contradictory signals was of little help. Proposing amendments to the already signed and sealed Hambantota Port deal was not just ridiculous it also sent wrong signals to the prospective investors.

In fact, inner contradictions within the government are not confined to the economy alone. The recent controversy over the Foreign Ministry condemning the North Korean missile tests, which is the right thing to do if Sri Lanka is to assert a role for itself in international politics, is a pointer to those contradictions spilling into other areas. At times, the President himself seems not to be in full control. A case in point is that of the SLFP parliamentary group which decided to support the 20th Amendment at a meeting chaired by the President going back on their decision the following day.   

"However, those democratic gains cannot supplant the absence of a cohesive economic strategy. The failure to create prosperity could overtime undermine the painstakingly achieved democratic gains"

It is a miracle that despite those disagreements, the UNP and the SLFP could agree to introduce some of the far-reaching democratic reforms, ranging from the 19th Amendment to the Constitution, to the setting up of the Office of Missing Persons, the Right to Information Act, etc. Those are salutary achievements in a political system that has seen the concentration of power by political leaders, beginning from the Sirimavo Bandaranaike Administration in 1970-77.   

However, those democratic gains cannot supplant the absence of a cohesive economic strategy. The failure to create prosperity could overtime undermine the painstakingly achieved democratic gains.   
The proposed NEC, “Will be a professionally-managed by a high level, national advisory institution reporting directly to the President”.

It will include the Prime Minister, their respective Secretaries, the Finance Minister, Secretary to the Cabinet, Governor of the Central Bank, Treasury Secretary and Secretary to the Ministry of National Policy and Economic Affairs. It will function in conjunction with another committee, the Cabinet Committee on Economic Development (CCEM). How the decisions of the CCEM would finally be channelled through the NEC is yet to be worked out.   

"The dissenting SLFP MPs and ministers are not exactly interested in the pros and cons of the leasing of the Hambantota Port to the Chinese or the joint-venture with India to develop the Trincomalee Port"

What is imperative is that the new council should aim to end the policy paralysis in the government and fast track the implementation of high profile development projects. Those development projects are held in abeyance because of a myriad of reasons, such as the policy paralysis in the government, absence of land allocation, uncertainty over their legal status and investment conditions, etc.

The government should allocate additional resources and personnel to cross-ministerial sub committees to clear up those impediments within set deadlines. Those officials ought to act with as much enthusiasm as the bond commission which meets every day to complete the investigation within a three-month deadline. The problem in Sri Lanka, and much of South Asia, is of officials being obsessed with the intricacies of the process and not the outcome. Thus petty differences result in the procrastination of the the process and often the cost of the delay is exorbitant. That there is no electoral imperative for a higher economic growth has not helped, partly because, Sri Lanka in the first place had not experienced the full force of development. Thus this is a vicious cycle.   

The proposed NEC would hopefully restore the balance of political power between the UNP and the SLFP. That should make the SLFP more integral in the decision making process of the government, and thus amend their behaviour to be more cooperative. However, to make sure that those agreed economic decisions are implemented and impediments on their path are removed, the government will also need a mechanism that can implement its mandate efficiently and where the need arises, even forcefully.   

The 3-year plan of the Unity Government

 Tuesday, 22 August 2017 

It is reported that the Government will unveil a three-year development program on 4 September to coincide with the second anniversary of the formation of the National Unity Government. The next budget would be formulated in keeping with this program. This would be a three-year program to be implemented within a frame of eight years.

This is extremely good news. The Sri Lankan economy is drifting like a ship without a rudder. It could hit the rocks very soon, drowning all of us, except the commission earners, unless it is manoeuvred properly by employing the best principles and techniques of national planning.

The people are, however, very sceptical of plans. They have been treated to development visions, Chinthanas, strategies and plans, which became obsolete even before the ink ran dry. The only saving grace is that the proposed exercise is to be steered by Eran Wickramaratne for whom there is very high regard among professionals.

The nine Cs

For the planning exercise to be successful it must be based on certain concepts and principles. I wish to share briefly the concepts and principles I have identified for the purpose of engaging MPA students, at the PIM, in interactive learning exercises on development planning. The Nine Cs diagram is reproduced on this page. It was developed to provide mental hooks for students to remember the most important features of good planning. They are by no means exhaustive and readers are invited to add value with their comments.

1. Conceptualisation – forming a clear picture of the current situation and where one would like the country to reach within a feasible period of time. There must be quantitative targets, employing, as far as possible, key performance indicators.

2. Cohesion – this reflects a clear appreciation of the inter-sectoral and intra-sectoral ramifications of policies and programs. There are symbiotic relationships within and among sectors that must be taken into account in a national planning exercise.

3. Consultation – there must be a clear understanding among all, at least the principal, stakeholders about the implications of policies and the role each could play in making them effective.


4. Coordination – this follows 3 above. Coordination is an imperative for success, in particular within government.

5. Collaboration – follows 4 above where stakeholders decide to take responsibilities. Collaboration is required not only within Government but also between Government agencies and the private sector.

6. Commitment – very often projects and programs fall off due to lack of commitment on the part of stakeholder Government agencies to implement them. This is often caused by myopic political considerations.

7. Capacity – this refers to the technical and managerial ability of public servants which must be taken into account when formulating projects. Where such capacity is lacking the projects must contain provision to build the required levels of competence.

8. Correction – even the best technically crafted plans need revision due to vicissitudes of the global economy as well as domestic contingencies. This is why most countries and Sri Lanka in the past used ‘rolling plan techniques’. The five-year Public Investment Program of the National Planning Department was prepared in the past on this basis.

9. Continuation – there is a tendency to abandon plans half way through due to political or administrative changes with severe economic and, often, social consequences.

The Greek temple indicates how the objective of development at the top is to be reached through the seven pillars of intra-sectoral and inter-sectoral coordination by applying the 9 Cs, firmly based on the principles and institutions of good governance.

Bridging the savings/investment gap

The biggest challenge is how to bridge the savings/investment gap. We could resort to external borrowing or invite FDI (Foreign Direct Investment). In both cases there must be strong cost benefit analysis, including environment impact assessment, before we decide to use them. In the case of loans, in particular, we have to ensure that the envisaged development activity will yield sufficient income for pay back. We have to avoid Mattala and Hambantota Port fiascos.


The macroeconomic pillar represents fiscal, monetary and balance of payment areas. The problems confronting fiscal policy are well known. We have to not only raise revenue but also ensure that it is equitable. The Prime Minister recognised the problem in his October 2015 speech. He said we need to reduce indirect tax revenue from 80% to 60% gradually. Yet in the Budget that was presented soon after, one month later, the Finance Ministry thought it fit to raise it further.

Where monetary policy is concerned we can be happy that the Central Bank is currently on the right track, particularly in managing the interest rate regime. It’s greatest challenge, however, is to deal with the exchange rate. Is it going to stifle it under political pressure to protect the domestic consumer or allow it to find its mark to discourage imports and encourage exports? The best way to protect the consumer is to promote domestic production, particularly in agriculture.

Infrastructure development 

Infrastructure development needs heavy long-term investment. This is where we need to look out for external sources.

One major issue with regard to large scale infrastructure projects is the shortage of semi-skilled and skilled labour. We have to avoid as far as possible too much reliance on imported labour. This is too large a problem to be dealt with piecemeal and in an ad hoc manner. It is only a well-crafted human resource development strategy and a plan that could address this problem effectively.

Unfortunately, all skills development programs so far seem to reflect piecemeal approaches, uncoordinated with sectoral development programmes, which is partly due to the lack of a medium to long term national plan.

Commodity production 

Commodity production covers basically areas that come under agriculture and manufacturing. More than 70% (international calculations say 86%) of the population live in rural areas. The need to raise agricultural productivity is a long recognised need.

Academics, researchers as well as public servants and businessmen have been talking about the benefits of a consolidated agricultural development drive, to raise both domestic consumption and export earnings. It has been estimated that nearly 35% of agricultural production is wasted through post-harvest losses. There have been numerous agricultural plans, but with little impact mainly due to lack of proper planning and implementation. The need of the hour is an integrated plan for agriculture and rural development, which, in short should take into account the 9Cs identified earlier.

Where the manufacturing sector is concerned, the country has to move away from traditional industries. We have to look for areas where Sri Lanka has the potential to develop internationally competitive products.

Good governance platform

In short, the way forward, in the present global context, is to look for international supply chain opportunities. This is where FDI could be productive. The Government, in association with the various business chambers, should explore opportunities and make provision to exploit them.


Cross-cutting issues relate to poverty, gender and environment concerns which are embedded in all sectors of the economy and need a consolidated approach. Education and health issues also have a bearing on these issues. Yet again, there are numerous plans to address these issues, what is lacking is the 9Cs approach. All the above conditions for successful planning can be fulfilled only on the platform of good governance. This is provided by the legal framework and the institutional structure. The available space does not permit an elaborate description. There is, however, one condition that needs stressing; that is, predictability. Uncertainty is caused by the Government’s habit of changing policy goal posts when the match is in progress. Rule of law must prevail to give confidence to investors.

The Hambantota imbroglio has done nothing good to provide such confidence. It is a reflection of the Government’s vulnerability to myopic political pressure. Of course, the Government too should take some responsibility due to lack of transparency and effective communication.

Good institutional framework

No matter how good the legal framework is, good governance cannot prevail without a good institutional framework. The Cabinet at the helm of policymaking and implementation must be of a manageable size and structure. The deficiencies in this regard in the present context are well known and needs no elaboration. But even the best of cabinets cannot deal effectively with the loads of proposals that are presented for approval. This is where cabinet sub-committees become useful.

Where development policy issues are concerned, the cabinet sub-committee (CCEM) needs technical advice. It needs the support of a body of professional advisors drawn from the administrative services, the business community and academia. This is the role that could be played by a National Planning (or Economic) Council.

However, even the best of cabinet structures and planning councils could do little, if there isn’t a solid foundation of a public administrative system that is both competent and motivated. The government, judging from the comments made by ministers themselves, our public administration system is almost moribund and archaic, unable to meet contemporary development challenges. The Government approach, in this regard, however, has been piecemeal and almost complete reliance on foreign consultancy services and short-term study tours, reflecting a lack of imagination on the part of our policymakers.

About piecemeal approaches, this is what Shelton Wanasinghe said in his monumental report (a prediction) published in 1987: “The committee does not consider that it is possible to implement bits and pieces of the proposed agenda and to expect to improve effectiveness. Actually, the implementation of bits and pieces of the suggested agenda could be dangerous in that it would lead to incoherent and chaotic results which would put the administrative system back rather than propel it forward.”

[Dr. Lloyd Fernando (Msc, Moscow, D Phil, Sussex) was in charge of the National Planning Department for 11 years before he joined the Board of Directors of the Asian Development Bank in Manila. On his return he held the position of Chairman of the Marga Institute. Currently, he is attached to the Postgraduate Institute of Management and is also a member of the Board of Directors of the Gamani Corea Foundation.]