Rallies have been held across Canada urging the government to reverse planned cuts to a healthcare programme for refugees and asylum seekers.

Dozens of people demonstrated in Toronto on Tuesday as part of a national day of action against cuts to the Interim Federal Health Program (IFHP), which are set to come into effect on May 1. Critics say the curbs put vulnerable people at risk and will lead to higher costs down the line.

“We want to make sure that we have a universal healthcare system, and we also don’t want a system that punches down against vulnerable people and migrants,” Dr Ritika Goel told Al Jazeera at the protest in downtown Toronto.

“We want to support a system that provides care to everyone,” she said.

The Canadian government announced in late January that it would be making changes to the IFHP, which provides basic health coverage to refugees, asylum claimants, and others not covered by other healthcare programmes in Canada.

As of next month, people receiving IFHP coverage will have to pay $4 per eligible prescription medication, as well as 30 percent of the cost of supplemental services such as dental and vision care, and counselling.

“Introducing co-payments for supplemental health products and services helps manage growing demand, keeping the IFHP sustainable over the long term,” a spokesperson for Immigration, Refugees and Citizenship Canada (IRCC) told Al Jazeera in an email.

“This approach will allow the government to continue supporting eligible beneficiaries while keeping the program fair and consistent with other publicly funded health insurance programs that provide supplemental benefits, including those available to many social assistance recipients.”

Major spending cuts

While the new co-payments may appear modest, doctors and refugee rights advocates say they can be prohibitively expensive for newcomers struggling to rebuild their lives in Canada amid soaring costs.

“Certainly, it can have the result of preventing or discouraging [people] from seeking healthcare supports and services that they need,” Aisling Bondy, president of the Canadian Association of Refugee Lawyers, said in an interview in late March.

That is “very concerning”, Bondy told Al Jazeera, “especially when we’re talking about people who have just arrived in Canada, who are just becoming established, and who are very vulnerable and have experienced physical and psychological trauma”.

The cuts come as views towards refugees and migrants in Canada have soured in recent years amid soaring costs of living and an affordable housing shortage.

After a rapid increase in arrivals during the COVID-19 pandemic, a poll in October of last year found that more than half of Canadians said they believe the country accepts too many immigrants.

And since taking office in March 2025, Canadian Prime Minister Mark Carney has moved to alleviate pressure on a strained immigration system.

Carney’s government is drastically cutting down on temporary visas, including for international students and foreign workers. It passed a new law last month that introduced new restrictions on access to asylum, drawing condemnation from rights groups.

It is also making massive budget cuts across various departments amid economic uncertainty, and is seeking to slash $60 billion in Canadian dollars ($43.5bn US) in public spending over five years.

‘Increasing suffering, expenditures’

According to the Office of the Parliamentary Budget Officer, the cost of the IFHP rose from $211 million Canadian dollars ($153m US) in 2020-2021 to $896 million Canadian dollars ($645m US) in 2024-2025 as the number of beneficiaries and cost per beneficiary “increased significantly”.

The programme is projected to grow at an average of 11.2 percent annually through 2030, although that is far below the 33.7 percent seen over the past five years, the office said.

The IRCC spokesperson told Al Jazeera that the changes to the programme “could result” in $126.8 million in Canadian dollars ($91.95m US) in savings in 2026-2027, and $231.9 million in Canadian dollars ($168.2m US) “onwards”.

But Dr Margot Burnell, president of the Canadian Medical Association, has said the changes to the IHRP would likely increase – not reduce – overall costs to the healthcare system.

“When patients cannot afford medications or essential supports, preventable conditions worsen and ultimately require emergency or hospital care, increasing both human suffering and system-wide expenditures,” she said in a letter to Canada’s health minister in February.

“The new co-payments will also create additional administrative burden for frontline providers, including pharmacists, dentists, optometrists, and physicians, further straining a healthcare system already under pressure,” Burnell said.

She also warned that the changes would amount to “a de facto denial of care” for patients living in poverty.

Similar arguments were made in 2012, when then-Prime Minister Stephen Harper also made cuts to the IHRP, prompting widespread protests and a legal challenge.

In 2014, the Federal Court of Canada ruled that the curbs amounted to “cruel and unusual” treatment and violated the Canadian Charter of Rights and Freedoms.

The cuts were later rescinded when former PM Justin Trudeau’s Liberal Party defeated Harper’s Conservatives in a 2015 election. (Al Jazeera)

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President Ranil Wickremesinghe says the government hopes to provide hospital facilities to cater to the mental health needs of the Northern Province, matching the healthcare standards of the West.

“Ragama Hospital was established to treat those disabled by the war and individuals with mental health issues. We have endeavoured to provide a similar modern facility for the people in this war-affected area,” the President said. 

President Ranil Wickremasinghe further expressed his pleasure in seeing the projects he initiated as Prime Minister in 2017 to elevate the health service in the Northern Province come to fruition.  

He highlighted that the Northern Province now boasts modern hospitals and emphasized his goal of making the region’s health services as advanced as those in the Western Province.

The President made these comments addressing an event to unveil the Medical Rehabilitation and Mental Health Center at Mankulam Base Hospital, which was constructed with the assistance of the Government of Netherlands at a cost of Rs.4, 500 million.

This is the largest medical rehabilitation therapy and mental health development centre in the Northern Province, featuring a psychiatric rehabilitation unit, an emergency unit, a surgery, a laboratory, a radiology unit, an outpatient department, and an intensive care unit.

President Ranil Wickremesinghe’s full statement: 

At the opening of this medical unit today, it is important to mention the background. After the war ended in 2009, the government at that time began the foundational work to restore services that had been halted in the Northern Province due to the conflict.

The first phase of this work was completed, but further progress required a second phase. As Prime Minister, I discussed with the Government of the Netherlands the establishment of new medical units to enhance the health sector in the Northern Province. The Minister of Health and the former Chief Minister of the Northern Provincial Council were actively involved in these efforts.

Before the war, Jaffna had become the best health centre after Colombo. As the Western Province developed, so did the Southern and Central Provinces. My goal is to restore the Northern Province to that level of excellence. This is why these hospitals are given special attention.

In 2017, as Prime Minister, I allocated funds for establishing the Faculty of Medicine at Jaffna University and constructing the necessary building for it. Today, I have the opportunity to attend its opening. Upon assuming the office of President, I ensured that these projects were completed promptly. Now, the Northern Province boasts modern hospitals.

We have decided to elevate Jaffna Hospital to a national hospital. Additionally, we are working to develop Mannar Hospital, transform Vavuniya Hospital into a teaching hospital, and provide a medical faculty to Vavuniya University. Mankulam Hospital, equipped with modern machines, is the only hospital after Ragama Hospital to have such advanced facilities.

Ragama Hospital was established to treat those disabled by the war and individuals with mental health issues. We have endeavoured to provide a similar modern facility for the people in this war-affected area.

Many hospitals in Sri Lanka lack the equipment that the four hospitals in the Northern Province now possess. It is crucial to protect these devices, and hospital administration and management must take the initiative. Cuba excels in health services due to its excellent hospital administration and management. 

Therefore, efforts should be made to elevate our hospital management and administration standards. The World Health Organization and the Asian Development Fund can provide the necessary allocations for this purpose. Through these efforts, we aim to establish a high-quality health service in the country. (Newswire)

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By – Anna Bjerde (World Bank Managing Director of Operations)

A recent visit to Sri Lanka took me to the Kopay Divisional Hospital in the Jaffna District in the northern part of the country. For the close to 16,000 people living in the area, this hospital serves as the first point of care.  It is also one of the primary medicalcare institutions that is part of Sri Lanka’s primary healthcare reorganization strategy, implemented with support from the World Bank. 

What impressed me the most about the hospital is its investment in preventive care and the shift in approach from episodic to continued care, which has been successfully introduced over the last few years. Now, patients are routinely screened for noncommunicable diseases, including diabetes and cardiovascular diseases, and connected to appropriate treatments.  

Non-communicable diseases are a leading cause of mortality and morbidity in Sri Lanka, accounting for 80 per cent of deaths and 77 per cent of disability-adjusted life years. Failing to address this challenge could have devastating consequences for the country’s human capital, particularly its workforce. The focus on early detection and continuum of care has the potential to reduce the risk of morbidity, keeping people healthier for longer.  

Sri Lanka’s change in approach to health care has produced impressive results, which have been replicated in nearly half of its almost 1,100 primary medical care institutions. It is an excellent example of the scalability and replicability the World Bank aims to achieve in its quest for more impactful and faster outcomes in the projects we finance.  

The project design lends itself to replication as the phased approach to reorganization has enabled the Ministry of Health and the project implementation team to iron out problems and introduce course corrections along the way. In year one of implementation, the project created the necessary policy environment, drafted guidelines and regulations for reform, empanelled the population, identified minimum standards for primary care facilities, and introduced a mechanism for community engagement. 

Three additional features have also contributed to making this project successful and scalable.   

1. It is forward-thinking. Sri Lanka has an impressive track record of achieving good health care at a low cost, and this success lies in part in the health system’s ability to adapt to change. It was this approach that led to the elimination of communicable diseases like malaria and the establishment of a world-renowned maternal and child health system. Now faced with a rise in non-communicable diseases, Sri Lanka is once again ready to change gears. The country’s primary care hospitals have been chronically underfunded, understaffed, and underutilized. These reorganization efforts aimed to create a paradigm shift, making facilities like the one I visited the first point of care. By increasing utilization, retaining patients, and improving the quality of these hospitals, Sri Lanka is laying the foundation for a robust primary care network that is better equipped to face emerging healthcare challenges. 
    
2. It is homegrown. From design to implementation, the project has drawn from the knowledge and expertise of professionals well-versed in Sri Lanka’s healthcare system. The reorganization strategy was developed through an extensive collaborative process involving more than 200 stakeholders, including healthcare providers, academics, civil society advocates, development partners, and international technical advisors. The buy-in and commitment of the key stakeholders responsible for the delivery of primary healthcare services have clearly underpinned the effectiveness of this project.  
    
3. It is people-centric. In addition to providing trained staff, essential equipment and medicines, and basic testing facilities, the project hoped to change how people seek and receive health care. To this end, the project has relied on local communities to promote the facilities through “Friends of the Facility committees.” These committees have played a key role in changing public perception and in introducing the new primary health care concept to their communities, thus creating a sense of ownership within the local community. 

Sri Lanka’s human capital indicators are among the best in South Asia, and it is heartening to see a continued commitment to health care, even in times of hardship. But beyond health, the project is furthering Sri Lanka’s broader human capital agenda. A win-win for the country and the people of Sri Lanka. (NewsWire)

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The Sri Lanka Army has been deployed to assist with challenges posed by the ongoing islandwide strike of healthcare staff trade unions. 

Issuing a statement, the Sri Lanka Army said the troops have been deployed in response to a request from the Ministry of Defence and under the guidance of Commander of the Army, Lieutenant General Vikum Liyanage. 

Troops have been deployed at various government hospitals across the country to ensure the uninterrupted delivery of essential health services today (Jan 16).

The affected hospitals include health institutions such as Colombo National Hospital, Kandy General Hospital, Kalubowila Teaching Hospital, Peradeniya Teaching Hospital, Matale District Hospital, Kurunegala Teaching Hospital and the Government Hospitals in Monarahala, Nuwara Eliya, Badulla, Hambanthota, Balangoda, Thissamahara, Debarawewa, Balangoda, Eheliyagoda, Diyathalawa, Matara, Avissawella and several others. The deployment is aimed at maintaining the smooth operation of healthcare facilities during this critical time.

Under the supervision of the respective Security Forces Commanders, Army personnel are actively stationed at these hospitals to lend support and ensure that healthcare services continue without disruptions. Troops also remain on standby for additional troop deployment in case of emergencies.

The healthcare workers from 72 trade unions, excluding doctors, launched a 24-hour strike at 06.30 am today.

The strike has been launched demanding that the Rs. 35,000 Disturbance, Availability & Transport (DAT) allowance provided only for doctors be granted to them as well. (NewsWire)

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Sri Lanka and the United Kingdom’s (UK) Department of Health and Social Care have held discussions on the commencement of the 2nd phase of the UK aid programme to Sri Lanka.

The discussion was held during a meeting between British Acting High Commissioner Lisa Whanstall and Prime Minister Dinesh Gunawardena at the Temple Trees in Colombo yesterday (Aug.23).

According to the Prime Minister’s Office, a delegation from the Fleming Fund of the UK Department of Health and Social Care participated in the discussion.

British Acting High Commissioner Lisa Whanstal said the health care grants programme, which was halted for the last couple of years due to the COVID-19 pandemic, will resume in January 2024. 

Under this grant, assistance will be provided to support the generation, sharing and use of antimicrobial resistance data to reduce drug resistance. It will support public health surveillance to help improve patient health, inform national health policies and warn emerging threats.

The grant programme will be implemented with the assistance of the Ministry of Health, the World Health Organization and other agencies. Under this programme training fellowships will be provided to health sector staff.

The Prime minister thanked the United Kingdom for selecting Sri Lanka as a recipient of this healthcare programme, which will be immensely useful to advance the health system in the country. He pointed out that Sri Lanka’s health service is based on the British system and there will not be any difficulty in implementing such health care programmes.

Meanwhile, the British Council’s Country Director Orlando Edwards presented a set of publications on English language training methods of the Council to the Prime Minister.

Prime Minister Gunawardena urged the Acting High Commission and the British Council to introduce English Language education to youths in rural areas.

Dr Jessica Wallis and Dr Neha Gulati of the UK Fleming Fund, Andrew Price of the British High Commission and Additional Secretary to the Prime Minister, Deepa Liyanage also took part in the discussion. (NewsWire)

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