Telehealth Without a Statute - Legal Gaps in Sri Lanka's Post-Pandemic Telemedicine Framework and the Case for Dedicated Legislation

Sri Lanka's health system has long been held up as an example of what an upper middle-income country can achieve with tax-funded, free-at-the-point-of-use public care. That reputation was tested twice in quick succession. The pandemic pushed outpatient consultations onto phones and video links almost overnight, and the economic collapse of 2022 then made travel, fuel and specialist time scarce for reasons that had nothing to do with infection control. Telemedicine, which had existed in pilot projects and a few private hospitals for more than a decade, became an ordinary part of practice.The law did not move at the same speed. A regional review published in 2023 found that, as of May that year, Sri Lanka was one of six WHO South-East Asia Region countries without separatenational telemedicine guidelines. Ministry officials told a WHO regional workshop the same year that the Medical Ordinance and the National Medicines Regulatory Authority Act did not address telemedicine at all, that the Electronic Transactions Act of 2006 was being used in practice to give remote transactions legal effect, and that the Sri Lanka Medical Council (SLMC) exercised no supervision over cross-border online practice. Earlier commentators had warned that the absence of any rules left providers to improvise.The Ministry of Health's Telemedicine Guidelines, finalised on 9 May 2024, were the first national response. They are welcome. This paper argues that they are also structurally limited, because guidance can tell a doctor what good practice looks like but cannot allocate legal risk, create enforceable rights, or bind the bodies that pay for care.