Tuesday, 19 October, 2021

Transparency key to end medical education maladies


The government and the entrepreneurs who have invested in medical education sectors have been stressing the need for developing Nepal as a hub of medical education. In this regard, a positive development was made by establishing a separate Medical Education Commission with rights to determine the fees for medical education, to cooperation with concerned stakeholders, and regulate the private and government medical institutions.
Similarly, Prof. Dr. Dharma Kanta Baskota was appointed Vice-chancellor of Tribhuvan University, after the oldest university was without its Vice-chancellor for over a month.
TU Vice-chancellor and the Medical Education Commission, have many tasks to perform to end the maladies prevalent in the medical education.
Against this backdrop, VC Prof. Dr. Baskota, vice-Chairman of Medical Education Commission Prof. Dr. Shrikrishna Giri and Prof. Dr. Chanda Karki, Principal of Nepal Medical College, shared various aspects of medical education and their future plans in the weekly Gorkhapatra Sambad on Sunday. Excerpts: 


Operating all medical colleges by government impossible: Baskota 

Medical education is facing many challenges. The students studying MBBS have been agitating since long. All stakeholders are equally responsible for dragging the country’s medical education sector to this contradicting stage. The current debate in the medical education sector is mainly on the fee structure of medical education. The dispute has arisen between the students and medical college because of the mistakes committed by all sides.
Firstly, the policymakers are responsible for it. Prior to 2072 BS or before the Mathema commission submitted its report on this, the university itself had the rights to fix the fee structure. But the university has not been able to say clearly about fee under every heading though it has granted affiliation to many medical colleges. Due to lack of clear fee structure, there is no mechanism to regulate the colleges about the status of the fee implementation. Although there is Medical Council as a regulating body for medical education, it could not regulate the fee implementation status in colleges as laws did not grant permission to regulate the fee structure of colleges. So, there were faults in the policy level too.
Secondly, medical colleges are also committing mistake by not implementing the government fixed fee structure.
Thirdly, we, public, are also equally responsible for the anomalies seen in the fee structure.
It is like people buying products by paying higher cost than the cost mentioned in its price tag. I am saying this because, many guardians agree to enroll their wards by paying higher fees than that determined by the government. The guardians have been paying high amount with a fear that their wards may not get enrollment if they do not pay the higher amount than the fixed one. Therefore, only one side cannot be blamed for all the anomalies seen in the medical education sector, all sides are equally responsible for the anomalies.
Many people praised the report of Mathema commission, but I had reservation on it right from starting.
The commission created confusion among the people by keeping all medical colleges in the same basket without classifying them according to quality of education disseminated by them. Here, the commission forgot that the fee structure may vary as per the quality of education. Likewise, the projection of the manpower produced by medical colleges was also faulty.
The commission projected that around 600 students graduate as doctors from abroad every year and 2,000 doctors are produced from Nepal. Due to that, the manpower requirement will be fulfilled from 2,600 production every year. But the reality is that private colleges affiliated to Tribhuvan University are teaching about 33 per cent foreign students and Kathmandu University’s colleges are teaching about 40 per cent foreign students every year. They returned to their own countries upon completion of their course. So, the projection is wrong.
Although the private sector has been contributing a lot for manpower production, we are unable to recognise them. Out of the total demand of 3,000 doctors every year, the government medical colleges has the capacity to produce only 300 doctors while the private sector has been contributing 2,200 doctors annually.
Likewise, the medical colleges are contributing to creating job opportunities. So, we must not be negative towards them. But the government has responsibility to bring such fraud colleges in the right track.
The government recently decreased the quotas of some medical colleges, but we can operate additional five colleges to stop the students from going abroad for MBBS education. But the media and many stakeholders could not understand this reality. At a time when the government is unable to allocate the PG scholarship to the students in time, operating all medical colleges by the government is impossible. So, it is not possible to take ownership of all medical colleges by the state.
Now Tribhuvan University has asked to send the numbers of required manpower. After getting the number, the university will grant the affiliation to the medical colleges on the basis of geographical location and population density.
Dr. Govinda K.C always remained supportive to me. We both are in the campaign for quality medical education. Though our mission is the same, our working style and ways are different. Dr. K.C is in the mission through hunger strike and we are in the same mission but through work.


Medical education is guided by the open market policy: Giri 

Nepal accepted the open market policy after the political change of 1990. Because of this policy, all sectors adopted the open market policy and the education sector was not exception to this. Medical education system was also guided by the open market policy.
When the government started running medical education, it was also guided by the open market policy prior to 1990s.
Today, many things have been focused on private sector. But when public or government level medical colleges started running, the Institute of Medicine (IOM) under the Tribhuvan University used to remain autonomous and assure quality education in medical education at the beginning.
Then no regulating body like Nepal Medical Council of today existed. Before the establishment of IOM, there was no regulating body in Nepal. The Institute of Medicine itself used to be the leading body for regulation.
But when the number of medical colleges increased, they started producing required human resources. The private medical institutions started giving a boost to Nepal's medical education sector. Number of beds in the hospital increased. A gradual improvement in the indicators of health and education was noticed. With the opening of the medical institutions from private initiative, access to medical education and treatment facilities also increased. These were the positive aspects of private medical institutions.
When the number of private institutions started increasing in the country, questions on quality medical education were gradually raised. However, compromises had been made on the quality when maintaining quality was understood only as submission or showcasing of quality report and infrastructure to the quality regulating body.
Rather than maintaining quality of education and producing quality medical manpower, they tend to establish medical institutions for profits.
Of late, the medical institutions are focused on producing medical manpower without analysing the needs and demand of the country. As a result, some sectors have more than needed manpower while other sectors lack even minimum human resources.
Still, the medical colleges are producing the human resources based on the interest of their institution and medical programmes and public (guardians), who can afford to pay for medical education.
Fee of the medical education is also guided by the market driven approach. This situation leads to unhealthy competition among the colleges. Enrolling more students may decrease the quality of education and service to be delivered by the colleges. The medical colleges are opening without proper projection and calculation of the required manpower in the concerned sectors. Second, the medical colleges are opened only by analysing their easy access, for example looking at the geographical location.
To control these anomalies, the government, civil society members and even individual campaigner like Dr. Govinda K.C, have been regularly voicing against the government and sometime against the medical colleges. To regulate all these grievances, the government established a separate body known as Medical Education Commission as a regulating body in the medical education. The Commission will very soon focus its attention on making a separate National Medical Education Policy to regulate all the bad practices prevalent in medical education sector. In the last two months, the Commission has taken three important steps for the correction of the anomalies.
One is the provision of going through compulsory examination or test under merit system to all domestic and international students. Second, a provision of providing 75 per cent scholarships to increase the access of poor and talented students in government run medical colleges from the current academic session was implemented from this year. Third, is about the fixation of medical education fee.
Under the present medical examination system, any student (either Nepali or foreign) and Nepalis who seek to go abroad for medical education, need to compulsorily pass their medical examination from the Universities and Institutions. In case of admission and study in Nepal's medical colleges and Universities, preparing a merit list for both the Nepalis and foreign students is also required. Those colleges and universities, which enrol 50 per cent of foreign students, should provide 20 per cent scholarships to Nepali students, so those who provide 20 per cent scholarship can enrol 50 per cent foreign students. Similarly, those, providing 10 per cent scholarship to Nepali students can enrol up to 1/3 foreign students in their colleges, which is maintained in the present Medical education Commission Act.
There are two sections in the medical education: basic science and clinical science. It means without passing basic science, no student could go through the clinical science. Basic science has a three-year course that means within three years, they should compulsorily pass that level for getting admission to clinical science. There are numbers of foreign students who even could not pass basic science but get admission in Nepali colleges.
All these steps are taken by the government and Nepal Medical Council for the quality control and developing Nepal a hub for medical education to foreign students.
In the final entrance examination conducted by IoM under the Tribhuvan University, there is a provision of getting enrolment to about 300 foreign students, but this year only 31 passed the entrance exam. This doesn't means that 1/3 foreign students should compulsorily get admission by passing their entrance, if in case of such situation, Nepali students too can get admission in the seats by appearing in the final entrance. So, this should not be taken as misconception that the seat is not allocated only to the foreign students. In case of some foreign students (especially Indian), who cannot get admission in India, comes here through various channels and agents. The private colleges here charge them higher fees than the provision. This is the unseen advantage being enjoyed by medical colleges.
Private medical colleges should also stop taking foreign students from unseen or illegal channel.
The present National Medical Education Commission has given liberty to finalise or fix the fee of medical education, and the fees fixed by the University should be transparent and the Universities and Colleges should be very transparent while informing and submitting their report to the Commission.
At present, even TU-based medical colleges and KU have not maintained such transparency while admitting new foreign students in their colleges. The Commission is facing manpower shortage. It has just around 10 officials. We seek to take support and use experts from various sectors remaining here in Nepal.   

Government’s role in medical education confusing: Karki 

When we talk about problems and mismanagement in medical education, it is very difficult to start from a distinct issue as there are so many issues and problems. In my observation, both the medical colleges and the government have to be corrected.
I had got an opportunity to work in Medical Council a few years ago. Initiation taken from the council at that time had made significant improvements in medical colleges in last four years. But there are still more issues to be improved.
But at the same time, the government’s role is also confusing regarding the medical education. For example, in Kathmandu Medical College, it is not currently a private college and has already become a public limited.
The government has made the provision of four batches. If there arises dual stance on the provision of two regulatory bodies- the Ministry of Education and the university, whose direction should be abided by the college.
This year, the government gave responsibility to Kathmandu University and Medical Council to fix fees of medical colleges and monitor them. When the works started and reached in a level, the Medical Education Commission came into existence to regulate them. Then, the commission started its works which created contradicts with the work of the university. There should be a provision for the settlement of the issue in this transitional phase.
In reality, college does not have any power, it should work as per the direction of Ministry of Education, Ministry of Health, University and Medical Council.
If some college made mistakes, why the issue was not raised at that time and was raised after 15 years. If colleges cheated students by charging more fees in the past, then why the regulatory agencies did not take action against those colleges at that time? There are flaws of both medical colleges and the government’s side.
The medical colleges should also improve them and the government should also not act to ruin the private medical colleges.
If the government actually does not want private medical colleges to exist in the market, the government can easily close them by writing a letter.
There should be justifiable evaluation of medical colleges. There should not be the situation of cheating students by medical colleges. It has ruined the image of the entire medical education and medical persons. The regulatory agencies should control it. But all medical colleges should not be treated by keeping in the same basket.
A few years ago, the university used to be regulated by the Ministry of Education, Medical Council and respective universities. But now, the number of regulatory agencies has increased. Medical colleges are also facing the regulation of student unions now. This should not be the case.
Nepal government formed around 10 committees since 2068 BS to resolve the problem in medical education sector, but the government bodies only take the reference of Mathema Commission, ignoring the report of all other committees.
The medical colleges do not get chance to listen to the government’s voices directly and are forced to know through the media. The media tend to damage the reputation of medical colleges without any evidences.
Who provides compensation for that? There is no transparency and credibility even in the media which used to charge medical colleges. Similar is the situation of school education.
The notion that medical college should be alright leaving all other business in mess is not the right judgment as medical colleges are also the outcomes of the same society.
Kathmandu Medical Colleges has never said to shut down the colleges and hand over the keys to the government against any decision of the government.
However, it is clear that the colleges will not continue their operation if the government policies go unfavorable to operate them financially. I think, any business has right to say this.



(Prepared by Purushottam P Khatri, CK Khanal and Manjima Dhakal.
Photo by Sagar Basnet)