Narayan Upadhyay

Medical education in Nepal has arrested general people's attention, albeit for wrong reasons. The operator of a private medical college in the eastern town of Biratnagar barred students from attending classes after the latter denied paying additional fees when asked by the college authority. The issue came to a head when students resisted against increased fees levied on them. According to some media reports, the added fees ran up to about Rs. 2 million.

Proprietors compelled the victims to stay in college hostels. The protesting undergraduates further revealed the college administration asked them to eat at the hostel canteens, for which they required paying heavy charges, besides footing the bill for tuition and other fees worth Rs. 4 to 5 million. The increased cost will add up to total spending for completing medical courses, while the exorbitant fees levied on gullible pupils would make the operators richer by millions of rupees.

Varied pretexts
Private college operators' eagerness to draw hefty cash from students' wallets by employing varied pretexts has mired the nation’s medical studies. Some aspirants who deposited fee installments for getting enrolment or after admission had no options but to provide the demanded fees, lest they would confront many obstructions in the path of accomplishing MBBS or postgraduate courses. Some victims showed guts to raise voices against private college owners against the latter's imposition of added fees that breached the government's earlier move to fix the fee ceiling.  
As the additional fee conundrum flared up, one owner stated, his college could not teach a student for the fees specified by the state. The owner, a member of the ruling political party, has not yet faced action. In the meantime, the local authority has delayed taking action against the erring colleges, citing that they would only initiate action if victims submitted a legitimate application soliciting action against erring owners.

With the students' protests against three colleges, Nobel Medical College (Biratnagar), Kathmandu Medical College (Kathmandu) and Manipal College of Pokhara causing media outcry, the Education Ministry warned it would scrap the misbehaving colleges’ affiliation to various universities. The ministry's admonition saw one college, Manipal, acquiescing to return the extra fees it charged from the undergraduates.

All the above incidents bring us to an important fact: medical education in our country is replete with anomalies. Besides the selfish character of college operators, the paucity of standards in medical education at many colleges is a matter of concern. Many private colleges lack qualified faculty members to run classes. The owners of the private medical institutions enroll those students who can pay fees as per their demands. The less qualified ones who get admission often occupy seats by paying unfair charges levied by these colleges. This trend only delivers a blow to the overall standard of health benefits. We can expect no excellence in health service when less accomplished pupils graduate to become doctors.

Here, it would be prudent to recall the efforts and struggles of Dr. Govinda KC, a retired Tribhuvan University Teaching Hospital orthopaedic, to bring reforms to the medical education and the overall health sector. KC staged several rounds of fast-unto-death protests in the past, calling for the authorities to reform the sector. Because of his relentless protests, the Ministry of Health and Population had set up a study committee that later settled the fee structure for MBBS and postgraduate courses in all medical colleges.

KC's appeal to the state to purchase or obtain all private medical colleges merits our attention as the move can help end the existing anomaly of proprietors' avarice to obtain higher payments from students. Despite all the government provisions to stop private colleges from milking money of needy students, the colleges often pile pressure on them to hand out extra fees.
There are 22 medical colleges in the country where around 2,500 seats are available for medical studies. Private medical institutions outnumber government-owned colleges. The government has separated seats for students under the full and partial scholarship schemes at the government and non-government colleges, besides allowing seats to those who want to pursue studies by paying tuition fees.

Political connection
One cannot deny that whenever the country's political situation gets fluid, private college proprietors are quick to rear their ugly heads to impose increased fees on hapless students. As these owners possess enough resources at their disposal, they often get closer to the politicians and political parties. They try to take advantage of their closeness to the leaders and parties. Our authority should allow none of them to take such benefits so that the pupils would not find themselves at the receiving end.

The existing anomalies must end, once and for all. We should not forget that once they compel a student to pay hefty fees as additional charges, the parents suffer the most. The students who complete the course can try their best to recoup the expenses for which they can go to any limit when he/she starts a career in the medical field.

Truly, quality health services in the nation have remained out of reach of a large population because they are expensive. The poor, lower middle class and middle class cannot think about getting medical services at the private hospitals of the capital and elsewhere. To make matters worse, negligible health insurance policies exist, impeding people from having easy access to standard health services. Private operators' greedy nature is one reason behind the country's pitiful health service system. The anomaly of imposing excessive fees makes a future doctor less inclined towards imparting quality services to needy patients. But it makes them extremely desirous to extract payments from patients using different methods.

(Upadhyay is managing editor at this daily. nara.upadhyay@gmail.com)