Controversy in the country’s medical sector resonated throughout the year 2014. The issue of granting affiliation to medical colleges was the bone of contention, and the fallout that ensued rang up the curtain on the systemic disease that afflicts the country’s health care industry.
Dr Govinda KC, a senior orthopaedician at the Tribhuvan University Teaching Hospital (TUTH), had seen it coming right from the beginning: that the “medical mafia”—backed by politicians and bureaucrats—were running the country’s health care sector to make huge profits for themselves.
In 2012, he staged a hunger strike, demanding reforms in the country’s medical sector. Among others, Dr KC had demanded an autonomous Institute of Medicine (IoM), halting affiliation extensions to new medical colleges and making appointments at the government-run IoM on the basis of seniority and merit. He ended his strike after the government appointed Dr Prakash Sayami the IoM dean in August, 2012, and assured him that they would address his other demands.
But in December, 2013, Dr Sayami resigned as the IoM dean, claiming that he could not work under constant political pressure to grant affiliation to new medical colleges. The TU Executive Committee then appointed Dr Sashi Sharma, the former vice-president of Nepal Medical Council, the new IoM dean.
With Dr Sayami gone, and his other demands still unfulfilled, Dr KC once again resorted to a hunger strike in the first week of January this year. The entire medical fraternity rallied behind Dr KC. Doctors across the country went on strike and many resigned en masse. Bowing down to the pressure, the government—once again—vowed to address Dr KC’s demands. Dr Sharma, too, resigned from IoM dean’s job.
All of these upheavals have happened against a backdrop in which investors of medical college see things one way, and the people at the policy level see things in another. Investors say that the billions of rupees they have invested will have gone in vain if their institutions are not granted an affiliation. The people at the policy level say they are having problems regulating the existing medical colleges and are not in a position to add more to their list.
Amidst this tug-of-war, the lingering issue of the “medical mafia” has slowly crept to the fore. The term was popularised by Dr KC, whenever he can, does fail to call them out for sullying the medical educational sector in the country. He says many doctors, politicians and bureaucrats all fall under the category of the medical mafia, and that they are involved in the sector solely to make money.
Earlier, there were four medical colleges—DevDaha Medical College, Birat Medical College, National Medical College, Kathmandu and Manmohan Memorial Medical College—that were waiting for their affiliation to be granted. Now, since DevDaha and Birat have been recognised by Kathmandu University, the fight for recognition has been left to National and Manmohan Memorial. But this fight is going to be daunting.
Manmohan Memorial has a significant investment from CPN-UML lawmaker RajendraPandey and many other leaders. Similarly, National Medical College is an extension of Birjung-based National Medical College, which is promoted by the UCPN-Maoist aide Basaruddhin Ansari.
In 2014, leaders who backed these colleges took the fight to the biggest stage. Pandey broached the issue of medical college affiliation in parliament, and recently in the last week of December he even threatened Subash Nembang, the CA Chair, that hew would disrupt parliament if affiliation was not granted to his medical college. Pandey also sought help from the Commission for the Investigation of Abuse of Authority, which wrote a letter to IoM asking to “resolve the issue of affiliation soon”. This move by the CIAA was widely criticised, and its jurisdiction was discussed in many quarters.
National Medical College, apart from using Maoist leaders to pressure universities to grant affiliation, has also moved the Supreme Court. The apex court in the second week of September asked Tribhuvan University to sort out the issue. But the IoM is yet to decide on the problem.
That means it will have to get vetted at several junctions. Each medical college has to first get a Letter of Intent from the Ministry of Education, then an approval from the concerned university (Tribhuvan University and Kathmandu University) and then a final consent from the Nepal Medical Council (NMC) on how many students they can enroll. The NMC is the government body that regulates medical education and doctors in the country.
“All of these problems have been created by the commercialisation of medical education,” says Dr Arjun Karki. “It is high time that the government defined if medical education is part of the business or the service sector. I believe medical education is part of the service sector and its commercialisation is completely unacceptable.”
If the amount that the private medical colleges that run MBBS programmes charge is any indication, he may be right. Their going rate is between Rs 4 million to Rs 5.5 million to complete the five-and-a-half-year course. One college can enroll up to 150 students in their courses annually. However, that quota is set by the NMC and the concerned university. Since a single student can bring in a lot of money, investors do their best to appease the council and increase their student quota.
This has made the NMC a controversial institution. In January, its former president Dr Damodar Gajurel resigned, saying he could not work with the recently elected members of the council. In the resignation letter submitted to the then Minister for Health Bidhyadhar Mallik, Dr Gajurel said: “Many members of the council were not present in many meetings where important decisions had to be taken. And it was hard to continue in this way.” Although his resignation was not accepted then, he was subsequently forced to resign by the incumbent Health Minister Khaga Raj Adhikari, who appointed his own candidate to the position.
Dr JP Agrawal, a medical educationist, believes that since the majority of the private medical colleges are making profit by enrolling Indian students, the year 2015 could be a tough year for them. “The Indian Medical Council has stopped recognising students who graduate from Nepali medical colleges. Now that there are already a plethora of medical colleges here, they might not even come here,” says Dr Agrawal. “So people who want to open medical colleges will have to rethink their decision.”
He also wants to see changes in the way that medical colleges admit students. He has called for the establishing of a National Medical Board, which would monitor the medical entrance tests in the country. This national accreditation board would oversee the MBBS and dentistry entrance examinations. At present TU, KU, the Patan Academy of Health Sciences, and the BP Koirala Institute of Health Sciences are running independent entrance exams for MBBS and Bachelor in Dentistry courses.
Dr Agrawal argues that separate entrance tests conducted by different universities and medical institutions are putting undue pressure on the students and promoting unhealthy competition among medical colleges. The students could instead, he figures, take a test conducted by the proposed medical board and choose colleges on the basis of merit, while the colleges determine the number of seats and scholarship programmes.
“Also a mandatory examination for students planning to go abroad for medical studies is something we need to look into,” said Dr Agrawal.
But the problems related to medical education is not just confined to the premises of medical colleges and universities. On December 6, during a raid by the Commission for the Investigation of Abuse of Authority at Golden Gate College, Battisputali, two people were held with a 10-page question paper for the MBBS Biology entrance exams. The CIAA also rounded up Dr Nabin Sharma, the owner of Name, a popular entrance-preparation centre, for his possible involvement in the leakage.
In order to clean up the dysfunctional industry, Dr Karki has urged the government to implement a report that has already been created by two committees on the formation of medical universities and on the national policy regarding medical education; it has been months since the report was submitted. That report was created following the fast-unto-death by Dr Govinda KC in February.
“These reports are for a noble cause. And its implementation will help keep the medical mafia in check and prevent them from using desperate means to ensure that they get affiliations to run medical classes,” says Dr Karki.