The Big Problem with medical education in Nepal
Unless the trend of opening medical colleges in Nepal is stopped, the country risks gaining a reputation as a “diploma factory.” The MBBS degrees awarded to young students in Nepal will not be useful in getting a medical job outside Nepal.
People don’t talk about it, but the fact is, many young medical students have the dream of going to UK, India, EU or USA to work as a doctor. It’s the best way to pay off the heavy student loans of medical college in Nepal. It’s not easy, but – it’s possible, because the medical council and the medical association are working hard to maintain some semblance of quality and accreditation.
The Nepal Medical Council and Nepal Medical Association have stood firm on the issue of quality, but are continually being challenged by politicians who wish to make money from awarding licenses to operate more and more Medical Colleges, which is lucrative due to high tuition fees and limited oversight.
Case in Point
The following article appeared in Republica Nov 6th, 2017:
KATHMANDU, Nov 6: Education Ministry has directed controversial Kathmandu National Medical College to allocate the seat numbers for new admissions from current academic calendar.
Breaching its own jurisdiction, the ministry has directed the controversial medical college to allocate the number of seats.
Though the Medical Council posses the right to allocate the seat for each academic calendar, Education Minister Gopal Man Shrestha wrote a letter to the college and directed to allot the seats.
The Senate and Executive Council of Tribhuvan University granted affiliation to the college on July 27. Later on, the university withdrew its decision to grant the affiliation citing that the college does not meet the basic requirements to operate a medical college. However, the Supreme Court, last week, issued a stay order against the decision of TU to scrap the affiliation granted to KNMC. Following the order, Minister Shrestha issued directive in writing lured with financial gain.
Nepal already has more than twenty medical colleges, with seven located in the Kathmandu Valley. ( TU, KU, Kist, NMC, NMC, PAHS).
This seems to be the fifth or sixth time somebody with political connections has tried to open a new medical college in the Kathmandu Valley. I am losing count!
Dr. Govinda KC conducted a hunger strike – his thirteenth – not too long ago to bring attention to this issue and to pressure the government to adopt measures to prevent this. The ink on the agreement is barely dry…. and now – this.
It must be noted that a team of experts led by Kedar Bhakta Mathema, former vice chancellor of Tribhuvan University, had recommended a 10-year moratorium on establishing new medical colleges in the Valley. The original HPE Bill also had a provision for that. But under pressure from some lawmakers, particularly those from the CPN-UML and the CPN (Maoist Centre) who have stakes in some medical schools, a House committee had inserted a new clause as per which the facilities that had already obtained the letters of intent and built infrastructure would get affiliation for running the MBBS course. This would have favoured facilities like Manamohan Memorial Institute of Health Sciences and B&C Hospital among others which are backed by UML and Maoist leaders.
This issue is so obvious and important, that Lancet, the prestigious medical journal, has reported on it in Dec 2016. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32423-0/fulltext?rss%3Dyes
Nepal is a low-income nation with a population of nearly 26·5 million. The doctor–patient ratio is 0·17 per 1000 population—substantially less than the WHO recommendation of 2·3 doctors per 1000 population.1 Nepal has seen a burgeoning of medical institutes in the past 10 years. However, this rapid surge in the number of medical colleges—with increases in fees and corruption involved in student admissions—has not aided undergraduate and postgraduate medical training, deteriorating the quality of medical education.2 The financial motives involved in these private medical colleges have further incurred political meddling, often resulting in disproportionate and unregulated licensing and affiliation to such colleges, which are not instructed to establish themselves in rural areas.2, 3
The increase in private medical colleges in Nepal has been a great source of debate in newspapers and national media.4 The establishment of medical colleges is often highly politicised, but repeated hunger strikes by a philanthropic activist and orthopedic surgeon, Dr Govinda KC, against the unregulated and uncontrolled accreditation of private medical colleges3 have failed to consolidate agreements made in the past. KC’s eighth hunger strike—lasting 15 days—ended on July 25, 2016, with an agreement with the government to establish medical colleges in remote regions, implement the previously drafted Mathema Committee report, abolish medical fees in government medical colleges, and depoliticise academia.3, 4 The agreement, however, is still doubtful, because the government has failed to implement the past seven agreements (from seven hunger strikes), which were breached owing to political tampering from private medical colleges.3, 5
The National Human Rights Commission and the Nepal Medical Association—the umbrella organisation of Nepali medical doctors—showed strong solidarity, and on July 15, 2016, issued a press release showing concern over KC’s deteriorating health and urging the government to honour their past agreements with KC.4
The increase in medical colleges—mostly private and urban-centric—has very little to do with the most remote and inaccessible communities. In a country where 80% of the population lives in villages,1 medical training needs to focus on the rural population. Of the 19 medical colleges in Nepal in 2012, 14 (74%) were private and eight (43%) were in Kathmandu Valley alone, serving only 1·7 million—6% of the total population.1, 6 Of the 11 medical colleges outside the Valley, almost all were based in the cities, largely depriving health care from those living in rural regions of Nepal.6
The growth of urban-centric medical institutes does not come with a golden solution that could regulate norms and policies. The first step to revert this growing trend is to immediately consolidate the Medical Act of Nepal in line with the Mathema Committee report. The second step is to entirely depoliticise medical and academic institutions, enabling them to run under the principles of pure academia and humanitarian service. The third step is to immediately monitor the Nepalese Medical Council and university boards, and bring transparency to their decisions with stringent implementation of the rule of law.
If this is allowed, there is no end to the number of “medical colleges” that can be authorized by politicians. A Nepal MBBS degree will become worthless in the international scheme of things. Nepal risks becoming known as a “diploma mill” and will be a pariah among the system of migration for doctors to other countries in addition to not meeting it’s won needs for trained doctors.
It should be noted that one privately-owned medical college, the one in Janakpur, is already for sale after years of instability.
Caribbean Diploma Mills
In USA, we are already aware of “offshore” medical colleges operating in small countries that have poor regulation, and rigorous steps have been taken to prevent these graduates from ever practicing in USA. https://forums.studentdoctor.net/threads/caribbean-diploma-mills.1261082/
Is this what potential medical students want in Nepal? Will this help Nepal address the myriad of issues in population health?
The answer is NO. Of course not.