Of late, medical education and affiliations have been a bone of contention in the country. With growing debate on declining quality of health professionals, the government had formed the Mathema Commission, an expert committee, to formulate a policy on medical education. The Commission had advised the government to form a Health Profession Education Commission, a supreme body, to deal with issues of medical education including affiliation and quality control. The policy also clearly mentions that a new medical college should not be established inside the Valley for the next decade. But the government has recently tabled a bill to establish one such medical academy. The Manmohan Adhikari Academy of Health Sciences (MAAHS), the proposed academy, has a majority of the shares of CPN-UML lawmakers. Against this background, Mukul Humagain and Manish Gautam spoke to Dr Arjun Karki, former Vice-Chancellor of Patan Academy of Health Sciences and a Mathema-commission member, regarding the new bill and quality of medical education in Nepal.     

As a member of the Mathema commission, how do you view this latest government move towards granting the Manmohan Adhikari Academy of Health Sciences (MAAHS) the status of an academy through a bill tabled in Parliament?

The Mathema Commission has clearly articulated that Kathmandu is already saturated with all sorts of medical institutions including medical and nursing schools. So there should be a moratorium for at least ten years on building any new medical institution in the Valley. It has also recommended that production of health human resources needs to be guided by the needs of the health sector and not by profit-making businessmen. As far as I am aware, no organisation in the country with a profit-making motive has been given the status of university or an academy. The MAAHS seems to claim that because it is a cooperative-based initiative, it deserves to become a university. But cooperative is a business entity. Therefore, if we let profit-driven organisations become stand-alone institutions of higher learning in our country, where corruption is rampant and law enforcement mechanisms weak, there is a risk of losing the very spirit of academic excellence and integrity, ultimately endangering the health and well-being of the public at large. Until the government offers a clear policy on allowing private medical institutes to run as a profit-making venture, it would be a mistake on the part of the government and political parties to endorse the MAAHS Bill in Parliament.

Bringing this bill through the back door, the promoters are trying to do everything in a hurry. Can a health sciences related academic institution like this be established in such an arbitrary manner?

It depends on the purpose of the organisation. If your purpose is to address the challenges faced by the nation in the healthcare sector, then it does demand careful consideration of all the aspects as to how best to define the agenda, set the goals, prepare the detailed operational plan, etc. It also requires a careful and extensive deliberation to make sure that the efforts that are being put into the organisation will have a major impact in improving the health of the population in Nepal. But if your sole purpose is to make profits, then there is no need to go into the details.

If the MAAHS bill is endorsed by Parliament, will it not set a negative precedent for other medical institutes waiting for affiliation?

Yes, this will set a negative precedent for the country, for many profit-making organisations or business groups that were unable to establish or expand their academic businesses because they could not get an affiliation. Moreover, the parliamentarians have been elected by the people with the expectations that they will see the bigger picture of the nation and will do things that will be in the best interest of the public at large. But if they misuse their position or privilege to promote their petty interests and cause serious damage to our educational system, the Nepali people will not remain silent.

More than 50 lawmakers currently have direct or indirect ownership in medical colleges or institutes. Are money and political influence the crux of the problem?

I am aware that in our country there is an unholy alliance between politics and business. However, I am not sure how many parliamentarians are connected to this alliance. But the lawmakers’ engagement in self-serving activities at the expense of national interest is a serious breach of public trust. If the democratically chosen representatives betray their constituencies, I think that is an ominous sign for our democracy and for the future of this nation.

There have been calls to regulate medical schools. Yet there have been attempts by the private sector to open more medical colleges. How does this affect the quality of medical education in Nepal?

The Mathema commission has analysed this issue in great detail and  has seen the anomalies that exist today— private medical schools in the name of training doctors are amassing profits without due regard to the quality of their graduates or the needs of the national health system. The Mathema report has suggested several recommendations as to how this needs to be addressed—selecting students or faculty, designing the curriculum, adopting proper methods for teaching, and restructuring fees. Unless these recommendations are implemented in earnest, it will be very difficult to ensure and improve the quality of health profession education. If we do not ensure the quality of education imparted to young graduates coming out of medical schools, we can not be sure about the quality of medical care being provided by the hospitals or clinics. So in order to implement the recommendations and to make sure the medical education in the country remains at par with other countries and as dictated by the global medical bodies, the Commission has also suggested the formation of a Health Profession Education Commission which will oversee all these issues. So the formation of this Commission is an urgent priority. 

How do you see the current trend of opening medical institutes in the Valley and other urban centres? Are they in line with our long-term requirement?

We analysed the requirement of doctors in Nepal for the next 15 years. The rate at which graduates are being produced currently  clearly indicates that within the next 15 years, several thousand doctors  will be unemployed. So is it fair that we allow our youngsters to study medicine in a situation where they have no jobs at the end of the day?

Apart from the issue of quality, there is also a huge discrepancy between the production of doctors and consumption capacity of the health sector. That is the reason why we have suggested that we have to put restraint on the proliferation of medical schools. It is not only the question of quality, but also a question of quantity. Like Dr. Govinda KC has demanded, let there be one public medical college in every region of the country. For example, in Far-West, there is no medical college. Let there be one public medical college there, which will allow the local students of that region to study medicine. And hopefully many of them will choose to work in that region.

How do you plan to continue putting pressure on the government to implement the Mathema commission Report?

Please remember that the Mathema commission no longer exists. The commission was created for a purpose and at the end of the process we submitted a report. Everyone who takes an interest in public health or is involved in the health sector should be taking a position on this issue, either for or against. But given that Dr. Govinda KC has already raised the issue publicly, asking the government to honour the agreement it has reached with him or he would begin his protest again. This issue will not die down easily. This will go beyond the Mathema Commission.