As I write this, Dr. Govinda K.C. is on a hunger strike in Karnali Academy of Health Sciences in Jumla protesting the current government’s proposed changes to the Medical Education Ordinance (MEO). The President promulgated the MEO about eight months ago on the recommendation of the Sher Bahadur Deuba government.  This is KC’s fifteenth hunger strike; an unending saga of an ordinary citizen fighting a powerful vested interest determined to protect its business of profiting through a corrupt, unregulated medical education. How will this protest end? What will be its ramifications?

Gutting the MEO

The MEO was the culmination of KC’s fourteen hunger strikes demanding legislation to control the unfettered commercialisation, corruption, and profiteering in medical education and establishment of a strong oversight on the registration and operation of medical colleges.  It was informed primarily by the report of the Mathema Committee—a high-level committee formed by the government to recommend a new health education policy for the country. The Committee chaired by the former vice chancellor of Tribhuban University, Kedar Mathema, comprised of medical doctors and other highly respected Nepali intellectuals.

The ordinance was promulgated after the parliament was dissolved before the last election. Our constitution requires any ordinance promulgated when the parliament is not in session to be ratified within sixty days of  the next sitting of the parliament.

KP Oli opposed the MOE from the beginning. During the last election campaign, he publicly scoffed at the Deuba government, for “ succumbing” to KC’s pressure. When he became Prime Minister, as if to send a message, a photo of him at a private dinner with Pushpa Kamal Dahal, the leader of Maoist center and Mr. Durga Prasai was circulated. Prasai is the owner of a medical college, which does not comply with the requirements of the MEO.

The government recently presented an amended version of the MEO at the parliament by excising some of its key quality control clauses and clauses intended to diversify Nepal’s Kathmandu centric healthcare. The diversification clauses intended to accelerate healthcare delivery to the rural poor. “The government’s bill essentially guts the soul of the MEO”, said a member of the Mathema Commission.

Onus is on the government

An investigation of the identity of the beneficiaries of the for-profit medical colleges helps to understand this excision and seeming contradiction of a Communist government favoring a loosely controlled laissez faire business to benefit the rich at the cost of the poor. A number of previous UML members including its senior leaders are invested in for-profit medical colleges.  

UML’s (now Nepal Communist Party, NCP) senior leader Rajendra Pandey is the CEO of Man Mohan Academic Institute of Health Sciences (MAIHS) whose majority shareholders are members of the NCP.  In Nepal’s bizarre democracy, Pandey, a Member of Parliament, participates without any qualms in drafting bills that directly impact his business.  The universally applied  “conflict of interest” restriction to members of parliament does not apply here.

Every government has the right to amend an ordinance before it is tabled as a bill in Parliament, but the amendment must be justified. It must be progressive and done for the greater good of the public. The onus of explaining the reasons for the amendment rests squarely on the government. This explanation is even more urgent in the case of the MEO because it was based on recommendations of some of the best brains in the country.

In defending the amendments, the Minister of Education, Science and Technology argued that the “government cannot move forward by regulating the private investors”, and pleaded that the opposition “understand the government’s difficulties” and assist it to move forward.

The truth is that the MEO does not discourage private investment. It simply wants to regulate it to maintain quality standards and encourage healthcare delivery outside Kathmandu. The Minister did not explain how regulating the private sector would put the government in difficulty. The government routinely regulates private transport agencies; hydropower and so on. Why can’t medical education which directly impacts people’s lives be regulated? A strong argument can be made that regulations for medical education must be more stringent than in any other sector.

The ultimate question that the government must answer is why the original MEO was against the interest of ordinary Nepalis and how their proposed amendments improve it. To date, the government has failed to provide a convincing answer.

Regardless of which way the government tries to spin their intent in “gutting” the MEO, it is obvious that this is to protect the interest of their cronies. Damn the quality and damn the poor!

The possibilities

So how will KC’s hunger strike end? And what will be its ramifications? There are three possibilities.

First, the government ignores public pressure, abuses its majority in the parliament and passes the amended ordinance. KC passes away. Avarice wins; humanity loses. KC becomes a national martyr. Oli looks like a pawn unable to control the grip of business interests in his party. The hope of a corruption-free government and quality healthcare for all under the Nepal Communist party government fades forever.  Oli’s credibility hits rock bottom.

Second, the government withdraws the bill. Every one gets a temporary reprieve, status quo continues until everything boils over yet again.  

Third, The government takes a broader view, finds some face-saving compromise such as buying the existing non-registered colleges/hospitals at a hefty price and silences its investors. The MEO or its legislated version (the Medical Education Law in its present form) is enforced. Nepali medical education enters a new era of quality and public responsibility.  Health care delivery reaches the poor and the unprivileged.  

And to prevent a repeat of the present situation, Oli initiates a law to bar members with “conflict of interest” to be involved in bills that impacts their financial interest. The nation wins. Oli shares national accolade with K.C.

These are trying times!

Koirala is a geotechnical engineer resident in Vancouver, Canada