Dr Chandra Karki, senior obstetrician and gynecologist, is the principal of Kathmandu Medical College. She spoke to The Himalayan Times on why private medical colleges feel victimised by the government’s decision to implement the recommendations of the Mathema Committee. Excerpts:

Why do private medical colleges feel they are being treated unfairly?

To understand this, you have to see the whole scenario of medical education in the country. Till 1993, there was only one medical college, the Institute of Medicine. In 1993, BP Koirala Institute of Heath Sciences came into being and then Kathmandu University came with its own hospital in 2001. Before that, only KU was providing affiliation to medical colleges since 1996. Patan Academy of Heath Sciences came later in 2008. If you look at the present scenario, there are around 23 institutions providing health care services and among them the private institutes are either affiliated to the Tribhuvan University or KU. Under TU, there are seven medical colleges and they are based in Bhairahawa, Birgunj, Bharatpur and Pokhara. Besides its own teaching hospital, the KU has nine institutes. This is the era of Public-Private Partnership and that is the reason private sector medical institutes sprung up.

Private medical colleges are governed by the Ministry of Education, the Ministry of Health and Population, the Nepal Medical Council and their respective universities. Most of the medical colleges under Kathmandu University are now running for about 18 years. Kathmandu Medical College is one of them.

The government formed the Mathema Committee, which worked extensively on issues relating to medical education, and presented its report. It is a very good report that speaks of how medical education can be improved and we all support that. However, somehow there are a few points that do not seem very practical as there are already 23 medical colleges that have been formed legally. If you don’t consider the problems posed by some of the points in the report, it will be very difficult for most private medical colleges to survive.

For example, Kathmandu Medical College has tried its best to follow all the rules set by the government, Nepal Medical Council, and KU. But some new points in the report pose a big problem to our existence. The education ministry, the private sector and all stakeholders must sit together to discuss the problems.

What are the points that pose a threat to continuity of private medical colleges?

KMC has been running with 150 students every year for more than four years now and we have all the required infrastructure, human resources and specialists. We don’t receive any subsidy from the government. Now suddenly, we are forced to reduce the number of students by 33 per cent.

Also I don’t think quality depends on the number of students. It is a matter of pride for us that we are teaching foreign students coming mainly from India, Sri Lanka, the Maldives, USA and others. India still has a deficit of 3.5 million doctors. Nepal has the potential to emerge as a hub for medical education. I believe it is necessary to regulate medical colleges. I also believe that colleges that do not perform well should be closed down. But if they are performing well and following the rules and regulations laid down by the government, they should be encouraged to grow.

What is the problem with the fee cap set by the government?

The recommendations made by the Mathema Committee state that colleges should not be allowed to charge more than Rs 3.5 million to students. In 2011, the government had formed a committee, which suggested that tuition fee should not exceed Rs 3.2 million, but we were allowed to add the inflation rate fixed by the Nepal Rastra Bank every year. As per this arrangement, this now comes to around Rs 4.2 million. This year we ourselves decided not to add the inflation rate keeping in view the devastating earthquake. I think the government should allow the competitive market system to run its course. If you reduce the seat by 33 per cent and reduce the cost also, you can imagine how difficult it would be for private medical colleges to sustain.

Why do private medical colleges have a poor public image?

Perhaps that is because we have not been able to convey our views to the common people. But nobody can deny the fact that private medical colleges have made a huge contribution to the country. Nepali students can now study in their own country. Earlier, they were compelled to go abroad and even compromise on the quality of education. This is evident from NMC exams where only 10 to 20 percent of such students get through. Many students from our college have secured good jobs and scholarships for further studies abroad.

The Mathema Committee report has also highlighted the contribution of private medical colleges, but the general public is not aware of it. Private medical colleges provide MBBS scholarship to 200 students. In our time there were hardly any MBBS scholarships seats, but now 200 students have this opportunity because of private medical colleges. If you remember health care services provided by private medical colleges after the devastating earthquake, you will realize that the private sector has played a very big role in the heath sector in Nepal. This has also been proven by reduced maternal, infant and under-five mortality rates.

How will reducing the seats affect the demand for doctors in Nepal?

If we reduce the number of medical seats, around 500 seats will be reduced every year. Not that these students will not study MBBS, but then they would go abroad where quality education may not be guaranteed. Moreover, the country would be losing in terms foreign exchange.

How are you supporting the government?

Private medical colleges support the Ministry of Health and Population by providing health care services to the public through 10,576 hospital beds which is around 76 per cent of the total hospital beds in the country. The country still needs 25,000 beds to reach WHO standards of 1.95 beds per 1,000. We are also providing not just basic health care but also specialised services in various parts of the country. Today a person who suffers heart attack in Nepalgunj or Palpa or Biratnagar can be treated there and saved. Access to such services would not have been possible without private medical colleges.

Private medical institutions provide health services to 150,000 people daily through outpatient departments. Moreover, we provide employment to more than 20,000 people. Private medical colleges have been able to create thousands of indirect job opportunities. It is a fact that the private sector has played a great role in improving heath parameters of the country.

But there is a misconception that private medical colleges are expensive?

This is not true. Yes, certain sections accuse us of being commercially driven. They say we overcharge students. I would like to share it with you that out of 780 beds at Kathmandu Medical College, 112 beds are allocated for the poor and underprivileged patients. These patients are provided free health check-ups, free surgery and free food. Similarly, 10- 15 per cents of beds in all private hospitals are free. Does the general public know this? Medical Colleges are the second biggest tax payers in the country after the banking sector. I am proud to say that the KMC has received the highest tax payers (among educational institutes) award last year. I am not against regulations and proper monitoring, but I am of the view that the regulating body should be able to monitor and facilitate rather than impose rules that will discourage private investment in the sector.