What ails medical education in Nepal?


After the government made public the high level task force report on national policy for Health Profession Education, private medical colleges in Nepal have raised concerns that should be addressed through discussion with them as stakeholders.

The report talks of several issues, such as affiliation of health institutions, enrollment of students, fee ceiling for MBBS studies, free education in post-graduate studies, launching new programmes on need basis, restructuring Nepal Medical Council, curriculum and evaluation, teaching methodology and others.

“The government made a mistake earlier without having proper monitoring and introducing open market in the sector. Now, it is trying to correct that. The quality of doctors that private medical colleges are producing is deteriorating every year. And to maintain the standard, we came up with the report. Now it is in the hands of the government whether to incorporate it as it is, or add or subtract from it in the Health Policy,” said Dr Gunraj Lohani, one of the members of the task force and chief of Curative Service Division of Ministry of Health and Population.

Nepal needs at least 28,000 doctors, while only 14,000 doctors are registered, and a mere 7,000 are available in the country

“The report states what the government will compensate for institutions based on passed students in post-graduation, add medical colleges on regional basis, provide lease land and tax holidays for investors to construct medical colleges in areas specified by the government, create criteria for maximum fee structure and limit seats based on infrastructure which will make the base for quality medical education,” said Dr Govinda KC, orthopaedic surgeon and philanthropic and social activist.

According to him, each year there are 400 seats in public medical colleges and 2,000 in private colleges.

The Nepal Private Medical Colleges’ Association pointed out areas where they feel problems will arise. It stated that private colleges were established under privatisation efforts and in partnership with the government to develop medical facilities throughout the country. They point out that they have taken the risk and invested in this sector, which is now growing and has reversed the trend of students forced to go abroad for medical education, to foreign students enrolling in Nepal.

NPMCA states that fixing the maximum fee at Rs 3.5 million is impractical because the cost of everything has gone up.

“Every year there is an increase in salary, increase in overall costs and increase in the dollar rate and most medical equipment are purchased in dollars,” says NPMCA president Dr Bhola Rijal, adding that all medical equipment have to be changed every three years. Agreements made by the government at the time of their establishment should be followed and new policies can be developed for the future.

“If you change the rules it is against international law and if you go back on your word our institutions will collapse,” he claims.

He claims that Nepal needs 28,000 doctors, while only 14,000 doctors are registered, and a mere 7,000 are available in the country.

The other issue they point out is competition from China, India, Bangladesh and Philippines, where many students still go for medical studies and they state that huge commissions are paid for each student sent.

“Medical colleges are mushrooming in the country though the quality of education is not up to the mark,” says Dr Anjani Kumar Jha, President of Nepal Medical Association. According to him, uneven distribution of medical colleges, deteriorating quality of education and profit motive alone, are major challenges. While he appreciated the recommendations of the report, he also feels that the government should be more open to discuss these issues and solve the problems through consultation with the private sector before implementing the report.

“Private colleges are only against the decision of the government to fix the fee ceiling at Rs 3.5 million and decrease students’ seats,” he said, adding that the problem can be solved through dialogue.