‘Draft National Medical Education Bill has many flaws’

The Parliamentary Health and Education Committee passed the draft National Medical Education Bill on the basis of majority and tabled it in the Parliament on Sunday. Lawmakers representing the main opposition Nepali Congress have written a note of dissent. Meanwhile, medical education activist Dr Govinda KC started his 16th hunger strike from Ilam. Jagdishor Panday of The Himalayan Times caught up with Nepal Communist Party (NCP) lawmaker Yogesh Bhattarai and NC lawmaker Gagan Kumar Thapa to talk about issues related to the bill. Excerpts:

What prompted you and lawmakers from your party to write a note of dissent on the bill?

The medical education sector is in a mess. From our experience and study, we have concluded that we need a high-level commission that oversees the entire medical education sector. Although the bill has provision for such a commission, it has also left many loopholes. If we don’t shut these loopholes, the main purpose of bringing this bill will be watered down.

Dr Govinda KC has been fighting for the same purpose. When the bill was tabled in the Parliament Dr KC had been on his 15th hunger strike. The government signed an agreement with Dr KC assuring him that the government would include all nine points of the agreement reached with him.

We had assumed that whatever the individual opinions, the government would abide by its commitments. But the government retracted at the last moment, leaving many issues in the sector unaddressed. This prompted us to write a note of dissent.

Could you please elaborate the points in the bill with which you differ?

Education sector is entirely different from other sectors. Who is investing, who is studying and what quality is maintained affect the education sector. This is probably the only sector where teachers and students are not enough, the community is also involved. That’s why, this sector needs public investment and the government should take responsibility. To take such a responsibility, the government has to form a strong supervising organisation first. After forming such a body, we can bring in non-governmental organisations.

So far there’s no such provision. So the bill is being introduced to include that provision. However, the bill has not made public investment compulsory. It favours profit-oriented medical colleges.

Also, lawmakers of the ruling NCP say the agreement reached with Dr KC does not bar opening medical colleges outside Kathmandu valley. They say the Mathema report has also recommended opening medical colleges outside the valley. What is clear is that Dr KC is for opening medical colleges outside the valley, but only with government investment. After the government runs medical colleges outside the valley, private sector organisations will come to those places following the government’s footsteps.

Moreover, the bill states that Tribhuvan University and Kathmandu University should issue permission to open medical colleges outside Kathmandu valley. But can these universities monitor and ensure quality in such a large number of medical institutions?

NCP lawmakers are also spreading rumour that it is not possible to run medical colleges outside the valley, which is totally wrong. Purvanchal University was about to start issuing affiliations after Nepal Medical Council allotted it fifty seats, but it could not as it lacked faculty. If the government had strengthened these universities — Purvanchal University, Sudur Paschim University and Mid-western University — they could have run medical colleges. But they did not do so.

The hilarious thing is the bill proposes revolutionary provisions such as existing for-profit medical colleges should adopt not-for-profit or trust model gradually in the next 10 years. However, it also proposes that those who have invested money and acquired letters of intent should be allowed to make profit. You should take one side, not both.

You’ve also expressed reservations over the content of the bill’s preamble. Could you elaborate?

The agreement reached with Dr KC states the preamble should include the name of Mathema Commission. This is logical because the bill has been prepared on the basis of the Mathema Commission’s report. But out of the blue, the bill has proposed a medical university based on a report of a judicial commission headed by Gauri Bahadur Karki. So not including Mahema Commission’s name in the preamble is guided by the intention of including provisions recommended by various commissions, committees and task-forces formed in different times just for the purpose of justification.

Also, the bill is not clear what type of medical university it is. The bill has barred opening medical colleges inside the valley for the next 10 years, but it does not bar opening a medical university. Even Education Minister (Giriraj Mani Pokharel) was against such a provision. This is an opportunity for Prime Minister KP Sharma Oli, who signed the agreement with Dr KC, to implement it, and prove his critics wrong. He has the opportunity to head the commission and reform the sector. This will also provide him a great plank for the next general elections after four years. But it seems he is missing that opportunity.

As for difficulties in managing those colleges that have already acquired letters of intent, regional universities can be strengthened and those institutions can be issued affiliations.

What are the bill’s positive aspects?

Some of the positive aspects of the bill include provision of a high-level commission to oversee the medical education sector, including health-related programmes of CTEVT and moratorium on opening new medical colleges in the valley for the next 10 years. The bill has barred a university from issuing affiliations to more than five medical colleges. However, the government is not committed to implementing these positive provisions as is evident from the fact that the government has provisioned a medical university mysteriously.

What’s your take on Dr KC’s 16th hunger strike?

Let me not comment on the way he speaks or the language he uses. The movement would have gained more traction had he spoken properly. However, Dr KC is a different person. He is not fighting for individual benefit.

The government signed an agreement with Dr KC and it is in no mood to implement it. PM Oli has an opportunity as the parliamentary party leader of the ruling party. He can bring back the bill on the right track within a minute. The ball is now in the PM’s court. People say the NC is resorting to propaganda as it does not have any agenda. If this is the case, we will be left agenda-less if the PM solves this problem.

‘Don’t know why Dr KC is dissatisfied, bill fufils most demands’

What is there in the National Medical Education Bill that prompted Nepali Congress lawmakers to write note of dissent and Dr KC to start his 16th hunger strike?

The committee passed the bill after around 26 rounds of meetings in the sub-committee. We also held consultations with experts, stakeholders, and those who support and oppose Dr KC’s demands. Unfortunately, we could not hold consultation with Dr KC as he refused to talk. It was a lost opportunity for both Dr KC and the House committee.

The rationale behind introducing this bill is to resolve issues related to the medical education sector. The bill includes, in crystal-clear terms, some important points that Dr KC has raised. The bill has barred opening of medical colleges in Kathmandu Valley for the next 10 years. The deal with Dr KC states that medical colleges should be opened outside the valley. So the bill provisions at least one medical college in each of the seven provinces and those colleges should be run by the government. This means the government has to compulsorily open medical colleges in Province 2 and Sudurpaschim Province where there is no medical college.

The bill also provisions medical university. There is a trend whereby a university issues affiliation to medical colleges even if it does not have its own medical department. As for the notion that the government should run the health and education sectors — guaranteed by the constitution’s fundamental rights — it might not be practical for the government to do that immediately. But the government can do it gradually. For that we have requested medical colleges presently under operation to gradually adopt the not-for-profit model and convert into service-based institutions. We have given them 10 years for it.

We are of the view that institutions that have acquired letters of intent and have built necessary infrastructure should be allowed to operate, but they will be suspended if they fail to meet the set criteria and standards.

To avoid question paper leaks, the bill envisions integrated entrance exam system. Nepali students studying in Nepali colleges, foreigners coming to study in Nepal, and Nepalis wanting to study medicine in foreign countries should pass the Central Entrance System conducted by Nepal Medical Council. This provision will control quality. Now onwards, a medical college should have hospitals with at least 300 beds operating for at least three years. A high-level commission led by the prime minister has been proposed to oversee the health education sector.

Why did NC lawmakers write note of dissent and Dr KC start hunger strike?

They have expressed dissatisfaction mainly over three points. The first is related to phasing out short-term medical courses run by CTEVT. Dr KC has demanded phasing out of such courses within the next five years. Theoretically, there’s no problem. But practically, it may be difficult. So the bill has provisioned either phasing out, upgrading or scrapping after necessary study. We just added the word ‘upgrading’, and the rest is in line with Dr KC’s demand. We have not been able to figure out what’s wrong in upgrading a course if it is necessary.

The second point is related to the bill’s preamble. The agreement reached with Dr KC states that the preamble should include the phrase that ‘the bill has been drafted in the spirit of the Mathema Commission report’. But doing so is not in practice internationally. Also, no law in the country has so far included such a phrase.  The language was generalised.

There are several commissions, committees and task forces that studied the matter and came up with reports, such as that headed by Gauri Bahadur Karki. How could we only write one commission’s name? Although it is generalised, we have included the Mathema Commission in the preamble as per the agreement with Dr KC, but I do not know why NC lawmakers wrote the note of dissent.

The third point is the bill’s provision that universities can issue affiliation to only five medical colleges, but those who have already built infrastructure and taken letters of intent should be allowed to operate outside Kathmandu valley. This is just a one-time measure for those who have already invested a huge amount of money. It will not be good to inflict huge monetary loss on them.

I want to ask my friends from the NC what’s wrong in promoting investment. A huge amount of money goes outside the country every year in fees of students pursuing medical education abroad. Is it wrong to curb the monetary outflow?

Also, most of those studying abroad fail in the Medical Council examination, but more than 80 per cent of those studying in Nepal pass. I do not know if Dr KC does not understand this, or he is being provoked by others. As far as the NC is concerned, it also objected to the provision of medical university. There are specialised universities in other disciplines, such as agriculture and Sanskrit. So what’s wrong with medical university? I think they lack understanding.

The deal with Dr KC was registered in the Parliament. Why was it excluded from the bill?

As you know the Parliament is a different entity. It has its own functions and rules. The agreement also states that it will be implemented on the basis of parliamentary norms and values, and we have followed those norms and values. It is not that the Parliament should do whatever the government desires. If you look at the case of Supreme Court Justice Deepak Raj Joshi, the parliamentary committee rejected his nomination for the post of chief justice even though the Constitutional Council recommended him.

What’s your view on Dr KC’s hunger strike?

I think it’s time he celebrated because the bill has provisioned whatever he demanded. He should be proud of himself. I don’t know why he is staging another hunger strike again. He is using foul language against some prominent leaders. It is going to harm none other than him. But I want to tell the NC they should stop using Dr KC to serve their vested interest.