‘Nationalisation of private medical colleges won’t solve problem’

Dr Govinda KC, who has been seeking reforms in the medical sector, broke his 27-day hunger strike on Thursday after the government agreed to address all his demands, including revising the National Medical Education Bill. The senior orthopaedic surgeon has long demanded that a moratorium of 10 years be put on opening of new medical colleges in Kathmandu valley, each university be allowed to provide affiliation to a maximum of five medical colleges, and new medical colleges be allowed to start operation only after operating a hospital for a period of three years. The government, under pressure from Dr KC, has agreed to incorporate these demands in the Bill, which has been tabled in the Parliament. Rupak D Sharma and Ujjwal Satyal of The Himalayan Times caught up with Prof Kedar Bhakta Mathema, former vice-chancellor of Tribhuvan University and ex-Nepali ambassador to Japan, to discuss the relevance of Dr KC’s demands and problems Nepal’s medical sector is facing. Excerpts:

Dr Govinda KC broke his hunger strike last week after the government agreed to address all his demands. Since then, the National Medical Education Bill has been tabled in Parliament and amendments are expected to be made to it as per Dr KC’s demands. What do you have to say about these developments?

Dr KC had to stage hunger strike for 27 days to make his demands heard. Although it took time for the government to respond, I am happy the ruling Nepal Communist Party (NCP) has finally taken ownership of the medical education bill. With this, all major parties are now on the same page in terms of addressing Dr KC’s demands, as opposition Nepali Congress, the second largest political party, had lent support to issues raised by the senior orthopaedic surgeon. So, I’m optimistic that the process of addressing Dr KC’s demand will go smoothly henceforth.

The government signed a nine-point pact with Dr KC to end his hunger strike. Was the agreement sealed with sincere intention of introducing reforms in the medical sector or just to break Dr KC’s fast-unto-death as his demise could have dealt a severe blow to the ruling party?

Demands for medical sector reform raised by Dr KC are in line with the NCP’s election manifesto, which envisages the creation of a socialist state. Prime Minister KP Sharma Oli, who is also NCP co-chair, had recently told me that a socialist state cannot be built overnight and health and education sectors have to be prioritised to meet this goal. These examples show that Dr KC’s demands and NCP’s ideology are similar. Yet NCP failed to acknowledge this. But in the final days of Dr KC’s hunger strike, PM Oli realised that Dr KC’s demands were not inappropriate.

So you think the agreement was signed with the intention of introducing reforms in the medical sector?

During one of our meetings, PM Oli had quite clearly said he did not object to any of the key demands raised by Dr KC. He was also of the view that no compromise should be made to ensure delivery of quality education and healthcare services to the general public.

If the PM was so serious about delivering quality education and healthcare services why was he publicly vilifying Dr KC? And why did he take so long to address Dr KC’s demands?

I think this was because of certain interest groups surrounding PM Oli. But later, some of the left-leaning intellectuals started expressing solidarity with Dr KC’s key demands. That was when senior NCP leaders started looking into Dr KC’s demands more objectively. At the same time, NCP leaders were also suspicious about some people who were representing Dr KC, including me. We had expressed our opinions impartially and were not influenced by any particular group. All we want to see is the formulation of public policies through research and recommendations of experts so that they could benefit the country.

Everyone knows that Dr KC’s latest hunger strike was his 15th since July 2012. He has been forced to stage fast-unto-death repeatedly because of delay in implementation of agreements signed with him. Will the agreement be implemented this time?

Actually, some of the issues raised by Dr KC have been addressed. For instance, students who have completed medical education from here or abroad must take entrance exams before becoming eligible to practise medicine. Nowadays, students are also selected for medical education on the basis of merit rather than their ability to pay fees. These changes occurred because of Dr KC. He had no option but to resort to a hunger strike because the country’s medical education sector is replete with problems as a result of mushrooming medical colleges. We wouldn’t have faced these problems had the government been on the driving seat in the operation of medical colleges as in Canada. This, however, should not mean the role of the private sector in the development of Nepal’s medical sector should be undermined. The country now has a good number of doctors because of the private sector’s contribution, which is a good thing.

But are you hopeful about the implementation of agreements reached with Dr KC, which, many believe, would be a starting point for undoing past mistakes?

The government is now at a crossroads. It has the option of framing public policies to benefit the country or to fulfil the vested interests of particular groups. We need to see how the government charts its course. Once the National Medical Education Bill is introduced, a powerful commission will be formed to oversee the entire health sector. If the government is able to choose the right person to head the commission, the health sector of the country will definitely improve. So, civil society should also be vigilant and remind the government not to make blunders.

The National Medical Education Bill has barred each university from providing affiliation to more than five medical colleges. There are concerns the country may not have an adequate number of medical colleges in the coming days, as Tribhuvan University and Kathmandu University, the only universities that are currently providing affiliation to medical colleges, have exceeded this quota. What is your take on this?

Currently, universities are granting affiliation to medical colleges for the lure of money. I had talked to high-ranking officials of universities when a commission was formed under me to prepare a report on health professionals’ education. During these discussions, they said they did not have an adequate number of human resources to monitor and supervise activities of more than three colleges. Despite this, we allowed each university to provide affiliation to five colleges. So, the number did not come out of thin air.

Talks about nationalisation of private medical colleges also did the rounds on the pretext of improving the quality of medical education and healthcare services. Is this possible because Industrial Enterprise Act bars nationalisation of private enterprises?

I do not think the government has resources to buy all private medical colleges. The report on medical professionals’ education prepared by the commission formed under me had not made any recommendation on nationalisation of private medical colleges. Yes, colleges can be operated under public-private partnership. But what is crucial is that the government needs to monitor the activities of all colleges whether they are private or public. Many private medical colleges in the country are not up to the mark because they have not been monitored and supervised properly. This is where we lag behind. So, the nationalisation of private medical colleges will not solve the problem.

The situation of medical education was not like this when you were vice-chancellor of Tribhuvan University from 1991 to 1995. What happened over the years?

This is what happens when politicians collude with the private sector to serve their own interests. Today, you need to be loyal to certain politicians to bag the post of VC of a university.  These politicians then exert undue pressure on everyone from VCs to professors to serve their vested interest. I was under similar pressure when I was VC of TU. But I did not succumb and gave no affiliation to medical colleges because they lacked capacity. That was when the government used Kathmandu University as a tool to provide affiliation to medical colleges. Despite this, NCP leader Yogesh Bhattarai is spreading rumours that I extended the licence to six medical colleges. This is false. So, politicians should not meddle in the works of experts, technocrats and academicians. If they continue to do this, universities will not be able to generate quality human resources and they will cease to be the reservoirs of knowledge.

Lastly, what are the flaws in Nepal’s medical education?

First is quality. In Nepal, medical students who have passed the MBBS must sit for exams to be eligible to practise medicine. Recently, around 44 per cent of medical students failed the written examination. Had we conducted practical exams, more would have failed. Medical students need to practice to hone their skills. That’s why medical colleges need good hospitals with lots of patients. I have seen around 30 nursing students queuing up to see a doctor injecting a patient. Students can never inject a patient unless they are allowed to perform the job on a human being. That’s why we have recommended a moratorium on opening new medical colleges in Kathmandu valley because many teaching hospitals in the valley do not have adequate patients. So to enhance the quality of medical education, colleges need to have hospitals with lots of patients. Second is access. Medical education is not only for the privileged ones. Even a brilliant, bright and smart student from the low-income group should get the opportunity to study medicine. This is where scholarships play a role and we have recommended this as well.