The government recently tried to expedite the process of endorsing the Medical Education Ordinance Replacement Bill by suspending a clause in the parliamentary regulation. It was later forced to backtrack following opposition from the Nepali Congress. The NC had criticised the move stating the new bill had removed some of the key provisions incorporated in the National Medical Education Ordinance introduced by the NC-led government. However, the government registered a new National Medical Education Bill in the Parliament on July 6 containing the same provisions in the bill that Dr Govinda KC and the NC had opposed. Ujjwal Satyal of THT talked to NC leader and former health minister Gagan Thapa about merits of the ordinance introduced in the past and why the new bill cannot introduce much-needed reforms in healthcare. Excerpts:

The government has registered a new National Medical Education Bill by amending various provisions of the National Medical Education Ordinance issued by the previous government. How do you assess the latest developments?

Generally, the government prepares the drafts of bills and tables them in Parliament for approval. The draft of the Medical Education ordinance, however, was not prepared by the government. This bill was drafted by a special taskforce comprising Kedar Bhakta Mathema, representatives of different universities, doctors, and other medical experts, including officials of the Health Ministry and the Education Ministry. A special taskforce had to be formed because of pressure from civil society.

The incumbent government has dropped some key provisions of the ordinance which completely undermines the task force’s recommendations. For example, the ordinance brought by Sher Bahadur Deuba government had barred the establishment of medical colleges inside Kathmandu Valley for 10 years. The provision was incorporated because the valley had plenty of medical colleges and allowing more colleges to be set up here would put the brakes on the establishment of such institutions in other parts of the country. There are 10 medical colleges in the valley at present, while Province 7 has no such institution and there are very few medical colleges in Province 6 and Province 2. Another reason why we are not in favour of opening more medical colleges in the valley is the limited number of patients. Medical colleges operate their own hospitals, where students can learn practical lessons. But due to overcrowding of medical colleges in the valley, many have started facing problems in attracting patients. Shortage of patients has hit the learning process leading to the generation of low-quality students. This ultimately hits the quality of healthcare service in the country. This is the reason why it was recommended that a university should be allowed to provide affiliation to a maximum of five medical colleges. This provision has been changed in the new Medical Education Bill proposed by the Oli-led government.

Is there any guarantee that incorporation of provisions recommended by the Deuba government would overhaul the country’s healthcare sector?

I can’t say that for sure. But it would be a stepping stone towards reforming the country’s healthcare sector. If recommendations made in the past are not included in the new bill, 10 to 12 more medical colleges and thousands of other technical medical schools, which can be set up after getting permission from the Council or Technical Education and Vocational Training will emerge in the valley. Overcrowding of medical schools in the valley will eventually lead to a decline in the quality of the country’s medical sector.

It is said government hospital doctors and medical students studying on government scholarships don’t want to work in hospitals in rural areas. What is your take on this?

The government spends up to Rs 10 million on each undergraduate and post-graduate student who bag scholarship. This is a big investment. We want these professionals to work in hospitals that lack basic facilities. This is not fair because the working environment in such places is not conducive. If doctors cannot practice in a good environment, they tend to seek work abroad. This is a disadvantage for the country as the knowledge doctors have acquired goes in vain. That is why we should focus on building a limited number of well-equipped hospitals at medical colleges where doctors can fully utilise their expertise. If we can do this, doctors will happily go to far-flung areas.

Is medical education only limited to doctors, medical colleges and hospitals? Shouldn’t it focus on health assistants and health posts as well?

The ordinance brought by Deuba’s government was named United Medicine Education Bill. It has been changed by the incumbent government. That draft had taken a holistic approach to reform the healthcare by incorporating provisions on the proper education of nurses, health assistants, lab technicians and other health service providers. We had also envisioned the establishment of healthcare centres at the local level and divided roles and responsibilities accordingly. The new bill has removed those provisions.

Why do you think the government is hell-bent on quashing the recommendations made by the previous government?

Nepal Communist Party (NCP) leaders are under pressure to provide licences to some medical colleges that have acquired Letters of Intent from the government, including Manmohan Medical College and National Medical College.

These permissions cannot be provided unless the provision barring new medical colleges for ten years in the valley is removed. Similarly, the recommendation allowing each university to provide affiliation to a maximum of five medical colleges will come in the way of establishing the Jhapa-based  B and C Medical College Teaching Hospital and Research Centre, which has initiated the process of getting affiliation from Kathmandu University. Also, the recommendation preventing the establishment of medical colleges that have not operated a hospital for a period of at least three years will put the brakes on the plan to establish Manmohan Medical College.

There are now rumours that groundwork is being laid to transform BP Koirala Institute of Health Sciences into a university with the sole purpose of enabling it to provide permission for the establishment of medical colleges. So the ruling party is misusing its two-thirds majority in Parliament to protect the vested interest of a few.

So, what is the NC planning to do to prevent the ruling party from misusing its majority in Parliament?

We will not accept the new bill in its current form. The ruling party needs to understand that the previous bill drafted during Deuba’s government was framed because of calls from civil society to introduce reforms in healthcare. The ruling party also needs to understand that the previous bill was framed after thorough discussions and research of seven to eight years.

Is the National Medical Education Ordinance brought by Deuba government ideal?

Provisions contained in the ordinance will help better manage the entire healthcare sector. At present, around 2,000 to 2,200 students complete MBBS every year. Of these, only 400 to 500 become medical doctors (MD). So, there is a big gap in the creation of medical specialists. The bill has proposed to pave the way for the National Academy of Medical Science to enable zonal hospitals to produce medical specialists. There are other provisions as well to improve the medical sector.

Why didn’t the NC-led government introduce the law instead of introducing it as an ordinance?

We could not, because the speaker of the House didn’t enrol the bill in Parliament’s business schedule and only two days were remaining for automatic dissolution of the House. Our coalition partner, the erstwhile CPN-Maoist Centre, also was not supportive. That’s why the law was introduced in the form of an ordinance.

So, how can all these issues, including Dr Govinda KC’s demands, be resolved?

The only way is to incorporate the provisions of the ordinance into the new bill.