A high level task force analysed health and development in Nepal in 2015 and came up with a load of recommendations to improve medical education in Nepal primarily in the next ten years.
However, it appears that the analysis overlooked demographic dynamics and health and development. More importantly, some of the recommendations are in conflict with the fundamental rights of Nepalese citizens laid down in the Constitution of Nepal 2072.
During the last 60 years, Nepal has made tremendous improvement in mortality.
The infant mortality rate and life expectancy at birth have improved—infant mortality has gone down by more than 450%, and life expectancy has increased by nearly 140%.
Interestingly, the pace of decline of IMR was faster – 2.8 infant deaths per 1000 live births, during the period following the restoration of democracy in 1990 than during the 30-year of Panchayat regime – 1.9 infant deaths per 1000 live births.
Similarly the pace of increase of life expectancy was faster, 0.7 year per year after 1990 than during the non-democracy period, 0.5 year per year.
The achievements of the health sector have been well recognized nationally as well as internationally and they are attributed to the concerted efforts and investments made by the government, UN bodies, NGOs, INGOs and the private sector.
Nevertheless, these indicators are still not very good by world standards and a lot of investment has to be made to improve the health of the people of Nepal.
In addition, although Nepal was successful in meeting many of the MDGs, including health goals, but now we have to work harder to achieve the ambitious SDGs by 2030.
In 2015 a “National Medical Education Policy Formulation High Level Task Force Report 2072” was published by the Government of Nepal. The report has reviewed and included some analysis of the health sector with special focus on medical education.
It discusses equity, inclusive development, disparities in access to health services and mentions government of Nepal’s commitment to health for all.
The report clearly shows concerns for quality medical education which appears to deteriorate with the ever increasing number of medical colleges.
Lack of government regulations to check the quality of medical teaching and learning are also well echoed.
Based on the analyses the report has made recommendations with respect to affiliation, size of students in a medical school, fees, new or specialized programmes, curriculum, teaching methods, institutional accountability and geographic distribution.
Overall, these recommendations are good but they tend to indicate that medical education is the responsibility of the government alone.
The report is silent on the role of the private and the non-governmental sectors although it is clear that remarkable progress made in the health sector following the restoration of democracy is attributed significantly to the efforts of these sectors.
Some of the recommendations are regressive and undermine the spirit of the fundamental rights of citizens.
For instance, recommendation 2.1 states that in the three districts of Kathmandu valley no new medical, dental or nursing schools shall be allowed to open in the next ten years.
If this is adopted, the citizenry of Kathmandu valley or for that matter of the whole country will have their access to health services diminished.
The valley has witnessed the highest average annual growth of population during 2001 to 2011 at 4.25% compared to 1.35% for the country.
The Task Force report puts 0.9 beds per 1000 population in 2006, and if this is broken down by Kathmandu valley and the rest of the country the corresponding figures become 2.9 and 0.6 beds per 1000 population.
If recommendation 2.1 is adopted by the government and if the rate of growth of population continues to increase at the same pace Kathmandu valley is likely to witness 1.6 beds per 1000 population, the rest of the country 0.5 and the country as a whole only 0.7 by 2016. Is it not regressive?
Producing more medical graduates would contribute to doctor population ratio over the years. In Nepal, doctors per 1000 population have increased substantially from 0.01 in 1960 to 0.05 in 1990 and further to 0.21 by 2006.
If an increasing number of medical graduates is not produced this ratio will be stalled; and aspiring students will have to look for admission outside the country.
Recommendation no. 2.10 lays down that in one district not more than one medical or dental college can be opened. This is absurd. According to recommendation no. 3.4, a medical college should not be allowed to admit more than 100 students at a time.
This is also a blanket recommendation because the number of seats in a college depends on classroom size, size of medical infrastructure, teacher student ratio and so on.
A number of recommendations that the report has made for the improvement of medical education contradicts the fundamental rights of the citizens of Nepal.
The Government advocates Public Private Partnership but the recommendations, if adopted without scrutiny, will discourage the private sector and the citizenry will be left to depend totally on public funding.
The Government’s ways of administering service to the public is not up to expectations, albeit, it is slowly improving.
Karki is a former member of the National Planning Commission.
A version of this article appears in print on August 18, 2016 of The Himalayan Times.
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