Adding medical colleges in Kathmandu doesn't make any sense

2015-03-22

Republica National Daily

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Adding medical colleges  in Kathmandu doesn't make any sense. There are already far too many. This is why the Institute of Medicine (IOM) faculty board is right to reject new applications for accreditation. Even now the IOM, which is tasked with granting affiliations to new medical colleges and monitoring existing ones, is overstretched. There are not enough boots on the ground to maintain oversight over its seven constituent and 16 affiliated campuses. 

If the goal of the promoters of these new colleges is to produce capable medical manpower, as they claim, why not open them in rural outposts where they are most needed? Even existing institutions in Kathmandu are struggling.

IOM monitors have found that many of them are short of doctors, educators and equipment. And at any given time, half the hospital beds in Kathmandu are vacant. In this condition, it isn't hard to see that money is the only motivating factor for these new establishments. But the sensitive health care sector, we are afraid, cannot be run with the sole goal of profit maximization.

It is troubling that Prime Minister Sushil Koirala has been putting pressure on IOM faculty board to agree to new affiliations, no doubt under the influence of the mighty medical mafia. Perhaps not to displease the prime minister, the IOM faculty board has decided against new affiliations, but just 'for the moment'. 

We fear the only reason the faculty board decided against new affiliations was Dr Govinda KC, the senior faulty at the Tribhuvan University Teaching Hospital (TUTH) who had threatened with (yet another) fast-unto-death if new colleges were accredited. Since the promoters of these colleges are adept at tugging political strings, everyone from the prime minster down, backdoor lobbying for new affiliations will continue.

To instill confidence in the people, more than verbal assurances, there must be policy-level changes that cap the number of medical colleges in the saturated urban markets. Private colleges should instead be encouraged in the under-served rural markets.

Another area of concern is the burgeoning cost of medical education, the reason so many vested interests want to get into this lucrative sector; an MBBS student currently fetches up to Rs 5-6 million. A thorough review of the cost of medical education is due. The fees of our medical colleges should not be prohibitively high. The current fee structure takes medical education out of reach of the vast majority of Nepalis. 

Yet another disturbing trend has emerged of late: even those who study on government scholarships are trying to evade the couple of years of mandatory service in rural areas after passing their MBBS exams. We are all for involvement of private sector in health care. But what we have seen in the last decade or so is the commercialization of medical sector run amok. Again, what is needed is a strong, rural-focused regulatory framework. It is shameful that Dr KC has had to repeatedly put his life on the line to prevent the few rotten eggs from violating the sanctity of the medical fraternity. He deserves more support.

Source: This editorial was published in Republica National daily on 20th March, 2015, entitled "Better without"