What after MBBS? This is the most common question a medic asks himself during his medical school. One wonders whether to write USMLE, or PLAB, or to pursue medical practice in Australia, or to get some experience as a house ofﬁcer in some private institutions of our own country. But, what about serving the nation through the government service? We believe that the country has just stepped into the new era and everyone is dreaming of the “New Nepal”. To make the change, we have to think differently. Now the time has come for the new doctors to really consider the government service as a preferable option. In the other hand, the government should be able to attract doctors by providing better working environment and better opportunities.
Why a new doctor prefers not to go into the government service? Not knowing much about the government service is one of the reasons for that. This article explains how a medical doctor can enter into the government service and progress through it.
How to enter?
When a post of a doctor falls vacant in any government hospital or Primary Health Centre, the District Public Health Ofﬁce sends the notice to the Ministry of Health and Population which, in turn, sends the demand to the Public Service Commission. The commission asks for the application from the eligible MBBS (or equivalent degree) doctors through the newspapers. All Nepali citizens, who have completed their MBBS degree from a recognised institute, who are registered in the Nepal Medical Council and who are 21 years or more are eligible for the job. The commission announces the date of the exam. There should be a minimum period of 35 days between the issue of request for application and the date of exam. The exam comprise of written exam (200 marks) and interview (30 marks). The written exam includes two papers; paper one being Multiple Choice Questions (100 marks) and paper two being subjective questions (100 marks). The written exams can be taken either in Nepali or in English language. The syllabus for the exams can be obtained from the commission’s website- www.psc.gov.np.
According to the merit list published by the commission, the Ministry of Health and Population appoints the doctors as the medical ofﬁcers, a post of the 8th grade of the government service hierarchy and one becomes the permanent employee of the government 1, 3.
Appointment and transfer
According to the demand, the ministry sends the newly appointed medical ofﬁcers to various places of the country. The country is divided into very rural, rural and urban regions according to the access to the health services. All the rights of the transfer are held by the ministry but there are certain criteria to be fulﬁ lled. Once the medical ofﬁcer completes one year in a very remote area, he will not be sent to a very remote area for the next four years3. If both the husband and wife are in government service, then the ministry will try to post them in the same district3.
Leaves and vacations
There are provisions for various leaves in the government service. The medical ofﬁcer gets 12 days of casual and festival leave in a year during which he will be given the salary3. Similarly, he gets a day of home leave per 12 days of work, during which, he will be paid his salary3. He gets 12 days of sick leave in a year. If he needs more sick leave, then he will be given another 12 days from the next year and he will not get sick leave the next year. Similarly, he can get more leave of up to 45 days which will be compensated from his home and sick leaves of the future years3. Due to the chronicity of the disease, if this is not enough, then he can get extraordinary leave of up to one year, but during this he will not be paid3. Unlike other leaves, sick leave, if not used gets added up for the next year. If the medical ofﬁcer needs more than 7 days as a sick leave, then he has to submit the medical documents proving his illness3.
The females get a total of 60 days of maternity leave during the perinatal period and this leave is provided only twice in the entire service period3. According to ones religion, if the medical ofﬁcer has to attend special rituals on the death of his family members, then he is given 15 days of funeral leave3.
If the medical ofﬁcer gets into the merit list in the exams held by the government or gets scholarship for the post graduation degree available for the government in various institutes in and outside the country, he gets the study leave of maximum 6 years, during which, he continues to get his salary1. If he wants to have post graduation degree on private efforts, then also he gets a maximum of 6 years as study leave but during this period he will not be paid3. Only after one year posting at very remote region and two years posting at remote region, one becomes eligible for the study leave. But for the scholarship in the institutes within the country, even one year experience at very remote region or two years experience at remote region will be enough to become eligible for the study leave1, 3.
If the medical ofﬁcer can convince the government with good reasons, then he gets a maximum of 3 years as extraordinary leave3. Only after ﬁve years of service, one becomes eligible for the extraordinary leave, but if one wants the extraordinary leave for having post graduation degree on private efforts, then only two years of service will be enough for the eligibility3. The government will not pay the medical ofﬁcer during his extraordinary leave.
When a post becomes vacant in the service, all the individuals who are working one level below and who have completed 3 years of government service in that level, including 2 years in the remote region, become candidates for the promotion to the post3. Promotion is done on the basis of work ability, which includes the evaluation of work performance (40%), seniority (20%), work in various regions-very rural, rural and urban (25%) and qualiﬁcations and trainings (15%). An evaluation committee evualuates the work performance of the candidates and maximum of 40 points are allocated for the work performance1. Regarding the seniority, one gets 2 points for each year he has spent in the current post (maximum of 16 points) and a half point for each year he has spent in the post one level below (maximum of 4 points)3. Similarly, he gets 4 to 5 points per year of his experience in very rural region, 2.5 to 3.5 points per year of his experience in rural region and 1 to 1.5 points per year of his experience in urban regions3. As the evaluation of qualiﬁcations, one gets 8 points for his MBBS degree and gets 2 to 5 more points if he has accomplished diploma or post graduation3. All the points are added up and the candidate with the highest point gets promoted.
Salary and allowances
The scale of the salary will be as designated by the government. Each month, an amount of 10 % of his salary goes to the provident fund after the amount being made double by the government1. The government personnel get festival allowances equal to their monthly salary during their major festival according to their religion1. If the personnel are working in the area where they are unable to do their private practice, then they get local allowances by the government3. Similarly, they get over time allowances for the work time more than that allocated by the government3.
Whenever the medical ofﬁcer or his family member gets sick the government covers the medical expenses upto the amount equivalent to his one year’s salary3. Various expenses covered by the government are doctors’ fee and drug expenses, hospital admission fee, operation charges except for plastic surgery and travelling, lodging and fooding expenses of the patient and one of his relatives (as a patient party) if the patient pursues treatment in foreign country3.
Post graduation and other trainings
After two years of service at remote region or one year of service at the very remote region, the medical ofﬁcer becomes eligible to ﬁght for the government seats for the post graduation degree in the government institutions of the country1. When the seats for post graduation degree are provided to the government by the foreign institutes, the ministry publishes a notice requesting application from the government medical ofﬁcers. Among the applicants, the selection is done by the ministry following the criteria similar to that for the promotion.
For the skill development of the medical personnel, the government frequently coordinates trainings for them. National Health Training Centre, Teku, has the responsibility of coordination and certiﬁcation of these skill development trainings4. These trainings are done either under the funding of the government or under the funding of external development partners like World Health Organization, UNICEF, USAID and so on. During the trainings, the trainees are given the training allowances apart from their normal salary. After the appointment, the medical ofﬁcer is given orientation and medicolegal trainings of 30 days including the autopsy. During the service, he is provided with management, leadership and skill based trainings. The trainings in Skill Birth Attendant, Comprehensive Abortion Care and Post Abortion Care are given at the maternity hospital.
Trainings in family planning including vasectomy and minilap is provided by the Family Planning Asociation. At the Bir Hospital, trainings in emergency and burn care management and disaster management are provided. Epidemiology and Disease Control Division, Teku, provides the training in the management of tropical diseases. Training in the management of leprosy is given at the Anandban hospital, Lalitpur. Child Health Division, Teku, provides trainings in Control of Diarrhoeal Disease, Acute Respiratory Infection and immunization. National Centre for HIV/AIDS and STI’s Control, Teku, provides training on HIV/AIDS. Similarly, Ultrasonography trainings are provided at the Bir hospital, Tribhuvan University Teaching Hospital and the Patan Hospital.
Retirement and pensions
After attaining the age of 60 years or after completing 5 years of service in 12th level of the government health service, the personnel get retired1. The service period can be extended for three more years if the government needs their skills and speciality1. After working for 20 years in the service, one becomes eligible to get pension during his retirement life1. His monthly pension amounts to his total service period (in years) times his monthly salary at the end of his service period divided by 501.
In the government service, one enjoys job security, better opportunities for further study and trainings, and pension after retirement. Still, most of the new doctors pursue their career in foreign countries and remaining few stick to the major cities of the country. This is because the lack of infrastructure and equipments in the periphery imposes fear of blunting the knowledge gathered during the MBBS studies.
All the tertiary centres are in the major cities. In the cities the doctor can earn more, learn more, can communicate well with the post graduate institutions and can prepare well for the entrance examinations for the post graduation studies. Besides, the bureaucratic complications and political inﬂuences prevailing over the government service and lack of security of government personnel in the periphery make the government service a non preferable option for the new doctors. If the government can work on these things and create a working environment, then we will certainly have many more doctors applying for the government service. After all, everyone loves to serve his nation.
This article was originally published by Ajay Dhakal and R Sharma in Kathmandu University Medical Journal few years ago.
Correspondence Dr. Ajay Dhakal
Kathmandu Medical College
1791, Surya Bikram Gyanwali Marga Kathmandu, Nepal