Regulating Medical Services Key To Curbing Unethical Practices


Mukti Rijal


A news item published in a national daily the other day  reported the sordid state of services in the district hospital of Siraha. The patients who arrive in the hospital for services have not only to face hassles but are made, according to the news item, to pay higher fees even for basic services that are either  free or available for a nominal fee. The report complains that not a single department in the hospital functions properly. And  the doctors and nursing staff assigned and posted to the district hospital are found not attending to their duties on a regular basis.

What is dismaying is that the basic diagnostic equipment and appliances like X-ray machines have been allowed to go dysfunctional, rendering the hospital’s services to go almost bust. The medicines supposed to be distributed to the common people for free, in line with the free health services policy of the government, have been allegedly swindled and sold through the medical outlets in the market.


State of district hospitals

It is reported that except for the cotton pad, nothing is distributed without payment in the district hospital. The Siraha district hospital indeed represents the state of service delivery in the district hospitals across the country where the ordinary and indigent people visit for all kinds of medical care and services.

The performance of the zonal hospitals is similarly tardy and poor while primary health care centres, health posts and sub health posts are not doing any better even though primary health care is a devolved subject allowing room for decentralised monitoring and local management innovation.

Not only the district hospitals but even the national level public hospitals like the Bir Hospital, Teaching Hospital and the Chitwan Cancer Hospital have not been doing well. The services at the Bir Hospital and Chitwan Cancer Hospital have come under sharper public scrutiny. The nefarious nexus of the physicians working at the BP Koirala Cancer Hospital in Chitwan and private pathological labs and clinics is said to be affecting the process and outcome of service delivery. Despite much hue and cry over the poor state of service delivery at the Bir Hospital, it has not improved at all.

Political meddling  in the appointment of the doctors and executives at the Bir Hospital together with the discrimination and partiality in the provisioning and allocation of services has been central to the deteriorating management of the nation’s oldest and premier hospital of the country.

At the broader national level too, there has been the long unresolved dispute on the modality, character and management of medical education. The entire medical personnel and doctors are split on several issues including the mode of medical education in the country.

The Mathema panel report, which  has emphasised on curbing the alleged unscrupulous practices entrenched in the field of medical education, stoked the fire of controversy, throwing the government in a dilemma. The controversy has even gripped the national parliament. Those lawmakers who have a personal stake in the lucre and lures of medical education have stood on the need to permit and create an enabling  environment for the expansion of medical colleges while others have argued for regulating it fairly to ensure their quality and development.

Govinda KC’s hunger strikes, resorted to time and again, have shaken not only the conscience of the medical fraternity but also the entire nation, underlining the need for proper regulation and management of medical education in the country. However, under the pretence of regulating and managing medical education, there should not be unnecessary curbs and control to discourage the genuine public initiatives to expand and develop medical education to cater to the needs of the country. Needless to repeat, the nation has been draining off huge resources outside the country to train doctors for the country.

The uglier face of the medical community came to the fore recently, especially following the arrest of 15 medical doctors from various parts of the country. It is reported that the Central Investigation Bureau (CIB) team in coordination with the district police offices arrested nine doctors from Birgunj, three from Biratnagar and two from Chitwan.

It is claimed that the arrests are part of the police’s Operation Quack, under which the CIB had also arrested, during the previous months, seven doctors for allegedly  possessing fake academic certificates. It is alleged that majority of the arrestees possess fake SLC and higher secondary level certificates.

There may be disagreement over the way the doctors were rounded up and detained, but the operation against the physicians for possessing counterfeit certificates should be commended and welcomed. The disclosure that the doctors, who are well placed and respected in the society for their services and contribution, have been involved in such grossly unethical and abhorrent practices is something to worry about.


Review medical education

If those who are trusted as the savior of lives are themselves found indulging in abominable practices, there cannot be a bigger criminal breach of ethics than this. In case those alleged are found culprits they should be punished severely to deter and prohibit such counter practices and indulgences in the days to come.

Finally there is an urgent need to review the entire spectrum of medical education and medical practices to ensure that the malpractices and criminal negligences do not seep to destroy their vital organisms.



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