Nepal Needs More Doctors

Pradipna Raj Panta

Medical education in Nepal is grappled with various challenges. Currently, there are 20 medical colleges in the country (5 public and 15 private). According to the latest data, around 11,000 students are studying in all medical collegeswhile an estimated of 5, 000 have gone are abroad to pursue the higher medical study.
The country has recently witnessed the proliferation of medical colleges. With the restoration of multiparty democracy in 1990, the then government pursued an open-up policy, paving the way for the establishmentprivate medical colleges, and now nearly two dozen of medical colleges are in operation. But such colleges’ remains highly controversial as these private medical institutions are not contributing toquality medical education, and are only concentrated in Kathmandu and a few metropolitan cities, ignoring the theory of demand-driven development. Moreover, they have commercialised medical education to the extent that even a mediocre studentcan become with a fat wallet but a talent student is deprived of opportunity.

Fraudulent practice
In addition, fraudulent practices and rampant corruption in private colleges have been frequently reported in the media. They reported that in order to pass inspection, theprivate medical colleges recruit the doctors from government hospitals and neighboring countries to stand in as faculties. Media also reported that healthy people (or what called khade baba ) are rounded up to pretend to be sick during inspection so that private medical college can show they have enough patients to provide clinical exposures to medical students.
Also, paying bribes in the form of donations is very common in private medical colleges. Some private colleges frequently charge under-the-table for admission. The illegal capitation fees may range from Rs 3.5 million to crore. The existing regulation in relation to medical education in Nepal has many loopholes that enable even those collegessand proper facilities secure affiliation. This has posed a big hurdle to impart quality management of medical education.
Despite poor quality of medical education, the students aspiring to be doctor are very high. According to Ministry of Education, nearly 15,000 students appeared for MBBS entrance exam this year but the total number of seats stands only 1,900 in the nation. This means that only less than 13 per cent of the total students geta chance to study MBBS. The Institute of Medicine, Maharajganj, considered the best undergraduate medical school in the country, enrolls only 76 students out of over 11,000 vying for the medical study.
A recent study has stated that patient-doctor ration is 1,721:1people and one nurse for every 500 people. Though Nepal has 20 medical colleges, the small graduate class strengths (90-120 students) create major problems for a population of Nepal. Doctor-patient ratio is less than the WHO-prescribed limit of 1:1000. What this means in practice is that Nepal has now acute shortage of doctors. This requires that the government should increase quota for medical study to provide quality health service to the populace.
At present, two different opinions can be found about the medical education. One argues that Nepal needs more medical colleges as more than 1,000 students go abroad for medical study. Of them, more than 500 students complete the MBBS study. Some others argue that there is no need for the expansion and increase in the number of medical colleges as existing colleges are not up to the mark when it comes to imparting quality medical education. Which argument should we accept?Are we talking about the same subject because the word ‘quality’ may be perceived differently by different people in different cultures? Furthermore, do we have clear understanding of meaning and propose of medical education and their relevance to health care management in the nation?
Undoubtedly, medical education is essentially linked with health care management of the nation. And health care management does not have a concrete path. There are some external dynamics, including their histories, development status, political economy, culture, level of technological development, and demographical constitution. There are some internal dynamics that demonstrate differences, including organisations’ functioning and effectiveness.
Also, health care system is not a logic-based policy. It is not like 5 medical colleges in particular district and no college in another district but it is an idea based on the ground reality of the nation. A national health care system cannot be isolated entities because they function within larger context. They are not static but constantly evolving. Therefore, it is paramount importance for both government and other stakeholders, including opposition party and activists, like Govind KC to understand ground realities of the nation if the outcome is to be successful. Imitating policies of countries with well-functioning systems, without considering the local realities, may not work. Whatever the intention of discourse on the matter, Nepalneeds both quantity and quality of doctors in the future.

Way forward
Producing enough doctors as well as meeting the global standards of medical education is crucial to the health and well-being of the country. To achieve excellence in medical education, all stakeholders of Nepal’s health care management need to substantially rethink and reevaluate all aspects of its prorgammes, createan efficient accreditation system; promote an equitable distribution of resources, redesign curricula and entrance examination system with stricter implementation and improved methodologies. This will generate competent medical graduates, and enhance health care management. This calls for sincere role of government, people, health activists, universities, faculty and students. The risk posed by reckless commercialisation of medical education has to be warded off and efforts should be made to ensure maintenance of global standards and check the unplanned growth of substandard medical colleges.

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