Reforming Medical Education

Mukti Rijal

Dr. Govinda KC has resorted to his oft repeated hunger strike this time, too. It is, in fact, fifteenth hunger strike staged by Dr. KC.This time he travelled all the way to Jumla for civic disobedience. It should have been presumably aimed to give new twist to his step by making it more pronounced reportedly in favour of the remote region of the country where health facilities are relatively meagre and health institutions of higher order do not exist. But he is transported back to Kathmandu the other day.
Whenever Dr. KC goes for hunger strike, it does grab the attention of all civic stakeholders and becomes a matter of headache for the government and politicians. It also impels one to raise question as to why Dr. KC is forced to resort to strike to get it across loudly that his demands to reform medical education have not been met despite agreements signed time and again in the past. It also indicates about the government apathy to implement the terms of the past accords agreed with him. This time the health ministry is headed by senior Madheshi leader Upendra Yadav and it is expected that he will step into centre stage to take lead to tackle the issues raised by Dr. KC and infuse fresh perspectives into the medical education and performance of public health institutions.

Discrimination
However, it looks like that he has not shown close much interest in it. The prime minister, other ministers and party leaders are actively defending the bill that has been already registered in the parliament and set to be deliberated soon. The bill, according to KC and those rallying behind him, is intended to grant affiliation to those proposed medical colleges that are being set up by the party colleagues or cronies. No matter Dr. KC complain or not, the state of public health service delivery is very poor in the country. The discrimination health service is evident in the fact that the leaders are sent overseas for minor check-ups at the expense of the state coffers, but poor people are suffering due to the lack of the provisions of the basic and rudimentary services at local hospitals especially in district hospitals spread across the country.
The poor people who land in the hospitals for medical services have not only to face hassles but are made to pay fees even for basic services that are declared to be free. And the doctors, medical personnel and nursing staff assigned and posted for the district hospitals are often found not attending their duties on a regular basis. The basic diagnostic equipment and appliances like X-ray tend to be allowed to go dysfunctional rendering the hospital assets non-performing and general services go bust. The medicines supposed to be distributed to the common people for free in line with welfare based health services policy of the government have been allegedly swindled and sold out through private medical outlets in the market. Not only the district hospitals but the performance of zonal hospitals is tardy and poor.
The responsibility for management of primary health care centres and health posts have been devolved upon the local government in line with the decentralised provision set forth in the constitution of Nepal. The decentralised service provision allows room for local monitoring and management of public health services in the country. Not only at the districts but the national level, public hospitals like Bir Hospital, Teaching Hospital and the Chitwan Cancer Hospital have not been doing well. The services especially in the Bir Hospital and Chitwan Cancer hospital have come under sharper public scrutiny. The nexus of the physicians working for the BP Koirala Chitwan Cancer Hospital and private pathological labs and clinics is said to be affecting the process of service delivery. Despite much hue and cry over the poor state of service delivery at Bir Hospital, it has not improved at all. The political meddling in the appointment of the doctors and executives in the Bir Hospital together with the discriminations and partiality in the provisioning and allocation of services have been central to the deterioration in the management of the nation’s oldest and premier hospital of the country.
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 that is central to the Dr. KC’s hunger strike t has emphasised on curbing the alleged unscrupulous practices entrenched in the field of medical education. The controversies often grip on the national parliament marked by much heated debate, too. Those lawmakers who have personal stake on the lures of the medical education have stood on the need to permit and grant affiliation to the medical colleges for the opportunity expansion.

Public initiative
Dr.KC’s hunger strike resorted to time and again has shaken not only the conscience of the medical fraternity but also the entire nation underlining the need for proper regulation and management of the medical education in the country. However, on the pretence of regulation and management of the medical education, there should not be unnecessary curbs and control to discourage the genuine public initiative in the expansion and development of medical education to cater to the needs of the country.

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