After Dr Govinda KC’s fifth fast-onto-death in 2014, the then government had formed a high-level commission under former TU Vice-chancellor Kedar Bhakta Mathema to suggest improvements in medical education. The committee submitted its final report in June 2015. Among its key recommendations were decentralizing medical education away from Kathmandu and capping the number of medical colleges that a university could grant affiliations to. But the version of the Medical Education Bill now in the parliament violates many of the commission’s key recommendations, which is why Dr KC is now on his 16^th fast-onto-death. Biswas Baral and Kamal Dev Bhattarai spoke to Mathema on what he makes of the unfolding scenario.  

Dr KC is on his 16^th fast. Why does he have to do this again and again?  

All parliamentarians know that the earlier version of the Medical Education Bill was prepared on the basis of our report, which aims to ensure the welfare of all citizens. My understanding is that the bill was modified to protect the interest of some private investors.  

Which are the most worrying modifications to the proposals made by the Mathema committee?

We had proposed that one university not be allowed to grant affiliation to more than five medical colleges. Otherwise, medical education will be compromised. TU and KU granted many affiliations but they failed to ensure necessary support and monitor mechanisms for these colleges. That is why there are lots of anomalies in the medical education sector.

What sorts of anomalies?

There are concerns that private colleges are conducting exams with nominal representation from the university they are affiliated with. Tribhuwan University and Kathmandu University have failed to properly supervise colleges under their watch. Each year, they have to conduct two exams but they don’t have adequate staff to do so. KU has provided affiliations to 11 colleges and TU to 10 colleges. We recommended only five affiliations for each. In fact, in the committee level discussions, we held that universities can handle no more than three affiliations.

We are not against opening medical colleges outside Kathmandu valley. There should be medical colleges in strategic locations outside the valley. But we need to develop a support system to assist those institutions. Just opening new medical colleges won’t do any good if our support system is weak.

What other tweaks have been made to the earlier Medical Education Bill?

We are of the view that the intermediate level should be abolished within five years. But the ruling party lawmakers want to continue the intermediate CTEVT program. Likewise, the parliamentary committee overseeing the health and education sectors wants a separate medical university. But how did this concept of a medical university come about? Which experts were consulted?

Many MPs have a direct stake in private medical education. Given such blatant conflict of interest, is there a way to ensure quality education?

I have a lot of respect for the parliament and its members. I also understand the supremacy of parliament. But laws should not be formulated to protect certain investors. Those should be impartially formulated, keeping the interest of the people and the country front and center. People who understand this issue should speak up because we are talking about the health of all Nepalis.  

Why is sustained civic activism on medical education reform missing?

Thomas Jefferson said if you want democracy, you have to be ready to pay the price of eternal vigilance. The vigilance is brought about by writers, the media and civil society. People are busy with their own lives. Civil society could be more vocal about important issues like higher education, deforestation, loss of public lands, growing pollution and medical education.  

How do you suggest the parliament should address these issues?

There are two parts. First, we humbly request the parliament to endorse the bill without distorting the spirit of our report—something that has been widely discussed among parliamentarians. Second, the government has inked a deal with Govinda KC. The government will face a crisis of credibility if agreements with Dr KC are breached. People may stop trusting the government. The agreement was signed in the presence of top ruling party leaders. PM Oli as well as Pushpa Kamal Dahal had thanked me when it was signed. Of course, our report is not carved in stone and, with time, it can be amended. But the government’s commitment should not go in vain.

What in your view should be the role of the private sector in medical education?

I do not want to blame the private sector because they have helped produce much-needed medical manpower. What’s lacking is a support system and monitoring mechanisms. Medical colleges are concentrated in Kathmandu valley, and driven mainly by money-making motives. There is an acute need of medical colleges and hospitals in the far-flung areas of the country. Now, medical education has become something that only the children of the rich can afford. Students who can pay exorbitant fees get seats, but poor ones, even with good marks, often struggle.  

Is there a model for medical education in other countries that we could emulate?

We seek a model appropriate for Nepal, with the government in the driving seat. But there are credible international examples. For example, there are no private medical colleges in Canada. Similarly, there is no private investment in medical education in Scandinavian countries. We are focusing on two major areas: access and quality. Poor students must have access to medical education. And government presence and investment in the medical education sector will ensure quality.