Dr Govinda KC, currently on his 12th fast-unto-death, is protesting against amendments to a health reform Bill that would essentially weaken one of the main recommendations of the report published by the Mathema Committee; to ban the establishment of more medical colleges inside Kathmandu Valley.

Protests have been occurring over the Parliament’s inability to pass the Health Profession Education (HPE) Bill in accordance to suggestions from the Mathema report.

Mukul Humagain and Manish Gautam interviewed ex-health minister and Nepali Congress leader Gagan Thapa.

Thapa has been a proponent for reform in the healthcare sector, and supports Dr KC's crusade. 

What are your thoughts on the recent compromises made in the Health Profession Education (HPE) Bill?

I would like to point out two things. Firstly, the way parliamentary committees and sub-committees are formed needs to change.

Currently, whether by assignment or by volunteering, MPs with vested interests in a certain sector are also in committees overseeing that very sector.

This creates a conflict of interest and it absolutely cannot continue if we are to have an impartial and transparent parliamentary process.

People are bound to be suspicious if MPs with interests in a certain sector are involved in parliamentary decisions regarding that sector; to change this, we have to ensure transparency. 

Secondly, the three major political parties (Nepali Congress, CPN-UML and Maoist Centre) need to spell out how they plan to provide quality education and healthcare to every Nepali—something they themselves have claimed to be a basic right 

in the constitution.

To provide healthcare to every Nepali, health posts and doctors need to be available in the farthest rural pockets of Nepal. For that, doctors have to be willing to practice medicine in these rural corners. 

We should realise that there is a genuine case for reform in the health education sector. Lawmakers and political parties are not seeing this as an issue that needs to be addressed immediately.

Dr Govinda KC is holding a fast-unto-death for reform; the Mathema Committee was formed and they filed a report. So right now, it’s this external pressure that is pushing lawmakers and politicians to present and pass a Bill. 

What is your take on the Mathema Committee report?

The Mathema Committee was established with the understanding that there is a need for positive change in the entire Nepali healthcare education sector.

The Mathema report gives insight as to what is required to fuel change in the healthcare and healthcare education sector.

I believe the HPE Bill is a good representation of what is recommended in the reports, but if we stray too far from the report’s recommendations, the Bill will lose its essence.

The sections of the Mathema report that would have made the HPE Bill more effective have been left out of the Bill making process, while, in my opinion, the sections that weaken the Bill have garnered more support in Parliament. 

Despite possibilities of compromise, we have started hearing issues related to the MMIMS attached to the HPE Bill again. Where did the progress stall?

When I was health minister, I suggested that Nepal Academy of Medical Sciences (NAMS) would buy MMIMS and run it.

It was a genuine attempt to keep the Bill judicious while protecting the investments of many. Another suggestion was to change the name of NAMS to Manmohan Adhikari Academy of Medical Sciences so as to honour Manmohan Adhikari.

However, it is not easy to change the name of an institution. The Bill has to be returned to make such a change; we informed the MPs that the Bill was being withdrawn for these reasons and would be brought back after the addendum. 

There were also groups with permission from the government to open medical facilities. We told them that if they were genuinely interested in opening a good medical school, we would give priority to permission holders to open up medical schools in other parts of the country after the Bill was passed and regulations had set in.

We were willing to provide incentives, subsidies and tax breaks to interested parties.

However, people were under the belief that the government was making a Bill to support the absorbing of one institution, while leaving other parties with permission from the government in complete limbo. We realised our mistake and withdrew the Bill entirely. 

Has the entry of private companies into the medical and education sectors eroded the states’ medical system?

The Nepalgunj Medical College in Kohalpur and Manipal Hospital in Pokhara are both private institutions; they have both benefitted the nation. So has the government run BP Koirala Cancer Hospital in Bharatpur.

The issue here is not private versus public medical colleges. The issue is the opening of colleges only in the Kathmandu Valley and the lack of measures of control. 

I believe we need to save colleges, private or public, and work to improve the system instead. During this time of revision, Nepal’s political parties have to put the people of the nation in the centre of conversation.

We have to deliver results, so why not create people centric results in the first place instead of facing backlash? Perhaps the way forward is to employ the resources and facilities provided by private hospitals for the benefit of the government and the public. 

How can a conflict of interest be avoided, particularly when lawmakers such as ours are driven by self-interest?

People have a vested interest in their own businesses and institutions; they want policies to support their ventures.

But to keep law-making fair, a person who has special interests in a bank, for example, cannot be allowed to serve in a committee addressing banking regulation issues. This should be enforced by regulations.

As a lawmaker, I was made to release information on my holdings. I propose for lawmakers to release information on their interests and past employment as well.

This information could be used to prevent people from holding committee and sub-committee positions that may bring out conflicts of self-interest.

This regulation would be more effective than lawmakers volunteering information; it would form a base for an impartial Parliament in the long run. 

Powerful businessmen seem to attach themselves to political leaders, promoting the role of the ‘medical mafia’ in Nepali politics. How can this problem be overcome?

I don’t blame businessmen who have built medical colleges—many were approached by governments in the past to open such institutions.

By investing in medical education, some businessmen have also brought better facilities to the country; we should appreciate this.

Political parties are comprised of a number of different people—businessmen, engineers, students, civil servants etc.

However, high ranking politicians tend to listen to only a few of these individuals, instead of thinking about all of the people they represent.

Leaders need to critically analyse whether they are listening to their entire support group or not.

At a point where medical college investors are not just lobbying politicians, but have become lawmakers themselves, isn’t it time to think about whether we need to start opening medical colleges in a different way to negate self-interest conflicts? 

What do you see will be the outcome of Dr Govinda KC’s 12th fast-unto-death?

This fast is different from the other ones. Before, every fast focused on a specific issue.  

For example, the second fast specifically concerned the nomination of deans. But this fast concerns passing a strong healthcare Bill.

If various points of the HPE Bill are rejected one by one, the fast might go on for months.

In focusing on small parts of the sum, the issue itself will lose focus. 

I met with Dr KC to request that he not go on a fast yet.

I told him that now the Bill has been presented, there will be discussions regarding its points and appropriate changes will be made.

I pointed out that we have to garner the support of more lawmakers and pressure political parties into seeing the merits of this Bill.

Now, the issue has been turned into whether you are with Dr KC or against him. Dr KC should have let the parliamentary process try to resolve the issue of the Bill first, but the fact is that he has already commenced with his fast. He is in a life threatening condition, and we cannot ignore his situation. 

What steps should be taken to move forward?

The protestors need to pressure their constituency representatives to see the merits of this Bill instead of taking to the streets.

We should argue the differences in parliament; all factions need to make their stance clear.

The people need to see who is behind the Bill and who is against it. We have to use Parliament as mandated by the constitution, and the entire nation should support this democratic process so that real change can happen institutionally.