Discord over affiliation leaves medical bill in limbo


Jan 22, 2019-

Eight years, 15 fasts-unto-death and 12 agreements later, Dr Govinda KC is on his 14th day of yet another hunger strike as the revised, but controversial, draft of the National Medical Education Bill remains pending in Parliament. The cycle of commitments from and agreements with the government have played out in the national psyche as if it were a script. Only this time, there are no negotiations on the table.

The bill is the most deliberated and debated bill in Nepali history and the ruling Nepal Communist Party made its intentions clear when the parliamentary subcommittee endorsed the contested report on the bill with a majority vote and presented it in Parliament on January 13.


Five days later, in what was Nepal’s first parliamentary practice of a Q&A session in the House, Prime Minister KP Sharma Oli, in response to opposition lawmaker and former health minister Gagan Thapa’s question, laid stress on the parliamentary supremacy. “An agreement is not truth and reconciliation,” Oli told the House. “The agreement was the need of the hour. Just because the prime minister holds a majority in the House does not mean that Parliament’s supremacy can be undermined. I can request the House to honour the agreement but I cannot order it to do so. No one is above the law.”


Two days after Oli’s address, Nepali Congress obstructed the House proceedings, including on Monday and Tuesday, when Speaker Krishna Bahadur Mahara included the bill in the House agenda despite the opposition’s objection and request to put the bill on hold until Oli’s return from Switzerland. All this while, the ruling party Chief Whip Dev Prasad Gurung issued an order, directing all the party lawmakers to be present at the parliamentary hearing to get the bill endorsed.


“The Speaker has favoured Nepal Communist Party lawmakers and is facilitating the endorsement of the revised bill while there should be an environment for further deliberation and debate on the revisions which are of national interest,” Thapa, who is also the parliamentary committee and subcommittee member told the Post.


“If the government endorses the bill as per the demands of KC and recommendations of the Mathema report, they don’t even need to meet KC and request him to end his hunger strike. The next parliamentary session is on Friday. We have enough time to discuss the revisions which are against the agreement and why the ruling party could only implement 95 percent of the Mathema report,” Thapa added.


At the heart of the bill lies three things: quality of medical education, accessibility of medical education across the country, and people’s access to health care and these are bound to hurt vested interests, says Kedar Bhakta Mathema, the convenor of the high-level committee formed by then prime minister Sushil Koirala to recommend a new national policy on Health Profession Education as demanded by KC.


“Our report supersedes all other reports,” Mathema told the Post. “Its recommendations are non-partisan and based on meticulous research and extensive discussions by a team of experts whose credentials and reformists stance are well known.”

Mathema said the government’s policies should be based on research that should determine how a country should move forward. “Off the cuff decisions and multiple prescriptions have compromised and tampered our recommendations,” he said.


Now dubbed the Mathema Report, its recommendations envisages ‘Health for All’ and a powerful commission at the centre that would regulate medical education across the country, based on which the original draft was formulated and registered in Parliament. But revisions endorsed by the subcommittee--it  includes granting affiliation to institutions that have already acquired Letter of Intent, gradually transforming private medical colleges into non-profits, and an establishment of a medical university among others--have the ruling party, the opposition party and KC at loggerheads once again.


“Medical University is the need of the hour and that’s the reason why we added it in the bill. This is something that Parliament and lawmakers can do,” said Yogesh Bhattarai, the ruling NCP lawmaker and parliamentary committee and subcommittee member, in a recent interview with Naya Patrika, while defending the ‘progressive’ draft bill and medical university.


Bhattarai also urged Mathema to read a report by Gauri Bahadur Karki, committee chair and former chairman of Special Court, which he said recommends setting up a medical university. “Karki actually recommends setting up universities at provincial level which can grant affiliations to three medical colleges within its jurisdiction,” Bhattarai said.


But the Karki report, which the Post has obtained a copy of, does not correspond to Bhattarai’s claims. “Each province can upgrade its health academies such as Dharan-based BP Koirala Institute of Health Sciences (BPKIHS) as a provincial university by endorsing a new Act following which it can grant affiliation to maximum three medical colleges within the province. Existing medical colleges can also change their existing affiliation to the new provincial university,” the report says.


In an interview with the Post, Karki confirmed that the report does not recommend establishing a medical university at all. “It recommends that existing health academies be upgraded to provincial universities,” he said. “This is needed because both Tribhuvan and Kathmandu universities have already exceeded their limits. A commission is all that is required to govern and regulate medical education.”


Following massive irregularities in the medical education sector, the Oli government had formed a three-member committee under Karki in April 2017 which included late neurosurgeon Upendra Devkota and then joint-secretary at the Ministry of Education Surya Prasad Gautam. Both the Karki and Mathema reports recommend similar prescriptions for the medical education sector, including affiliations and a powerful regulatory body at the centre.


“There has been no public debate on a medical university or transforming existing medical colleges to nonprofits in ten years time,” said Mathema, a former vice-chancellor at the Tribhuvan University. “If a separate university were needed at all, there would be a solid rationale behind it and it had to come from the University Grants Commission or the Ministry of Education or the National Planning Commission and not from members of Parliament.”


While the ruling and the opposition parties are at discords over granting affiliations, the process to upgrade academies as universities, however, is already underway and could pave the way to grant affiliations for institutions outside the Valley.

“Our senate meeting has already decided to upgrade the institution as a university because we fulfil all the criteria,” Vice-chancellor of BPKIHS Dr Raj Kumar Rauniyar told the Post. “We addressed both the chancellor (prime minister) and the co-chancellor (health minister) in this regard more than two months ago, but we haven’t heard from them.”


Rauniyar said upgrading the institute as the university would only require a single line to be added in the existing law.

The revised draft of the bill also differs from the agreement reached with KC last year to phase out short-term technical and vocational training courses within five years after the enactment of the bill. The revision rules that the decision will be taken on this issue based on the recommendation of a commission that will be formed to regulate the medical education.


The provision, however, contradicts the Health Ministry's plan to make technical positions redundant in the next five years. Earlier in June 2018, the Ministry of Education, Science and Technology had decided to establish federal offices of Council for Technical Education and Vocational Training in all provinces.


Talking to the Post before he began his 16th fast in Ilam, KC had also hinted at another possibility for medical colleges outside the Valley to get affiliation. “The government could run a constituent medical campus of Purbanchal University and could start affiliating medical colleges once its first batch graduates,” he said.


Provided that the BPKIHS is upgraded as a university that grants affiliations and the other possibility of a constituent campus, it could bring respite to the Jhapa-based B&C Medical College Teaching Hospital and Research Centre, which is at the heart of the revisions in the latest draft of the bill. According to the amendments, once the bill is enacted, a university cannot grant affiliation to more than five medical colleges. But the commission would decide in the case of educational institutions outside the Valley that have already acquired Letter of Intent.


“Both Tribhuvan and Kathmandu universities which have granted 10 and 11 affiliations respectively are already beyond their supervision capacities,” Mathema said. “They cannot even monitor more than three colleges.”

Published: 23-01-2019 07:03

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