(In response to the Republica editorial titled 'Costs and benefits' published on 1st July that doubted the practicality and desirability of a free PG training in medicine in Nepal, Prof Govinda KC makes a strong case for free PG in medicine. The letter to editor was carried by Republica on July 4th. As the published text of letter to editor is apparently unavailable in the website of the paper, here I carry the draft version. Only small modifications have been made in the published version, which is, anyway, available in the adjoining photograph.)
I
read with interest the editorial titled ‘Costs and benefits’ published
in your esteemed daily on July 2, 2015 . Thanks to Republica for
raising the issue.
However,
I strongly disagree with the editor’s statement that our attempt for
free post graduation training program in medical science in the country
is idealistic/unrealistic. It appears that it was written with utterly
superfluous understanding of the reality.
Please
note that we have been pressing for affordable if not free medical
education after a detailed appraisal of the same in other countries
where the health care delivery system is incomparably better than ours.
Moreover, having visited every district of Nepal I do have fair
knowledge of the implementation side of national health policy and
health service system of the country as well as the health needs of
people of Nepal.
Even
in developed capitalist countries, education and health (medical
education encompasses both) are not commercialized. Where they are, very
stringent regulations are in place. That helps to maintain the high
degree of standard in education and health service. That also makes it
possible for qualified students to get a medical degree at minimal cost.
Post graduate course/training is essentially free; rather the students
get fair amount of salaries during the residential training programs.
That is because the PG programs in medicine are fundamentally different
from the same in other fields: here a registered doctor engages in
patient services, which generate revenues for the institute, as part of
his training. That indeed is the reason we are demanding an affordable
UG education but FREE PG education. Many wealthy parents may be
inclinced to spend millions as you indicate in the editorial but that
should not obfuscate this reality and the state should not deprive the
other students--better qualified but from poor financial
background--from having the same shot at PG programs.
It
is thus no wonder that in most of the developing countries and in
almost all the developed countries there are no private medical schools
for fear of compromising the quality of health services. Unfortunately
in Nepal, government :private medical college ratio is 1:6 and in terms
of output of medical graduates, it is 1:9. They heavily charge the
students and number of students they take every year is ridiculously
high. That has led to a very costly medical education with little regard
for quality in Nepal. Only 3-5 % of parents in Nepal can afford to pay
tens of millions rupees for their children's medical education.
Please
note that, the fee collected from PG trainees now is practically used
to subsidize the other costs of the institutes as the residents
themselves contribute in revenue generation as much as or even more than
a specialist employed by the institute. With PG training so costly both
in govt and private institutes (a large no. of seats in govt institutes
are also high-paying so far), how can we hope to dispatch these
specialists to remote places to serve the people most in need? Ensuring a
free PG in medicine now may look like a costly idea but in the long
term, this will immensely help the state by making it possible to
provide specialist services to places which have been deprived of the
same so far.
Lastly,
the wise way to lessen the financial burden to the state will be,
rather than extorting heavy sum from the prospective PG graduates, to
appoint efficient and capable managers to the govt institutes instead of
grossly inept ones who are now appointed on the sole basis of loyalty
to the politicians and political parties. We should press the leaders to
mend their ways of appointing those officials rather than questioning
the relevance of a long overdue effort to make PG free in medicine.
Dr. Govinda KC
TUTH, Maharajgunj, Kathmandu.
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