BY CHARMINDA RODRIGO-2016-08-09
We live in a country where the government is expected to provide education and health free to the people. The country needs to produce competent professionals to provide such free services without any interruption. Is our education system capable of producing the required number of professionals? Do we need private institutions to shoulder the burden? This has been a much debated topic for many years.
State universities alone produce about 1,200 medical graduates every year. The government incurs nearly Rs 10 million per undergraduate for the six years of medical training provided under the free education system. The money is collected from taxpayers. Students who score high marks at the GCE A/L Examination get admission to the medical colleges. Then the government spends the tax money for their education.
Students who score high grades in the bio-science stream gain admission to medical faculties to be trained as doctors. Although students have to put in hard work to complete their medical education at State universities, it is worth the trouble because they are assured of well paid jobs in government hospitals. Therefore it is not just a matter of expanding the medical education, but allocating provisions to absorb more medical practitioners to the state sector.
The ratio
Sri Lanka has 55.2 per cent doctors for 100,000 people (i.e. one doctor for 1,811 people). The ratio is far below the global average of 170 per cent for 100,000 people. The Ceylon Medical Journal (October 2008) stipulates the findings of a research conducted on "Medical labour force." It indicates that 1,150 medical graduates from the State sector and 125 foreign qualified medical graduates have obtained registration from the Sri Lanka Medical Council (SLMC) in 2007. Further, the research predicts that if the workforce remains static then the SLMC registrations will reach 30,800 by 2020. Then we will have 120 practising doctors for 100,000 people, provided that overseas migration also remains at 15 per cent. Is it what we should strive for? Or should it be otherwise?
Sri Lanka has 55.2 per cent doctors for 100,000 people (i.e. one doctor for 1,811 people). The ratio is far below the global average of 170 per cent for 100,000 people. The Ceylon Medical Journal (October 2008) stipulates the findings of a research conducted on "Medical labour force." It indicates that 1,150 medical graduates from the State sector and 125 foreign qualified medical graduates have obtained registration from the Sri Lanka Medical Council (SLMC) in 2007. Further, the research predicts that if the workforce remains static then the SLMC registrations will reach 30,800 by 2020. Then we will have 120 practising doctors for 100,000 people, provided that overseas migration also remains at 15 per cent. Is it what we should strive for? Or should it be otherwise?
At the Global Health Workforce Alliance of the World Health Organization (WHO) in 2013, Sri Lanka had partnered with other countries to bring about a lasting change in human resources for health requirements. This was carried out with the collaboration of several sectors and constituencies. Nothing could stop one from admitting the fact that there is a shortage of doctors in the country to serve the people. During the same year the accepted standard of WHO threshold was 345 skilled health professionals per 100,000 of the population. This includes midwives, nurses and physicians. The report predicts a global deficit rising to nearly 12.9 million skilled health professionals by 2035.
The country struggles with a shortage of medical practitioners while thousands of students who get through the Advanced Level Examination in the bio-science stream are left behind. This is due to their failure to get better results. This results in most students not getting the opportunity to enter any of the medical colleges. A large number of students are deprived of their fundamental right to education simply because they do not get the required marks at the GCE Advanced Level Examination.
The country struggles with a shortage of medical practitioners while thousands of students who get through the Advanced Level Examination in the bio-science stream are left behind. This is due to their failure to get better results. This results in most students not getting the opportunity to enter any of the medical colleges. A large number of students are deprived of their fundamental right to education simply because they do not get the required marks at the GCE Advanced Level Examination.
Medical degrees
Either the government should broaden the spectrum of education or a way should be paved to establish private medical colleges to fill the gap. Some of the students who do not get selected to State medical colleges go abroad for their studies. SLMC recognizes medical degrees conferred by 205 foreign universities. However, if you take a good look at the accepted list of foreign universities, The International Medical and Technological University (IMTU) in Tanzania falls as far as 17,779 in the world university rankings and the entry criteria to the university are below the local standards. Still it has been recognized as a standard institute.
Either the government should broaden the spectrum of education or a way should be paved to establish private medical colleges to fill the gap. Some of the students who do not get selected to State medical colleges go abroad for their studies. SLMC recognizes medical degrees conferred by 205 foreign universities. However, if you take a good look at the accepted list of foreign universities, The International Medical and Technological University (IMTU) in Tanzania falls as far as 17,779 in the world university rankings and the entry criteria to the university are below the local standards. Still it has been recognized as a standard institute.
Undoubtedly the country needs more medical practitioners to fill the vacuum in the medical profession. Therefore, provision should be made for local private medical colleges. What we really should be worried about is the quality of education, and not the mode of funding. Whether the medical college is run by the State or the private sector is immaterial. When we refer to private medical colleges, we do not necessarily mean the South Asian Institute of Technology and Medicine (SAITM). However, it is perhaps the only private medical faculty operating in Sri Lanka.
SAITM began its operations as a private medical institution in 2009 and commenced awarding medical degrees in 2012. It was recognized as a degree awarding institution by a Gazette Notification, No. 1721/19 of 30 November 2011. SAITM awarded the Bachelor of Medicine and Bachelor of Surgery (MBBS).
SAITM began its operations as a private medical institution in 2009 and commenced awarding medical degrees in 2012. It was recognized as a degree awarding institution by a Gazette Notification, No. 1721/19 of 30 November 2011. SAITM awarded the Bachelor of Medicine and Bachelor of Surgery (MBBS).
Gazette notification
The Gazette Notification is applicable to students who enrolled for the MBBS degree after August 2011. The degree awarding institute order was amended by the Gazette Notification, No. 1829/36 to include the students registered for the MD degree programme, subject to conditions specified therein. The conditions include the establishment of the Neville Fernando Teaching Hospital (NFTH) for clinical training of students, following the MBBS degree programme. Subsequently, the Ministry of Higher Education acknowledged in writing that all conditions stipulated in the Gazette Notification had been met. Therefore, the students who graduated from SAITM should obtain provisional registration from the SLMC to complete their internship training at a government hospital.
The Gazette Notification is applicable to students who enrolled for the MBBS degree after August 2011. The degree awarding institute order was amended by the Gazette Notification, No. 1829/36 to include the students registered for the MD degree programme, subject to conditions specified therein. The conditions include the establishment of the Neville Fernando Teaching Hospital (NFTH) for clinical training of students, following the MBBS degree programme. Subsequently, the Ministry of Higher Education acknowledged in writing that all conditions stipulated in the Gazette Notification had been met. Therefore, the students who graduated from SAITM should obtain provisional registration from the SLMC to complete their internship training at a government hospital.
The medical graduates get the opportunity to register themselves with the SLMC to practise as doctors in Sri Lanka only after their successful completion of the internship. SLMC is obliged by law to register students with a MBBS degree conferred by a degree awarding institute under section 29 (1)(b)(i) of the Medical Ordinance as amended in 1988. This is similar to a student with an MBBS degree from a State Medical Faculty.
Originally SAITM had a "twinning programme" with an affiliation to Nizhny Novgorod State Academy of Medicine (NMSMA) to conduct the MD degree programme. Thereafter, the then President of the SLMC in 2010 recommended to the then Secretary of the Ministry of Health to allow SAITM to function as a degree awarding institute. After obtaining recommendations under section 70(c) of the Universities Act, No. 16 of 1978 and its subsequent amendments, the Ministry of Higher Education recognized SAITM to award the MBBS degree for the students who registered for the degree after 30 August 2011. With the Gazette No. 1829/36, the students who had enrolled from September 2009 to 2011 were also granted registration for the MBBS degree. Therefore prima facie evidence suggests that SAITM has cleared the basic legal requirements to be considered as an MBBS degree awarding body under the prevailing laws in the land.
Reservations
Some people have reservations about SAITM as far as the quality of the education is concerned. However, SAITM claims that its courses were strictly in compliance with the University Grants Commission (UGC) directives under section 70 of the Universities Act, No. 16 of 1978. SAITM also claims that it maintains strict compliance with UGC entry criteria when enrolling students. The Secretary of the Ministry of Higher Education is entrusted with the authority to oversee the enrolment process, under the Gazette Notification. Only the students who successfully get through the bio-stream at the local A/L Examination or equal qualification under the London curriculum, are eligible to be enrolled to follow the MBBS programme at SAITM. Further the academic panel at SAITM meets the prerequisites of the UGC and it is on par or above State medical faculties.
Some people have reservations about SAITM as far as the quality of the education is concerned. However, SAITM claims that its courses were strictly in compliance with the University Grants Commission (UGC) directives under section 70 of the Universities Act, No. 16 of 1978. SAITM also claims that it maintains strict compliance with UGC entry criteria when enrolling students. The Secretary of the Ministry of Higher Education is entrusted with the authority to oversee the enrolment process, under the Gazette Notification. Only the students who successfully get through the bio-stream at the local A/L Examination or equal qualification under the London curriculum, are eligible to be enrolled to follow the MBBS programme at SAITM. Further the academic panel at SAITM meets the prerequisites of the UGC and it is on par or above State medical faculties.
Many members of the professorial staff at SAITM consist of retired professors from State institutions. Hence it is rather strange to see former students of the same professors protesting against the teaching standards at SAITM. The teaching curriculum at SAITM follows the subject benchmark statement in medicine of the UGC. Their academic infrastructure facilities are of the highest standards and meets with the stipulated criteria from the UGC. The final MBBS examinations are conducted according to UGC requirements with the involvement of external examiners from State universities and State hospitals. SLMC has not found fault with the composition or the qualifications of the academic staff at SAITM and the methodology of teaching.
Another serious allegation raised against SAITM is the cost factor. There is a private capital investment associated with the establishment of the institution. The entity should make a substantial profit for any venture to sustain itself. This is the plain truth. With due diligence to the recurrent and the cost of capital, it needs much funding to operate. The cost per head for education is more or less similar to the State and non-State faculty. This is the only difference of the method of funding. In the non-State sector, parents bear the cost while in State sector it is equally divided among the tax payers of the country.
Bitter experiences
We have bitter experiences introducing medical education to non-State institutions in Sri Lanka. One of the biggest criticisms raised was that the medical graduates who come out of those institutions may not have the same quality of State medical colleges. As far as the quality of the services provided at government hospitals, we cannot forget what happened during the last month. According to media reports, two amputations had been done due to medical negligence. However, as it normally happens, medical negligence has not been challenged in Courts.
We have bitter experiences introducing medical education to non-State institutions in Sri Lanka. One of the biggest criticisms raised was that the medical graduates who come out of those institutions may not have the same quality of State medical colleges. As far as the quality of the services provided at government hospitals, we cannot forget what happened during the last month. According to media reports, two amputations had been done due to medical negligence. However, as it normally happens, medical negligence has not been challenged in Courts.
Many organizations and unions have protested against the establishment of private medical faculties. However, some of their claims are spurious. They believe that only the State sector can impart medical knowledge to the younger generation. Some of the protesting unions objected when the government wanted to trim the four-year Allied Health Sciences degree course to three years.
The banner hanging at the Colombo Medical Faculty says, "Education is a right, not a commodity." However, they have intentionally missed out the important part in the tagline that is "Medicine is also a right, not a commodity."Most of the protesters should reflect on it while driving their way to private clinics after working at State hospitals.
