The Island Feature – by Dr Mahinda Kommalage
The establishment of private medical colleges was a topic in Sri Lankan media for the last few years. With the recent changes in ministries, establishing private universities was again highlighted in the media. First of all I would like to admit that I do not oppose the establishment of private universities and colleges and I consider it as a need of the day.
Sri Lanka does not have private medical colleges which are controlled by the Sri Lanka Medical Council. This is contrary to the situations in many countries in South Asia, Asia and the world. There were instances where private medical colleges were established in Sri Lanka. But due to the resistance from certain sections of the society, some of these medical colleges ceased to function.
There were many private medical colleges in India. Some of them are very reputed and maintained their reputation for years at the same level and there were many private medical colleges in India which have a bad reputation. Deficiencies and malpractices of these medical colleges were often discussed in the media and medical journals (The Lancet, Volume 375, Issue 9727, Page 1679,15 May 2010).
The latest incident is the arrest of the head of the Indian medical council on bribery charges. Ketan Desai was President of the Medical Council of India (MCI) and Indian Medical Association (IMA), two of the most prestigious medical organizations in India. He was arrested on the 22nd of April by India’s Central Bureau of Investigation (CBI) for allegedly accepting a bribe of 20 million Indian rupees ($450 000) to allow permission for private medical college in the northern Indian town of Patiala without necessary infrastructure (British Medical Journal 2010;340:c2355). This is not the first corruption incident involving Ketan Desai. In 2001, while holding the same prestigious position, he had charges involving corruption of this nature (British Medical Journal 2001;323:1385). In the court case, it was revealed that unexplained receipt of 6.5 million Indian rupees ($136000) via bank drafts in the names of his wife, daughters, and himself. The court directed that Ketan Desai shall cease to hold office as the president of Medical Council of India. But due to political influence, he secured the position until last April when he got caught again for the same offence.
The Medical Council of India, similar to Sri Lanka Medical Council, regulates medical education in India. The Medical Council of India also regulate establishment of new medical colleges, the number of students the colleges can admit, required resources for the collages and many other requirements. It was known that a large number of medical colleges in India have allegedly become corrupt. There were occasions of illegally charging money running into millions of rupees over and above the normal medical school fees to give admissions. This practice of charging “capitation fees” was admitted and banned by the Indian Supreme Court a few years ago but is still known to thrive illegally (quotation from British Medical Journal 2001;323:1385).
Many new private medical colleges were setup in the past decade in India. A study in Maharashtra state found that most private medical colleges do not have adequate infrastructure, academic staff, nonacademic staff or facilities (British Medical Journal 2004;328:70). Charging fees not commensurate with the cost of facilities provided to students and cost of establishing the colleges or the facilities. Shortage of academic staff was between 50% and 63%. Many staff members are working on part-time basis on very low salaries as low as 2000 rupees per month. Shortage of non-academic staff was between 60% and 70%. Reports say that although teaching beds were available, there were no adequate patients for clinical teaching-learning process.
In India, this corruption is not limited only to medical colleges but the Council for Technical Education (AICTE), the governing body for technical and engineering education is also corrupted. Last year, the member-secretary of AICTE was arrested by the CBI for allegedly accepting a bribe of 500,000 Indian rupees from a person for doing “favourable inspection” of an engineering college in Andhra Pradesh.
These are examples from India, our close neighbour. Many corruptions related to private medical colleges were continuously reported in India. India provides good examples for how private medical education can lead to corruption and how a supreme regulating body can facilitate this process with the political influences. Is it applicable to us, in Sri Lanka? Do deeply rooted corruptions and political influences differ here in Sri Lanka? Is the same thing impossible here in Sri Lanka?
On the eve of private universities thriving in the country, we should really think about the quality of the education they are going to provide. When it comes to medical education, we have to consider health of the nation and life of the people. I think we cannot avoid establishing private medical colleges and universities in this country in the present situation. But strict regulations to guide them in the right direction are essential. Is the current social, political, and economical structure in the country feasible for corruption free establishment and regulation of private medical colleges? Just forget about private medical colleges in Sri Lanka for a moment. Consider the current medical education of the country which is totally controlled by the government. There was evidence of corruption related activities in the current medical education in Sri Lanka. The common MCQ paper in Obstetrics and Gynaecology in March 2009 was ‘grossly deviated’ from the strict guideline laid down by the UGC. These guidelines make sure the confidentiality of this type of common examination paper and were prepared with the contribution of a few medical faculties. The result of that examination was withheld making difficulties for several medical faculties. Newspapers reported the incident with details; who involved where it happened and who received the ‘advantages’. Unlike in India, there was no further news about investigations and charges against those who were responsible.
There is much evidence of political influence in the administrative process of the current medical education. A selection of many high positions is under the influence of politicians. When they come to those positions they are obligated to work for the politician to retain the position.
Therefore, the future of these medical colleges can easily go beyond the situation in India. These private medical colleges can easily lead to corruption and political influence. This will be a multimillion business making big profits but providing poor resources for the teaching-learning processes which can produce ‘poor’ quality doctors. To avoid that, there should be a clear regulatory process. The relevant authorities have the responsibility to avoid corruption even in the planning stages.
Private medical colleges can easily destroy the medical education in Sri Lanka and reputation of Sri Lankan doctors. Learning a lesson from India, we should not direct our medical education in that direction.
There is a need for training more medical doctors to meet the needs of the growing population of most Asian countries. However, private medical colleges are not a very good solution. I do agree that there are many reputed private medical colleges in India, which are of comparable quality to the best medical colleges run by the State. However, the last decade has seen a mushrooming of so many private medical colleges which are run purely for profit without any concern for providing quality education.
I have the experience of working as a faculty in one such college in India after my training and find that we are doing a dis-service to the country and its citizens by allowing these colleges to run. Hope the expose will bring a halt to these malpractices.
I hope Sri Lanka learns from India’s mistakes and does better.
Wish you the best.