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Privatisation and keeping standards in medical education

| by Shanie

"I envision the universities as an educational pyramid whose base is wide and wide open to everyone, whether they have pre-requisites or not. We should open our doors to the country as a whole. We should then pay attention to the middle level, the substantive body of the pyramid, and, finally, make the best possible resources available to the apex. This would enable us to combine the notion of excellence with social responsibility and social justice."

(November 05, Colombo, Sri Lanka Guardian) Five years ago, Professor Senake Bandaranaike was conferred an honorary doctorate by the Open University of Sri Lanka. In his Convocation Address, he dwelt on the subject of higher education. His reflections and analysis of what is needed to take higher education forward in our country are founded on a rounded academic career involving research, teaching, writing and university administration. They also show that archaeologists are not merely into digging up the past but can also provide insights for the present and the future.

Access to wider higher education must not
 be at the expense of quality, particularly in
 a professional field like medicine. This quality
needs to be ensured particularly in the private
sector. The state sector, by the very nature of
their existence, will have quality; though in
 Sri Lanka, over the years, educational policies
of succeeding governments have eroded
that quality.
Last week, the Socialist Study Circle had a well-attended seminar at the Dr N M Perera Centre on higher education at which two young academics from Peradeniya and the Open University made presentations. This was followed by a quite lively discussion in which many academics, senior and junior, participated. The focus of the discussion was on the privatization of education and Professor Senake Bandaranaike’s 2006 Convocation Address has much relevance to the issues raised at that seminar discussion. This also the subject of debate in the country at this time.

There has been much denigration recently, mainly by short-sighted politicians and unthinking bureaucrats with private agendas, of the quality of education and graduates being produced by the university system. A top bureaucrat in the Ministry of Higher Education had reportedly asked a delegation of academics from FUTA recently whether the universities could turn out travel guides for the tourist industry! It is not known whether he merely meant to humiliate the academics or if the man had no understanding of university education. But, it was asked in all seriousness. Such is the quality of the people who seek to decide on higher education policies and dictate to the academics in university administration and to the regulators in the University Grants Commission.

It is true that standards have drastically lowered from the heyday of the then University of Ceylon, which was its first two decades. But the system still produces men and women of quality. What Bandaranaike said in 2006 still holds true: ’Whenever I have any doubts about the quality of our universities – and I am sure that all of us do have those doubts and will also agree that questioning and criticism are the essence of progress and development – these are immediately dispelled when I meet with so many excellent products of our university system, of all generations, in many different working situations. The human potential that is so often reflected by the university product, the intellectual and social energies that are generated and released by the university experience, seem to outstrip any deficiencies that are there in the educational and professional training universities impart.’

Contribution of the private sector

Privatisation of education has been going on for quite some time, both at secondary and tertiary levels. At the secondary level, several ‘international schools’ have sprung up, some of which are of sound quality, comparable to the best among the old established ‘local’ schools, private and state. These new schools prepare students in the English medium for internationally recognized examinations. At the tertiary level, many private institutes have been set up to prepare students for the degree examinations of foreign universities. These are mainly in the humanities, law and the pure sciences. There are also institutes preparing students for post-secondary professional (mainly in the fields of IT and Accountancy) examinations of internationally recognised professional bodies. These provisions for privatized secondary and post-secondary education are welcome. It opens up avenues for higher education within the country to a greater number. But graduates of such institutes suffer a serious disadvantage as they lack the benefits of cross-disciplinary intellectual exchanges, staff-student relationships, access to a good Library, etc that an in-campus student at a university will enjoy. Yet there can be doubt that the quality of a degree awarded by a reputed foreign university through their local partner will conform to the standards of that university.

However, this access to private institute preparing students for a degree awarded by a recognized foreign university is available only to a class of students who can afford the high fees. This is why there should be no reduction in funding and support for state institutions and universities. It is the concept of free education introduced in the nineteen forties as part of educational reforms in the State Council that has made Sri Lanka one of the most literate countries in the world. It is those reforms that have produced some outstanding scholars and professionals whose potential may otherwise have been wasted in the desert air.

The need for quality

Access to wider higher education must not be at the expense of quality, particularly in a professional field like medicine. This quality needs to be ensured particularly in the private sector. The state sector, by the very nature of their existence, will have quality; though in Sri Lanka, over the years, educational policies of succeeding governments have eroded that quality. Leading academics, most recently Professor Savitri Goonesekere in last week’s Sunday Island, have referred to this on a number of occasions. The private sector, unlike the state sector, enters into the field of education (or any other field) primarily for commercial reasons. They will invest in education, only if sufficient returns can be obtained in as short a time span as possible. Private medical schools have prospered in other countries, including in neighbouring India. They continue to provide internationally recognized medical degrees. Many Sri Lankans have benefitted from these private medical schools, with their degrees recognized by the Sri Lanka Medical Council, and these medical graduates serve now in the state and private health sector in the country. But all those private medical schools were set up for commercial gain – the only exceptions possibly being the Christian Medical Colleges in Vellore and Ludhiana which were set up perhaps for a variety of other reasons. Those reasons do not concern us here now.

We will be fooling ourselves if we believe that the newly established BOI approved venture South Asian Institute of Technology and Medicine at Malabe was set up for any reason other than commercial gain. It is understood that more than one batch of students have been enrolled. The admission requirements will certainly not be up to the same standards as set by the University Grants Commission for admission to the Medical Colleges in the Sri Lankan university system. But that is the way6 the system works. Many of our students who fail to gain admission to local universities end up obtaining admission to private universities elsewhere. But what concerns everyone concerned with higher education in our country is the quality of the medical degrees being offered at the Malabe institute. This Institute falls outside the purview of the University Grants Commission. Professor Sherifdeen articulated the concerns of the medical profession when he stated recently that quality medical education requires clinical training throughout a student’s career in the medical college. Sadly, the Malabe institute is now not equipped to provide any clinical training to its students.

Clinical Training

In response to criticism on this issue, the Malabe Institute says it is now in the process of setting up a Teaching Hospital also at Malabe. This is like putting the cart before the horse. A Hospital equipped with adequate facilities in all branches of medicine, with patients and clinical staff, should have been a pre-requisite for admission of students. The management now claims that they are making arrangements, obviously being hastily done to meet criticism, with hospitals in the private sector to provide clinical training. Even a layperson familiar with the working of private hospitals will know that consultants at these private hospitals just will not be able devote the time required to provide proper clinical training to the medical students. The teaching staff at the Malabe institute will not have the luxury of having their own patients at the private hospitals. So any scheme to provide clinical training at private hospitals will be totally unacceptable to meet the rigorous standards of any quality medical education.

In the pursuit of commercial gain, the Malabe Institute is not playing fair by the students it has already enrolled. The students, if they are able to go through the four years at Malabe and the fifth year in Russia, will probably end up with an MD degree awarded by the Russian Medical Academy to which the Malabe Institute is affiliated. But for them to practice their profession, at least in Sri Lanka, their degree will need to be recognized. The Sri Lanka Medical Council has very high and rigorous standards for such recognition. Will the Malabe-trained Russian graduates be able to meet those standards?

There are issues other than clinical training involved regarding the quality of medical education at the Malabe Institute. For instance, one concern is the quality of its permanent teaching staff. Already, its Director, a former general practitioner, politician and now a business entrepreneur, is being referred to as a ‘Professor’. In the state universities, the UGC has laid down strict criteria for promotion in the university to the rank of Professor. In BOI ventures presumably, no such regulatory standards will apply. Some years ago, another medical business entrepreneur ran an alternate medicine institute and styled himself ‘Professor’. There must be a regulatory body like the UGC to ensure that academic titles are used in conformity with acceptable criteria.

A large amount of capital has been invested in the Malabe Institute. But the pursuit of quick returns should not be at the expense of quality. It has the potential to provide access to medical studies for young men and women who can afford it. But the Institute needs to work in co-operation with and conform to the standards set by the regulatory bodies for medical graduates. That is the only way to treat the future of their students with dignity and integrity.

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