Implement the report

  • The probe panel has made a fine set of proposals to ensure quality medical education

– Kahar Singh Khadka

Feb 23, 2018- The Kathmandu Post

The Deuba administration stepped down shortly after receiving the report of the Medical Education Probe Commission (MEPC), and it remains to be seen whether the new government will implement the recommendations of a panel formed by its predecessor. People are also curious about what will happen to the National Medical Education Ordinance which needs to be approved by Parliament. The probe report has not been made public because it needs to be reviewed by the Health and Education ministries first. But as per media reports, it has recommended wide ranging reforms besides calling for action against 43 persons including the vice-chancellor, rector and registrar of Tribhuvan University (TU) for abuse of power to benefit the ‘medical mafia’.

The probe panel has made a fine set of proposals to ensure quality education and regulate the medical education sector. The report contains 29 recommendations which include taking stern action against medical colleges which disregard the regulator’s instructions. The university which has granted affiliation to a medical college can also withdraw it for failing to follow directions repeatedly. Likewise, the operation licence of medical colleges which charge exorbitant fees, admits more students than the enrolment quota and shows negligence in providing quality education can be revoked at any time.

The commission has also recommended establishing provincial medical universities in all seven provinces. They will have the authority to grant affiliation, but they cannot grant affiliation to more than three medical colleges. The report has called for allocation of seats by the university which issues the affiliation, inspection of medical colleges at least twice yearly by a committee consisting of experts from the university, Health and Education ministries and the Medical Council and payment of tuition fees through the bank. Likewise, students who get selected for reservation seats in the entrance examination are required to have at least 70 percent marks.

The probe commission, which also scrutinised the controversial affiliation issue of National Medical College (NMC), found a fake inspection report submitted by a committee led by a senior doctor. NMC had been recommended for affiliation by TU even though it did not fulfil the requirements. Following sustained criticism, TU cancelled its decision to grant affiliation to NMC.

The report of the commission, which was headed by Gauri Bahadur Karki, former chairman of the Special Court, can be taken as one step towards the betterment of health education and healthcare. This achievement is the result of the continuous efforts of medical education reform activist Dr Govinda KC, and the support of all the people and stakeholders who have supported his crusade. The Deuba-led government had been generally agreeable to the demands put forward by Dr KC. If Deuba had shown courage by taking action against the people accused by the Karki panel, he would definitely have received some credit. But he missed the opportunity.

Now a new administration has been sworn in, and it does not look like it will implement the commission’s recommendations. It is common knowledge that the CPN-UML is not in favour of such an ordinance. A bill related to medical education was rejected by the previous Parliament due to lack of support from the UML and the CPN (Maoist Centre).

So there is very little chance that the new government will fully implement the report.

The process of reform in the medical education sector faces tough days ahead. Dr KC has warned of another round of protests if the government fails to implement the recommendations of the probe panel. The way will not be easy for Dr KC because a group of people who are unwilling to back up his efforts have come to power. They will not hesitate to use all the resources at their disposal to make sure that the reform process fails.

Considering the circumstances and the gravity of the current situation, another round of protests seems to be inevitable. To prevent the occurrence of such a state of affairs, the KP Oli government should take this matter seriously and implement the probe panel’s report as soon as possible. MEPC chief Karki rightly said after submitting the report to the government, “I have done my job, now the responsibility lies with the government.” Let’s hope that the new government fulfils its duty by implementing the report.

– Khadka is chairperson of Prakriya Nepal, an NGO working in the field of health, education and consumer rights

 

Get insured

  • Recently-introduced health insurance scheme will not succeed without people’s understanding and participation
Kahar Singh Khadka
Jul 6,2017 – The Kathmandu Post

These days we frequently come across advertisements for the health insurance scheme recently introduced by the Ministry of Health (MoH). The public promotional ad includes an appeal to the general public to register their names in the scheme, which was launched with the aim of providing health security coverage and ensuring access to quality health care at an affordable cost for all citizens.

The government aims to bring the entire national population under the insurance coverage within three years by covering at least an additional 25 districts every successive year. It seems a challenging task to achieve such an ambitious goal within that time frame. The progress of the programme currently running in eight districts is not satisfactory, mainly because the rate of participation is very low.

Better informed

Before we start to examine the various aspects of the insurance scheme including enrolment, benefit packages, sustainability and quality of health services, it is better to know about the scheme and the process of becoming a member because most people are unaware about them.

It is a community-based health insurance programme which involves prepayment and the pooling of resources to protect against the cost of illness. It operates within the scope of a family, so it can be viewed as a family-based insurance programme. All the members of the family need to get registered and make an Individual Identity Card. Registration assistants visit every household in the community for the promotion of the insurance scheme. A five-member family will have to pay an annual premium of Rs2,500. For a family with more than five members, an extra Rs425 will have to be paid for each additional member. In return, each family will receive a benefit package of up to Rs50,000 annually for medical treatment. An additional member will get a financial coverage of up to Rs10,000, but the package amount cannot exceed Rs100,000 in total.

As of now, medical treatment for insured families is only available at government-run health care centres. But the MoH has been trying to find a way to make services available at private hospitals, too. The insured members cannot go to any government hospital they choose, except in cases of emergency. This is because members must choose a specific health care provider while filling the registration form.

Prior to this, Nepalis did not have any experience of a community-based health insurance scheme. A few pilot projects were launched, but their reach was limited. There is no statute law relating to health insurance in the country. The MoH has drafted a bill, but it is yet to be endorsed. Even private insurance companies do not sell health insurance policies like this. They have only issued an accidental health insurance policy, which apply only in the case of accidents. Nepal obviously has a long way to go to reach the level of developed countries in terms of providing health insurance for its citizens.

Why low enrolment?

There are many reasons behind the low enrolment. An important one is the lack of knowledge about health insurance. Even those who are mindful of their health are not convinced that insurance helps them minimise their health care cost. Some people even say that if no family member falls sick within a year, then the family will lose their Rs2,500. It’s a little strange that some people do not seem to understand there is always a possibility of them falling sick at any given time, and that by investing a little money, they can have access to a larger amount at their time of need.

It’s true that there are many others for whom the insurance scheme is not financially viable. The government has allocated a monetary fund for the poor with the purpose of involving them in the insurance scheme, but that fund has not been fully utilised as the intended beneficiary has to show a Poor Identity Card. Many people who qualify haven’t received the card. There are many disadvantaged, marginalised and differently-abled people who also need to be brought under the insurance scheme. So the MoH should come up with a plan to find an alternative source of finance for them.

The benefit package provided by the government is acceptable in the present context. It can offer financial protection for those who cannot afford the high cost of medical expenses. But people have doubts that the health service provided under this scheme will be of the same quality as the one provided to those who pay out of pocket. Such doubts are also responsible for low enrolment in the scheme. To dispel the doubts, a health insurance policy paper should be issued along with an ID card, clearly mentioning the contents of the services and their quality and potential benefits.

In conclusion, the health insurance programme shows the government’s commitment to public health. But without people’s informed understanding and active involvement, the health insurance scheme may not be utilised by the intended population. So the MoH should ramp up efforts to make people more aware of the benefits of health insurance. The government also needs support from various concerned stakeholders to make the programme successful.

 

– Khadka is chairperson of Prakriya Nepal, an NGO working in the field of health, education and consumer rights

Talking is easy

  • The greatest challenge in the health sector is making services available nationwide
 By:  Kahar Singh Khadka
 April 20, 2017- The Kathmandu Post

People have been asking what improvements have occurred in the health sector after the many initiatives launched by Health Minister Gagan Thapa. Some say that they are just populist political gestures. The reason behind this perception is that people are not much hopeful about the implementation part, which is yet to be seen. At the same time, Minister Thapa has become a champion in the eyes of the populace. He may have come up with ambitious health programmes, but one thing we must say honestly is that he has been trying his best to bring changes.

Thapa has done a praiseworthy job after assuming office by creating rules regarding the amount of financial assistance the government can provide to political leaders and cadres for medical treatment. The guideline has capped medical aid at Rs1.5 million. Let’s hope this ceiling will be strictly followed. The minister has also announced various health care facilities. A number of services have been made totally free of cost to all Nepali citizens. Provisions have been made to provide free treatment to certain groups of people who cannot afford expensive medical treatment.

Laudable initiative

Medical treatment like dialysis and valve transplantation for rheumatic heart patients have been made free for everybody. Now anyone can get free dialysis for life in the case of kidney failure. Likewise, kidney transplant will be done without charge if the patient’s nearest relative is the donor. The minister has also extended free valve transplant service to rheumatic heart patients of all ages. Earlier, this service was free only for those below the age of 15 years.

The Health Ministry has also introduced a provision allocating 10 percent of hospital beds to the poor, disabled, underprivileged and old citizens. They will also receive free medical treatment. Potential beneficiaries have to produce a recommendation letter from the concerned village or municipal council and the District Health Post to obtain this facility. However, getting this paperwork can be a lengthy process for poor and illiterate people. Due to such technical difficulties, there is little chance of getting this facility at the time of need. Therefore, it is important to analyse whether the target people have really benefitted from the free coverage.

Minister Thapa has also instructed hospitals to provide OPD services during office hours, provided allowances to doctors, made arrangements for the government to procure medicines itself, sent doctors to remote areas and signed partnerships with varied agencies. In addition to the Health Ministry, another government agency has come forward with a very commendable decision to support cancer patients. The Ministry of Women, Children and Social Welfare has decided to bear all treatment costs of women suffering from uterine or breast cancer. If the ministry follows up on its promise, it will be a great relief to women who are suffering from such diseases.

It is not possible to achieve great results in a short period of time in the health sector which involves the entire population. So we should not expect drastic changes in the nine months since Minister Thapa assumed office. But this does not mean that he can shirk his responsibility to reform the health system in the country. This does not mean that there are no immediate needs that need to be dealt with in the health sector. This means that he needs to focus on finding out the social determinants of health instead of concentrating on short-term goals.

Inequality in health care

Thapa is a responsible youth political leader. He stood by Dr Govinda KC during his campaign to end malpractices in the health sector. People expect much more from him because they think that things will turn out well under his leadership. So he has to present himself as a result-oriented leader who cares about the people’s concerns all the time. Has he been able to stand out from other ministers by showing good performance? Has he succeeded in bringing an outstanding plan for the betterment of public health?

If the truth be told, Thapa has not yet been able to address the concerns of people who lack access to health care services. Inequality in health care services prevails in the country. A large section of the population still has no access to basic health. There is a disparity between private and public health service providers in terms of service, quality and cost. So what has been really achieved so far? We need to find out a long-term solution to this problem.

Every year, the Health Ministry issues a strategic plan which is a long-standing tradition. And this year too, the health minister has unveiled a five-year plan entitled Nepal Health Sector Strategy Implementation Plan. After Thapa leaves office, the next health minister will repeat the same process next year. But just issuing health strategies is not enough; the targeted results can only be achieved by successful execution. The main problem we are facing is that there is a serious lack of implementation of the policies that are frequently issued. Giving an interview to a newspaper, Thapa said, “The first thing is political will, and I have that will.” Of course, your actions have shown that. But Minister Thapa, please keep one thing in mind, “Well done is better than well said.”

Know your rights

Consumers can claim compensation for damages caused by bad products or services

 By, Kahar Singh Khadka 
Mar 15, 2017- The Kathmandu Post

Consumer rights activists, organisations and government consumer agencies around the globe have been marking International Consumer Rights Day on March 15 even though it is not formally recognised by the United Nations (UN). In Nepal too, the international event has been observed for a few years, albeit on a small scale. The celebrations, unfortunately, have remained a formality and no tangible changes have been seen in terms of the protection and promotion of consumer rights. A majority of the people are unaware about their consumer rights which are protected by law. Very few have exercised their rights to safeguard their health and ensure protection from unfair trade practices.

History of consumer rights
The history of the consumer rights movement is not very long. It only gained momentum after the Second World War. On March 15, 1962, the then US president John F Kennedy declared four consumer rights while serving a directive to the US Consumer Advisory Council. They are now regarded as fundamental rights. Kennedy stated that consumers had the right to safety, the right to be informed, the right to choose and the right to be heard. These rights were not universally recognised until the UN endorsed them.
The history of consumer rights in Nepal is not so long either. The movement has made much progress, but there’s still a long way to go. After the political change in 1990, consumer rights issues came to the notice of rights activists and lawmakers. The turning point came when the government introduced the Consumer Protection Act 1998 and the regulation in 1999. Before the enactment of these statutes, there were some legal provisions in the Civil Code, but there was no specific law for the protection of consumers.
The Consumer Protection Act has established the right to be heard and compensated against exploitation and hardships resulting from trade irregularities and poor service quality. Compensation committees have been established in every district to hear complaints from consumers. However, these committees need to be replaced by consumer courts.
The constitution has also declared consumer right as a fundamental right of every citizen. The supreme law of the land states, “Each consumer shall have the right to quality foodstuffs and services. A person who has suffered from substandard object or service shall have the right to be compensated as provided for by law.” This constitutional declaration has enabled consumers to fight if their rights are violated. Unfortunately, very few people have stood up for their rights. And very few cases have been filed against those who have sold and supplied substandard consumer goods and services.

Protection and education
We have frequently encountered news stories about shops being sealed by government inspection teams for selling bad products. But we have rarely come across reports about compensation being paid to consumers by offending companies and service providers for the damage caused by their products and services. This is simply because most consumers do not claim compensation for the loss they have suffered. There are two reasons behind this. One, many people do not know that their rights are protected by law. Two, those who are aware that their rights are protected do not bother to begin legal proceedings.
Most consumers in Nepal fall under the first category. This is the major challenge we are facing. As the concerned agencies have not been able to educate the masses about their rights, everyday people are being made to buy low quality goods and services. In order to avoid being cheated repeatedly and obtain redress in case of severe damage, it becomes necessary for consumers to be always aware.
Nepal is far behind other countries in the field of consumer protection. The main thing we lack is consumer rights education. If we want more and more people to know about consumer rights, we must generate and strengthen awareness programmes effectively. In a country like Nepal where people lack consumer rights awareness, only celebrating an international day is not sufficient to raise awareness and safeguard the rights of consumers. Much effort needs to be made by all stakeholders to promote consumer protection. The government can play a vital role in protecting the rights and interests of consumers by establishing proper mechanisms for their overall welfare.

– Khadka is chairperson of Prakriya Nepal, an NGO working in the field of health, education and consumer rights

Published: 15-03-2017 08:21

 

Running out of patience

  • Unresolved medical malpractice claims have been piling up due to lack of judges

By, Kahar Singh Khadka
Jan 22, 2017- The Kathmandu Post

The hearing date for a medical compensation case, which has long been pending at the Supreme Court, has been deferred for the eighth time. The case began the legal journey at the District Compensation Committee Kathmandu in 2005, and it is still not sure how long the proceedings will last. A hospital patient filed a lawsuit claiming compensation from her doctor and the hospital for medical negligence. She was admitted to the hospital in Kathmandu for the treatment of a small tumour below her right knee. She underwent a surgical operation by an orthopaedic doctor to remove the lump.

Unfortunately, further complications arose after the operation, and the victim had to face an unexpected consequence which was very hard to believe. She had to have her leg amputated. What’s more, her leg was amputated twice, the first time below the knee and again above the knee. She suffered terribly by losing her leg, and now she is desperately waiting for justice.
Diagnostic errors

We regularly come across news reports about relatives of patients launching protests against hospitals for not providing proper treatment. Many times, such incidents, which were suspected to be cases of medical negligence, are not made public and settled privately. This is because health care providers do not want such incidents to be published in the media for fear of losing public credibility. It is also unfortunate that, on many occasions, victims do not declare that they have suffered due to the negligence of medical practitioners. Sometimes, they deal with the situation aggressively. Angry family members of patients have even vandalised hospital property and clashed with the staff.

It will definitely hurt when someone gets harmed unnaturally or a loved one is lost. Everything cannot always be under human control. Sometimes, unpleasant results will appear, even though care providers have skilfully performed their duty to cure the patient. It is normally understood that doctors treat patients to save their lives. That is why doctors are called saviours of human beings. They cannot be liable for all types of harm or injury, and they can be held responsible only when substandard treatment has resulted in injury or damage. Sometimes, a small mistake made by a doctor can be catastrophic for the patient. As a result, the patient undergoes severe physical damage including pain, injury, distress, disfigurement, financial burden and even death.

Researchers at US-based Johns Hopkins have reported in BMJ Quality & Safety that “diagnostic errors are one of the most dangerous and expensive mistakes made by American doctors, estimated to cause between 80,000 and 160,000 deaths every year”. Despite being a developed country where advanced medical equipment is used, diagnostic errors are still commonly noticed in US. What is the situation in an underdeveloped country like Nepal where there is no basic health equipment at many health posts, and where a number of quacks have been arrested? Nobody has the exact data.

Speedy justice

Every citizen has the right to have a standard degree of care and skills while receiving medical treatment.

In Nepal, most people do not know about medical malpractice. And they rarely go to court for legal action. Even in the Kathmandu Valley, very few people have taken legal action against wrongdoers and claimed compensation. Though there is no specific act to regulate and govern medical malpractice in Nepal, there are some legal provisions in the Civil Code and Consumer Protection Act 1998. These provisions are not sufficient, but they can help to make healthcare professionals accountable in case of medical negligence.

Clause 22 of the Consumer Protection Act says that any consumer who suffers a loss or damage of any kind as a result of the sale of any consumer goods or service contrary to the Consumer Act may file a complaint with the Compensation Committee for compensation. Not only that, when medical service providers cause harm to a patient by rendering service in a negligent manner, the victim can begin legal proceedings so that they are punished by a fine or confinement in jail and made to pay compensation.

Our judicial system suffers from lack of judges which have resulted in cases piling up. Recently, vacant judicial positions at the Supreme Court have been filled with new justices, but it is still overloaded with cases, and things have not been speeded up. Besides a backlog of cases related to medical malpractice, there are many other cases which have also been waiting for a final decision. Delays in delivering judgment in time have not only added pain to the innocent party. Victims have to endure hardship, waste of time, economic loss and other undesirable impacts. Justice cannot be established unless it is delivered in a timely manner. So our judicial system should focus on ensuring speedy justice as far as possible.

 

Khadka is chairperson of Prakriya Nepal, an NGO working in the field of health, education and consumer rights

 

Legal corruption

  • Politicians get millions for medical care while poor patients die for lack of money

By, Kahar Singh Khadka

Dec 15, 2016- The Kathmandu Post

Last month, there were two scandalous events that received uneven coverage in the media. The first one, which was highly publicised, was the government’s decision to provide Rs5 million to former deputy prime minister and Nepali Congress leader Sujata Koirala for cancer treatment despite a huge public outcry. And the second, which was barely reported by the media, was a suicide committed by a patient named Anuj Bishwash at Birat Nursing Home. He had jumped out of a third-floor window for being unable to pay his hospital bills. These two instances are a true picture of how different social classes receive medical treatment. They not only illustrate the widening inequality between the elite and the general public in terms of access to health care, but highlight the exploitation and victimisation between the two social strata.

In Nepal, it appears that people are destined to be exploited by a few who are bent on taking advantage of every available resource. While our rich politicians have been receiving huge amounts of money from the state coffers for medical treatment in foreign countries, poor people are compelled to sell their meagre properties to pay their medical bills. Some even resort to killing themselves to free their family from financial burdens. Sometimes, it becomes the duty of the government to pay the medical expenses of people who have made a great contribution to the country. But this only applies to personages who cannot afford the costs. But the case here is different. Regardless of their fat bank balances and many other assets, our politicians never hesitate to dip into taxpayer money. They demand the money from the state as if it is their right. Such practices are a violation of the public’s right to equal access to health care.

Cancer treatment

Millions of rupees have thus been allocated from the state treasury to political leaders and their cadres. Recently, the government had also provided Rs6 million to former president Ram Baran Yadav for cancer treatment abroad. While all kinds of medical services including cancer treatment are available in Nepal, the trend of going abroad for medical treatment by misusing taxpayer money has not stopped. In fact, it is on the rise. Political leaders have been zooming off to foreign countries for simple medical conditions that can be easily cured in Nepal. Nepali doctors have criticised such tendencies among politicians and said that different kinds of medical services are available in Nepal. Why do our leaders prefer to get medical treatment overseas? Everybody can easily answer the question. It is because they do not have to spend their own money and can get the treatment free of cost in foreign countries.

While the number of leaders travelling abroad to receive medical attention has been swelling, ordinary people who are suffering from cancer are forced to crowd into the few hospitals that offer radiotherapy service. Due to the negligence of the concerned department, radiotherapy services are not currently available at all the cancer hospitals. For the last few months, two radiotherapy machines at BP Koirala Memorial Cancer Hospital and one at Bir Hospital have lain inoperative. So there is an overflow of patients at Bhaktapur Cancer Hospital. People have to wait for weeks to get radiotherapy service at the government hospitals, and such delays in getting treatment will raise the chances of the cancer spreading. Recently, a private cancer hospital has started offering services in Kathmandu with many kinds of treatment facilities, but it is very expensive compared to government hospitals.

Unanswered questions

As there are no definite rules and criteria for the issuance of medical assistance, influential leaders have been trying to get all the money they can from the government. Treatment expenses are being distributed in a discriminatory way. Some have been given a lot while others have received very little. The process of allocating money has not been done in a transparent manner. The recipients of the largesse do not have to submit details of how they spent the money. How much do they actually need? And what if they have money left over? Do they refund it? Do not they need to get a recommendation from the concerned agencies? These questions remain unanswered.

The Health Ministry has recently made a praiseworthy move. It submitted a guideline setting a ceiling on the amount of aid that the government can give for medical treatment. But the Cabinet decided to give the money to Koirala by bypassing the Health Ministry’s proposal. Many times in the past, the government has not followed instructions given by parliamentary committees to go through the Health Ministry while issuing cash gifts. As decisions made by the executive branch cannot be investigated by watchdog agencies, they are legally committing corruption in the guise of issuing medical assistance. This is abuse of power within the provisions of the law for private gain, especially for political leaders, their cadres and relatives. It is legal corruption. In order to stop this practice, the other two state organs should take up the matter seriously.

Khadka is chairperson of Prakriya Nepal, an NGO working in the field of health, education and consumer rights

 

Old plan, new plan

Despite all its efforts, govt has not come even close to bridging the gap between private and public education 

By, Kahar Singh Khadka

Nov 20, 2016- The Kathmandu Post

The Ministry of Education has recently endorsed the School Sector Development Plan (SSDP) for the development of school education as per the spirit of the new constitution. The ministry introduced this policy after its earlier School Sector Reform Plan (SSRP) expired in August. As mentioned in its recently approved SSDP, it is in a preliminary stage and a lot of work still needs to be done before it can come into force. First, the Core Document, which will identify the policies and strategies required to restructure school education, needs to be prepared. For that, the ministry will undertake a consultative process with professionals, experts and concerned stakeholders at district, regional and national levels. After collecting feedback from them, the ministry will come up with an Approach Paper, which will be developed as the fundamental document for the SSDP. After that, the ministry will start the implementation process.

Though some new objectives have been included in the SSDP, such as education under a federal set-up and reconstruction of school buildings damaged by the earthquake, there is not much difference between the SSDP and the SSRP. Most of the plans and programmes such as Education for All, Secondary Education Support Programme, Community School Support Programme and Teacher Education Project are the same as they were under the SSRP. Similarly, increasing access to and enrolment in schools, restructuring school education and improving the quality of education still remained topmost agendas as in the past. In fact, the SSDP is just the continuation of the unfinished work of the SSRP. So it is fair to argue that the SSRP could not achieve its goals, which gives reasons for donors to be sceptical about the new plan. Given the performance under the SSRP, it is doubtful if the newly formulated SSDP will meet its stated goals within a short period of seven years.

Focus on quality

An underdeveloped country like Nepal, which has long been struggling to graduate from its status of Least Developed Country (LDC), does have to face huge challenges to attain development goals. With regard to the SSDP, political instability, prolonged political transition, lack of political determination, ineffectiveness of state mechanisms, inadequacy of government budget and absence of legal provisions in education are some of the major obstructions to the plan’s success. Furthermore, dependence on the donors for the cost of the projects due to the government’s limited funding is another factor that hinders the implementation of the plan.

It will be wrong to say that the country has not had any reforms in education since the introduction of the first National Education System Plan in 1973. The government has done substantial work in the past, and the country’s increased literacy and enrolment rates are a result of that. When the literacy rate was low in the past, the government had only focused on quantity. But now that a lot of progress has been made towards that end, the focus now needs to shift to quality in education.

In the absence of quality education, we lose the whole purpose of education, which is to provide learners with capabilities they require to become economically productive, develop sustainable livelihoods, contribute to peaceful and democratic societies and enhance individual well-being. Unfortunately, in Nepal, there is a substantial difference in the quality of education provided in private and public education institutions. For instance, if you compare the SLC results of students studying in private and public schools, you can clearly see the blatant inequality. Government schools’ performance in SLC has been miserable for years despite huge efforts made by the government to improve the quality of education in public schools. The government has not come even close to bridging the gap between private and public education systems over the years.

Why do the two education systems differ so much in the country? Why do the people in general prefer private education institutions to public education institutions? The SSDP should find the answer to these questions. To bring about the expected results as sought by the SSDP, the government must seriously focus on raising the quality, efficiency and effectiveness of the public education system.

Additional goals

With the promulgation of the constitution, and after last year’s earthquake, new challenges have emerged. Ensuring the rights guaranteed by the constitution, making legal and structural arrangements in line with the federal structure, reconstructing school buildings and creating a conducive environment for the children affected by the earthquake to go to school are some additional goals incorporated into the SSDP. The feedback provided by the concerned stakeholders and the performance of the government will determine whether the the new plan will succeed. Work should be done scrupulously according to a well-defined framework to achieve the goals. Otherwise, the new plan will follow the trajectory of the old one.

Khadka is the chairperson of Prakriya Nepal, an NGO working in the field of health, education and consumer rights

Still a lot to learn

Reducing the disparity between public and private education should be the government’s main concern.

By, Kahar Singh Khadka

June 14, 2016- The Kathmandu Post

After a long and intense debate over the education bill, Parliament has recently endorsed the eighth amendment to the 1972 Education Act. The major amendments to the act are the phasing out of the School Leaving Certificate (SLC) examination and the ‘Golden Handshake’ offer to the temporary teachers.

Although people are not very hopeful that the amendments will bring about overall development of the education sector, the amendment has at least succeeded in addressing a few issues that have long been pending. The issue of temporary teachers remained unresolved for a long time. And the teachers who were forced to quit their job during the Maoist insurgency feel relieved, as they are going to be reinstated in their previous position.

Terminating the SLC examination system, which existed over 80 years, and upgrading the high school level to grade 12 is another breakthrough. It is a positive step towards making our education system on a par with international standards. Questions had long been raised over the relevance of the SLC exams. Many people believe that SLC was one of the reasons behind the existing disparity between private and public education, as some private schools have used the SLC result of their students to lure more students. Additionally, from this year, the government has decided to adopt the grade system; students will receive grades instead of marks from this year on.

The recent amendment to the Education Act has also changed the registration process of schools. Until now, schools have been registered under the company act. When the bill was pending in the legislature, maximum efforts were made to bring all the schools under cooperatives. But such efforts did not succeed. As per the new amended law, schools now have to be registered under private and public ‘Guthi’. A few other new provisions have also been made to the newly enacted law pertaining to school education.

There are divergent views on the recent amendment to the Education Act. Some argue that this amendment has only focused on technical aspects, as it has simply categorised the grade, level and testing process of students for school education. They claim that it has not been able to address the issue of how to improve the quality of education, especially in public schools. However, there are others who are fully supporting  this new enactment, saying that it is a good initiative towards the betterment of the education sector.

Private vs public

We all know that we have two types of education system—private and public—but there is little similarity between them in terms of access, equity and quality. Reducing the disparity between the two types should be the main concern for the government. Public schools of the country have been struggling for years to provide quality education. The first National Education System Plan was introduced in the same year as the Education Act 1972. Still after 44 years, the country has not seen tangible changes in public education. Literacy rate has increased over the years but the dire state of public schools persists.

In Nepal, the performance of public schools is not satisfactory in comparion to private schools. That is why most parents who can afford it prefer to send their children to private schools. Thus, while the country has made significant progress in school enrolment, public schools are witnessing low enrolment. Many public schools are undergoing mergers due to lack of students. Poor infrastructure, limited financial sources, lack of trained and experienced teachers, irregularity of students, absenteeism among teachers are some of the problems plaguing the public schools in the country. Things are worse off in rural areas and earthquake affected-districts. And in many mountain districts, students have not yet received their textbooks even though the academic session has already begun.

Private schools are better in terms of infrastructure, facilities and competitive education. Every year, above 80 percent of the students from private schools passed the SLC exam with good results, while the results of public school students have generally been miserable.

Bridging the gap

Although private schools have been providing better education, they have been charging exorbitant fees. Most private schools of the country have not abided by the fee ceiling set by the government. All private schools are required to get their fee structure approved by the District Education Office. But this requirement is not strictly followed. Private schools in the country have usually focused on profit-making rather than being service-oriented. They look more like business houses than educational institutes.

Therefore, just amending the Education Act is not enough to bridge the gap between private and public education, which is the actual need of the hour. When it comes to the quality of education, drastic measures are needed to reform public schools. So the government must come up with concrete plans and implement them to make the community schools as competitive as private schools. Without this, the country’s education system will continue to suffer.

Khadka is chairperson at Prakriya Nepal, an NGO working in health, education and consumer rights

Health inequality

Constitutional provisions do not mean much if they are not implemented

By, Kahar Singh Khadka
May 15, 2016-  The Kathmandu Post

Nepalis have two choices before them to prevent or cure ill health, and one’s choice depends on one’s financial capability. There are two kinds of health service providers in the country—the private and the public. People who are financially well-off go to the well-equipped private nursing homes or hospitals. On the other hand, those who cannot afford such a costly treatment approach the public health care centres. Such public health service providers are the government’s health posts and hospitals. Unfortunately, many of them are in a dire condition with poor services, facilities and equipment.

The services provided by the public health care centres in remote areas are even worse. There is not a single doctor at many public health care centres. In many circumstances, health assistants and other minimally trained staff members look after the patients who require medical care. But unavailability of doctors in the government hospitals is a big problem even in urban areas. Most of the doctors serving in the government hospitals spend a limited amount of time there, insufficient to meet people’s needs. This is because most of them prefer working for private hospitals and spend more time there. The rule which prohibits the health professionals assigned to the government hospitals against working in private health centres has not been strictly enforced. But recently in Chitwan, a bold step was taken by the police. They arrested two health professionals of the BP Memorial Cancer Hospital on charges of working in a private clinic during duty hours.

Public versus private

There are many differences between private and public health centres in terms of services, facilities and costs. Private health care centres are established with a commercial mindset; they are therefore profit-oriented. As a result, services and facilities are comparatively better in private health care centres than in state-run hospitals.

But the benefits of going to a private health facility come with a price.  It has become common practice in all private health centres to overcharge for their services. They levy a high service charge on a minor medical or surgical treatment, and their medicines and medical supplies are also quite expensive. Though it is beyond the financial capacity of many people to go to private health centres, they are compelled to do so.

Unlike private hospitals, government hospitals are inexpensive and are therefore overcrowded. People have to spend long hours in a queue for a medical checkup.  The doctors serving in the government hospitals do not pay much attention to the patients; some of them even convince patients admitted in the government hospitals to shift to private institutions. It is really an unfortunate scenario to have such money-minded health professionals. A few months ago it was reported how private hospitals in the Capital were bribing ambulance drivers to bring in patients.

There is a clear disparity between the haves and the have-nots as far as receiving quality health services in Nepal is concerned. And this difference has prevailed in the country since the privatisation of health services. After the restoration of democracy in 1990, the government accepted a more liberal policy with a view to promote a competitive market in different sectors. As a result, a large number of private institutions in the health sector were established, creating a sharp division between the rich and the poor in the face of growing health concerns.

Right to health

The low quality of service in the public health care centres, lack of easy access to health services for a majority of the people and cartels in the private health care centres have widened health inequality in the country. This is a major concern that needs to be addressed. It is the responsibility of the government to ensure equal health access to its populace. The Constitution of Nepal has guaranteed the right to health. As per the article 35(3) of the constitution: ‘Each person shall have equal access to health care’. But it is not enough to just write this in the constitution. It will only matter if the government takes solid actions to improve the ailing health sector of our country. While the government health facilities need to be strengthened, private institutions need to be strictly monitored for financial irregularities.
Khadka is chairperson at Prakriya Nepal, an NGO working in health, education and consumer rights