By Godwin Constantine –

Dr. Godwin Constantine

The SAITM issue has become a national issue. This has become an issue for politicking for various politically motivated groups. Various groups and individuals have raised their voices for and against SAITM creating much heat and less light.

The SAITM issue has brought out some important questions regarding state funded/private higher education in this country. SAITM assumes importance since it is an institution providing private medical degree. In this regard the following questions needs to be addressed:

1. Do we need private medical degree warding institutions?

2. Is it possible to provide adequate training for private medical students in the private sector?

3. What are the entry criteria for private medical colleges?

4. What are the important issues with SAITM

5. Will private medical colleges affect the state medical faculties?

Do we need private medical degree warding institutions?

The simple answer for this question is yes. We have private education from kindergarten to university level except for medical profession. There are two important factors that make private medical degree contentious issue compared to other professional courses:

    1. Inadequate patient turnover in the private sector hospitals 

    2. Immediate government employment at completion of the degree course.

At present not a single private sector hospital in Sri Lanka could provide the number and the variety of patients needed for training medical graduates. This can only be resolved by giving private medical students access to government hospitals and other health care facilities for training purposes. This will benefit the private sector as well as the government sector in the long run.

Immediate government employment at the completion of the degree course is a privilege enjoyed by medical graduates in this country. State medical graduates and foreign medical graduates enjoy this benefit at present. This ensured state employment has given rise to the argument about the number of doctors produced vs number needed to serve the country. However, the number of graduates / professionals produced in the country and the need of the country has not been raised in any other profession. All the doctors produced in this country are not going to stay in this country and are not going to be confined to state sector alone. We need not assume that the kinetics/ dynamics will remain the same when there is high demand and when there is surplus production. 

The popular argument against private medical education is that it will affect the free education. Is that applicable only for medical education? Is it acceptable to prevent a tax payer’s child obtaining a private medical degree in spite of the tax payer providing money for the ‘free education’ of a state medical faculty graduate? However those who have money are sending their children to other countries to obtain medical degree at a loss to the country’s foreign exchange.

What are the entry criteria for private medical colleges?

Medical students are admitted to the state medical faculties once a year depending on the National Advanced Level examination results. However, the SAITM and the Kotelawala Defence University (KDU) admits students more than once a year depending on National or London Advanced Level examination results. There are three important issues regarding student entry into private medical faculties:

1 Minimum results at the Advanced Level examination 

2. Students entering at a younger age into private medical faculties 

3 more than one batch being admitted per year

The minimum results required to enter the university in Sri Lanka has remained as simple pass in all subjects probably since the time the A/L examinations started. That was so when 4As were hard to find and it remains same when 3As are in abundance. This needs to be revised.

The students who are entering through London A/L have an undue advantage of being at least one year younger to their peers who enter state universities through the National A/L. The state university students will waste one more year to enter state medical faculties whereas the students entering the non-state institutions will be able to start their medical education soon after the A/L results are released. This anomaly will affect the career of medical graduates from state medical faculties as they will be older than their parallels from the private medical college. This will become one of the major disadvantages of being a medical student in a state medical faculty in the future. 

What are the important issues with SAITM?

The main complaint against SAITM is that it had not complied with the recommendations made by the SLMC. The pertinent question we need to ask is whether the KDU and all the state medical faculties have the essential facilities to conduct a medical degree course? The answer is no. However SAITM needs to be singled out in this issue as it is totally a private enterprise. If one private institution is allowed to offer medical degree without adequate facilities it will result in mushrooming of medical colleges without adequate facilities, like in some other countries. 

The SAITM administration has failed to satisfy the expectations of the medical community. There had been some shady issues relating to the SAITM from the beginning. All these facts need to be considered in deciding on the future of SAITM. There needs to be a drastic change in the administrative structure of the SAITM if it is to continue. On the other hand if SAITM is nationalised the establishment of private medical degree awarding institutions in this country will be pushed back by several decades and we will continue to lose foreign exchange. 

Will private medical colleges affect the state medical faculties?

There is a fear that the private medical colleges will lead to deterioration of the state faculties as in the case of Sri Lanka Transport Board. Higher education cannot be simply compared to the other enterprises. The Law College, Institute of Chemistry and various other organisations are conducting higher degree programs for a long time. There are offshore campuses of high ranking international universities in Sri Lanka. None of them have so far been a threat to the Sri Lankan universities.

The government has to take measures to improve the state universities. The well established medical faculties should be promoted to Schools of Medicine with more independence. The facilities in the state faculties can be improved and the possibility of admitting paying students to state faculties could also be explored.

The current trend to promote foreign universities and non state higher education institutions by the government, even by providing infrastructure facilities needs to be questioned.  The recent move by the SAITM owner to ‘gift’ the Neville Fernando Hospital to the government, need to be considered as a serious issue. This is obviously an attempt to resuscitate a private education facility which is in a debt trap. What transactions go on behind this ‘gift’ is unknown.  SAITM medical faculty is a bad start of an acceptable initiative to introduce private medical education in this country.

In addition to SAITM issue further bigger issues have emerged recently. One such issue is the creation of a quality assurance unit to ensure quality of higher education both state and non-state institutions. Though this appears to be founded on a sound principle, this institution may undermine the importance of the Sri Lanka Medical Council in determining the standard of medical education in this country. Which of these two institutions will be the final authority to accredit/approve non-state medical education institutions will be a pertinent question in this regard?

And the pending appointment of the chair person for the SLMC is also an immediate challenge facing the medical community at present. The SLMC chair person will be able to give the necessary green light to fast track the approval of SAITM.  Apart from the issues created by SAITM, the important question of the role of non-state medical education in Sri Lanka has fallen by the wayside. Various professional bodies in the medical field need to address this question, they should not shy away from addressing this pertinent question at this moment in time.

In conclusion, private medical education is a necessary evil. If it is to be accepted in Sri Lanka it needs to be monitored and regulated by the government and the Sri Lanka Medical Association. The number of private institutions and the student admission needs to be monitored and regulated. Remedial measures needs to be taken to ensure that the time of entry of students to the private or the state medical faculties from affecting their career in the long run. All private medical college students should be placed at the bottom of the merit list, as in the case of foreign students, for the purpose of internship appointments. And more importantly there should not be any political interference in the process of establishing a private medical education facility.