Features
Private medical schools: Next assault on Free Education?
By Ramya Kumar
Interest-free loans of LKR 1.1 million are to be offered for students to follow degree programmes at private higher educational institutions. An amendment to the Universities Act has been proposed to establish a Quality Assurance Council under the University Grants Commission (UGC) to maintain the quality of academic programmes offered by state and non-state higher educational institutions.
According to the government, these policies are designed to increase access to higher education and standardize the quality of academic programmes. However, the relentless attacks on the student movement, arbitrary arrests of Inter-University Students’ Federation (IUSF) leaders and the media campaigns against free education signal a different agenda: privatisation. As the government sets the stage for a ‘radical’ revamping of higher education, this article looks at what might be in store for medical education.
Minimum standards
Private medical education is a sensitive topic in Sri Lanka, so much so that the government has kept mum about its plans. The foundation for the establishment of private medical schools has already been laid through the setting up of an Accreditation Unit under the Sri Lanka Medical Council (SLMC). The medical fraternity may oppose private medical schools of questionable standards, but does not, in principle, object to private medical education. Indeed, there is much complacency on this front since the gazetting of the Minimum Standards of Medical Education in 2018, after the SAITM debacle. Even the Government Medical Officers’ Association (GMOA), which opposed SAITM based on ‘quality’ concerns, now simply demands that they be consulted in matters pertaining to private medical education.
It is believed that the quality of MBBS degree programmes can be assured by the requirements set out in the Minimum Standards, for instance, minimum qualifications for student admission, staff requirements, hospital bed numbers, bed occupancy rates, etc. To be sure, the Minimum Standards do set much-needed ‘benchmarks’ to check the proliferation of low-quality private medical schools.
However, by considering state and non-state medical schools on an equal footing, neither the Minimum Standards nor accreditation processes give due consideration to the impact private medical schools will have on state medical faculties. In particular, they overlook equity and justice in access to medical education.
An unhealthy symbiosis
Take, for instance, the staff requirements laid out in the Minimum Standards. In terms of academic staff, the Standards specify that MBBS degree-awarding institutions should “conform to teacher-student ratios… not less than one teacher for every 14 medical students, taking into account the permanent academic staff and the extended faculty of specialists in affiliated teaching hospitals and other healthcare settings.” They include provisions for a balance between full-time and part-time academic staff, and ask that “all medically qualified staff engaged in patient care are registered with the designated body responsible for registration of medical professions in the relevant country” (Note: the Minimum Standards apply to overseas medical schools that produce MBBS graduates who intend to work in Sri Lanka).
In the event that private medical schools set foot in the country, it is unlikely that these institutions will be able to attract diaspora medical professionals who could renew their SLMC registration, given the economic situation in the country. Therefore, these institutions would need to rely on retired medical professionals or current teaching faculty at state medical faculties. As the Standards do not place limits on teaching hours, university teachers will be able to divide their time between public and private medical schools (akin to ‘dual practice’ by clinicians) or, if the benefits are appealing, a wholesale movement from state to private medical schools may occur.
If teaching faculty engage in ‘dual practice’ in state and private medical schools, there is no guarantee that their primary commitments will remain with state medical faculties. Given the required hospital beds and occupancy rates specified in the Minimum Standards, private medical schools may need to rely on public hospitals for clinical training. For this reason, they may be located adjacent to tertiary hospitals in peripheral districts that do not serve as clinical training centres for students of state medical faculties.
Winners and losers
Student intake to state universities, including medical faculties, has steeply risen in recent years (see table). Even so, the Colombo Medical Faculty has been able to maintain its student to permanent academic staff ratio at 7:1. Owing to its location, the Colombo Medical Faculty would be able to attract medical professionals to full-time teaching positions despite the higher salaries offered by the Ministry of Health.
However, the student to permanent academic staff ratio at the Jaffna Medical Faculty has risen over the years, climbing to 19:1 in 2021. The availability of vacant cadre positions at Ministry of Health institutions in and around Jaffna gives medical professionals no reason to resign from the Ministry to take up teaching positions that pay substantially less. (See table)
The requirement of 14:1 is fulfilled by state medical faculties in peripheral districts when temporary staff and extended faculty at teaching hospitals are considered. Yet, curriculum development, ‘quality assurance,’ student welfare and other time-consuming activities are undertaken primarily by permanent academic staff. If private medical schools are established in such districts, state medical faculties will need to compete not only with the Ministry of Health, but also with private medical schools that can offer much higher salaries, causing a dearth in teaching staff at state medical faculties.
Equity of access
The government will gloss over equity concerns by promising loans, voucher schemes and other carrots to study at private medical schools. Even as the state university system as a whole is seeing declines in state investment (see table), and even more so after the economic crisis, it is unclear how these loans will be financed. Accumulating student debt has shown to influence the career choices of medical students in other settings.
As the country struggles to retain medical professionals, it is unlikely that medical graduates burdened by student debt will serve in the public health sector under the present salary structure. It is even less likely that fee-levying international students, the government’s primary target for forex, will serve in Sri Lanka’s health sector. In other words, whether private medical schools will produce medical professionals to service the healthcare needs of ordinary citizens is uncertain.
The entry of private medical schools will change the demographic makeup of medical students by creating a two-tiered system of medical education. Given the emphasis on student resumes and ‘soft skills’, not to mention the hefty fees that will be levied, those who enter private medical schools will mostly represent the middle/upper-middle classes. According to UGC statistics, in 2020/2021, about 63% of enrollment in state medical faculties was through the district quote system. While the Colombo elite suggest that this is a form of reverse discrimination, such arguments overlook the tremendous disadvantages experienced by students from rural districts.
A closer look at the UGC’s admission statistics of 2020/2021 shows that the majority of students who entered medicine from the Vanni districts, Polonnaruwa, Anuradhapura, Moneragala and Nuwara Eliya, did so through the district quotas. With the entrenchment of private medical education, and weakening of state medical faculties, the opportunities for students from rural and plantation districts to access medical education will contract. It must be remembered that it is also these students who tend to populate peripherally located state medical faculties.
Ideology in the making
As health professionals leave en masse from the country, it is argued that private medical schools might present a solution for physician brain drain. The entry of private medical schools will surely create a two-tiered system with lasting impacts on who has access to medical education and on the healthcare system more broadly. Until now, state medical faculties have furnished the public health sector with its medical cadre. While there is certainly room for improvement, at this point, the focus should be on supporting state medical faculties to ensure the survival of the public health sector.
As welfare is steadily chipped away in the name of the economic crisis, the government, supported by sections of the elite, suggest that it is a ‘welfare mindset’ that has brought the country to this state of crisis. The media is drumming up support for the government’s short-sighted policies, including the dismantling of free education. Images of student protests are being deployed to further delegitimize state universities, detracting attention from the ongoing mass-scale dispossession that is taking place in this country, whether through ‘domestic debt optimisation’, labour reforms or the proposals on restructuring higher education and public health. In this context, opposing private medical education is portrayed as ‘ideological’ or impractical, concealing the ideological work that has been undertaken over the years to convince many to believe that fee-levying university education is the way forward.
(The author is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna)
Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.
Features
US’ drastic aid cut to UN poses moral challenge to world
‘Adapt, shrink or die’ – thus runs the warning issued by the Trump administration to UN humanitarian agencies with brute insensitivity in the wake of its recent decision to drastically reduce to $2bn its humanitarian aid to the UN system. This is a substantial climb down from the $17bn the US usually provided to the UN for its humanitarian operations.
Considering that the US has hitherto been the UN’s biggest aid provider, it need hardly be said that the US decision would pose a daunting challenge to the UN’s humanitarian operations around the world. This would indeed mean that, among other things, people living in poverty and stifling material hardships, in particularly the Southern hemisphere, could dramatically increase. Coming on top of the US decision to bring to an end USAID operations, the poor of the world could be said to have been left to their devices as a consequence of these morally insensitive policy rethinks of the Trump administration.
Earlier, the UN had warned that it would be compelled to reduce its aid programs in the face of ‘the deepest funding cuts ever.’ In fact the UN is on record as requesting the world for $23bn for its 2026 aid operations.
If this UN appeal happens to go unheeded, the possibilities are that the UN would not be in a position to uphold the status it has hitherto held as the world’s foremost humanitarian aid provider. It would not be incorrect to state that a substantial part of the rationale for the UN’s existence could come in for questioning if its humanitarian identity is thus eroded.
Inherent in these developments is a challenge for those sections of the international community that wish to stand up and be counted as humanists and the ‘Conscience of the World.’ A responsibility is cast on them to not only keep the UN system going but to also ensure its increased efficiency as a humanitarian aid provider to particularly the poorest of the poor.
It is unfortunate that the US is increasingly opting for a position of international isolation. Such a policy position was adopted by it in the decades leading to World War Two and the consequences for the world as a result for this policy posture were most disquieting. For instance, it opened the door to the flourishing of dictatorial regimes in the West, such as that led by Adolph Hitler in Germany, which nearly paved the way for the subjugation of a good part of Europe by the Nazis.
If the US had not intervened militarily in the war on the side of the Allies, the West would have faced the distressing prospect of coming under the sway of the Nazis and as a result earned indefinite political and military repression. By entering World War Two the US helped to ward off these bleak outcomes and indeed helped the major democracies of Western Europe to hold their own and thrive against fascism and dictatorial rule.
Republican administrations in the US in particular have not proved the greatest defenders of democratic rule the world over, but by helping to keep the international power balance in favour of democracy and fundamental human rights they could keep under a tight leash fascism and linked anti-democratic forces even in contemporary times. Russia’s invasion and continued occupation of parts of Ukraine reminds us starkly that the democracy versus fascism battle is far from over.
Right now, the US needs to remain on the side of the rest of the West very firmly, lest fascism enjoys another unfettered lease of life through the absence of countervailing and substantial military and political power.
However, by reducing its financial support for the UN and backing away from sustaining its humanitarian programs the world over the US could be laying the ground work for an aggravation of poverty in the South in particular and its accompaniments, such as, political repression, runaway social discontent and anarchy.
What should not go unnoticed by the US is the fact that peace and social stability in the South and the flourishing of the same conditions in the global North are symbiotically linked, although not so apparent at first blush. For instance, if illegal migration from the South to the US is a major problem for the US today, it is because poor countries are not receiving development assistance from the UN system to the required degree. Such deprivation on the part of the South leads to aggravating social discontent in the latter and consequences such as illegal migratory movements from South to North.
Accordingly, it will be in the North’s best interests to ensure that the South is not deprived of sustained development assistance since the latter is an essential condition for social contentment and stable governance, which factors in turn would guard against the emergence of phenomena such as illegal migration.
Meanwhile, democratic sections of the rest of the world in particular need to consider it a matter of conscience to ensure the sustenance and flourishing of the UN system. To be sure, the UN system is considerably flawed but at present it could be called the most equitable and fair among international development organizations and the most far-flung one. Without it world poverty would have proved unmanageable along with the ills that come along with it.
Dehumanizing poverty is an indictment on humanity. It stands to reason that the world community should rally round the UN and ensure its survival lest the abomination which is poverty flourishes. In this undertaking the world needs to stand united. Ambiguities on this score could be self-defeating for the world community.
For example, all groupings of countries that could demonstrate economic muscle need to figure prominently in this initiative. One such grouping is BRICS. Inasmuch as the US and the West should shrug aside Realpolitik considerations in this enterprise, the same goes for organizations such as BRICS.
The arrival at the above international consensus would be greatly facilitated by stepped up dialogue among states on the continued importance of the UN system. Fresh efforts to speed-up UN reform would prove major catalysts in bringing about these positive changes as well. Also requiring to be shunned is the blind pursuit of narrow national interests.
Features
Egg white scene …
Hi! Great to be back after my Christmas break.
Thought of starting this week with egg white.
Yes, eggs are brimming with nutrients beneficial for your overall health and wellness, but did you know that eggs, especially the whites, are excellent for your complexion?
OK, if you have no idea about how to use egg whites for your face, read on.
Egg White, Lemon, Honey:
Separate the yolk from the egg white and add about a teaspoon of freshly squeezed lemon juice and about one and a half teaspoons of organic honey. Whisk all the ingredients together until they are mixed well.
Apply this mixture to your face and allow it to rest for about 15 minutes before cleansing your face with a gentle face wash.
Don’t forget to apply your favourite moisturiser, after using this face mask, to help seal in all the goodness.
Egg White, Avocado:
In a clean mixing bowl, start by mashing the avocado, until it turns into a soft, lump-free paste, and then add the whites of one egg, a teaspoon of yoghurt and mix everything together until it looks like a creamy paste.
Apply this mixture all over your face and neck area, and leave it on for about 20 to 30 minutes before washing it off with cold water and a gentle face wash.
Egg White, Cucumber, Yoghurt:
In a bowl, add one egg white, one teaspoon each of yoghurt, fresh cucumber juice and organic honey. Mix all the ingredients together until it forms a thick paste.
Apply this paste all over your face and neck area and leave it on for at least 20 minutes and then gently rinse off this face mask with lukewarm water and immediately follow it up with a gentle and nourishing moisturiser.
Egg White, Aloe Vera, Castor Oil:
To the egg white, add about a teaspoon each of aloe vera gel and castor oil and then mix all the ingredients together and apply it all over your face and neck area in a thin, even layer.
Leave it on for about 20 minutes and wash it off with a gentle face wash and some cold water. Follow it up with your favourite moisturiser.
Features
Confusion cropping up with Ne-Yo in the spotlight
Superlatives galore were used, especially on social media, to highlight R&B singer Ne-Yo’s trip to Sri Lanka: Global superstar Ne-Yo to perform live in Colombo this December; Ne-Yo concert puts Sri Lanka back on the global entertainment map; A global music sensation is coming to Sri Lanka … and there were lots more!
At an official press conference, held at a five-star venue, in Colombo, it was indicated that the gathering marked a defining moment for Sri Lanka’s entertainment industry as international R&B powerhouse and three-time Grammy Award winner Ne-Yo prepares to take the stage in Colombo this December.
What’s more, the occasion was graced by the presence of Sunil Kumara Gamage, Minister of Sports & Youth Affairs of Sri Lanka, and Professor Ruwan Ranasinghe, Deputy Minister of Tourism, alongside distinguished dignitaries, sponsors, and members of the media.
According to reports, the concert had received the official endorsement of the Sri Lanka Tourism Promotion Bureau, recognising it as a flagship initiative in developing the country’s concert economy by attracting fans, and media, from all over South Asia.
However, I had that strange feeling that this concert would not become a reality, keeping in mind what happened to Nick Carter’s Colombo concert – cancelled at the very last moment.
Carter issued a video message announcing he had to return to the USA due to “unforeseen circumstances” and a “family emergency”.
Though “unforeseen circumstances” was the official reason provided by Carter and the local organisers, there was speculation that low ticket sales may also have been a factor in the cancellation.
Well, “Unforeseen Circumstances” has cropped up again!
In a brief statement, via social media, the organisers of the Ne-Yo concert said the decision was taken due to “unforeseen circumstances and factors beyond their control.”
Ne-Yo, too, subsequently made an announcement, citing “Unforeseen circumstances.”
The public has a right to know what these “unforeseen circumstances” are, and who is to be blamed – the organisers or Ne-Yo!
Ne-Yo’s management certainly need to come out with the truth.
However, those who are aware of some of the happenings in the setup here put it down to poor ticket sales, mentioning that the tickets for the concert, and a meet-and-greet event, were exorbitantly high, considering that Ne-Yo is not a current mega star.
We also had a cancellation coming our way from Shah Rukh Khan, who was scheduled to visit Sri Lanka for the City of Dreams resort launch, and then this was received: “Unfortunately due to unforeseen personal reasons beyond his control, Mr. Khan is no longer able to attend.”
Referring to this kind of mess up, a leading showbiz personality said that it will only make people reluctant to buy their tickets, online.
“Tickets will go mostly at the gate and it will be very bad for the industry,” he added.
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