The SAITM drama

The Court of Appeal’s ruling on the legality of the South Asian Institute of Technology and Medicine (SAITM) stirred up a hornets’ nest, last week.

The Court of Appeal made the judgement that the medical degree offered by SAITM was lawful and could be accredited by the Sri Lanka Medical Council.

The Government Medical Officers’ Association (GMOA) declared war on this ruling and, various student bodies, including the Sri Lanka Medical Students’ Union (SLMSU) and the Inter University Students Federation (IUSF), held a series of protests in Colombo.

The GMOA – the main professional body of doctors – threatened to take union action if the government failed to dissolve SAITM. They even convened an emergency meeting on Thursday to discuss the ‘next move’ following the Court of Appeal’s verdict.

At the meeting, the GMOA decided to join hands with many political groups to exert pressure on the government to take action on the SAITM issue: They met with former President Mahinda Rajapaksa’s camp and also the Janatha Vimukthi Peramuna (JVP), a party that often floats its commitment to ‘free education’.

It is against this backdrop that former President Mahinda Rajapaksa made the statement that the SAITM should take the GMOA’s views on SAITM into consideration.

He added that the government should take appropriate action on SAITM, if the institution did not meet proper standards.

In making these statements, Rajapaksa, under whose Presidency SAITM was formed, consolidated his position as a crusader against SAITM and private medical education in Sri Lanka.

Bearings

It is important to understand that the issue of SAITM did not fall from the sky. Its founder, Dr. Neville Fernando, is considered a close friend of former President Rajapaksa and launched his business with the full backing of the state.

The first major legal battle against SAITM was in 2012, when a Fundamental Rights petition was filed before the Supreme Court against the legality of the institution.

The petitioners were Dr. S. Sankalpa Marasinghe, Dr. Upul M. Gunasekera, Dr. Nirmal Ranjith Devasiri and K.R.A. Pradeep Perera who claimed their Fundamental Rights were violated in naming SAITM a degree awarding institution.

The Sri Lanka Medical College, Higher Education Minister S. B. Dissanayake, the South Asian Institute of Technology and Medicine, its chairman Dr. Neville Fernando, its Registrar and the then Health Minister Maithripala Sirisena were among those who were named as respondents in the case.

The petitioners also sought an interim injunction to stay the operation of the gazette dated August 30, 2011 declaring the South Asian Institute of Technology and Medicine a medical degree awarding institution, claiming SAITM was incompetent.

They cited as example an incident at which the Sri Lanka Medical Council had not accepted the South Asian Institute of Technology and Medicine as a medical degree awarding body.

President’s Counsel Romesh de Silva appearing for the respondents countered the petition on the grounds that the gazette declaring the South Asian Institute of Technology and Medicine a MBBS degree awarding institution was published on August 30, 2011 and that a Fundamental Rights petition can only be filed in relation to the publication, within one month of publication – and that had not happened.

Counsel submitted that in terms of Section 126 (2) of the constitution, which held that a FR petition should be filed within one month of publication, the petition was filed on September 11, after a lapse of one year and therefore should be barred.

The bench comprising then Chief Justice Shirani Bandaranayake, Justice S.I. Imam and Justice P.A. Ratnayake dismissed the petition paving the way for SAITM to obtain the University Grants Commission’s recognition.

Former President Mahinda Rajapaksa also gave out scholarships to 10 students who obtained 3As at the Advanced Level examination, but failed to enter the state medical faculties: They were given scholarships worth Rs. 7 million each to complete their medical education at SAITM.

Former Higher Education Minister S.B. Dissanayake and his Ministry Secretary Dr. Sunil Jayantha Nawarathne were present at the event – which goes to show that the previous government gave full recognition to the private medical college, formed by Dr. Fernando.

Opening

At the time SAITM was formed, there was a specific vacuum to be filled in the country’s educational sector.

Of the hundreds of thousands of students who sit for the Advanced Level examination in Sri Lanka, only 26,000 are selected for tertiary education.

This abysmally low percentage can be attributed to limited facilities at state universities.

Even the students who achieve excellent results at the Advanced Level examination are sometimes left out of the state medical faculties due to limited opportunities.

Over the years this problem has become one of increasing concern for the country’s policymakers.

Students who fail to gain access to state universities, go abroad or enter privately run, fee-levying higher educational institutions: A larger proportion of students join the job market, as unskilled or inexperienced workers.

From an objective perspective, the solution to this problem is quite simple. The opportunities for tertiary education should be expanded in every possible way.

This requires a lot of capital, resources and expertise.

If the state finds it difficult to make such investments in the education, the private sector should be allowed to bridge this gap and the government should play the role of a regulator.

This is why the GMOA’s and the IUSF’s “anti-privatization, pro-free education” is frivolous. The basic tenets of free education are violated when tens of thousands of students are left out of state universities due to a lack of facilities and resources.

In every part of the world, the private sector is working hand in hand with the state in the tertiary education sector. Sri Lanka is not in a position to escape this solution.

There are already many private sector higher education bodies in Sri Lanka: There is strong private sector involvement in the IT field and in other streams. Medical education, however, is still restricted to the state.

Students being left out of the state university system contributes to ‘brain drain’, and also to a ‘money drain’ as funds that could be invested in the country are taken out.

SAITM

If Sri Lanka manages to approach the private sector to invest in this sector, with the government playing the role of a regulator, it will project Sri Lanka as a regional hub for ‘education tourism’.

It will also contain the ‘brain and money drain’ – at least to some degree.

But this does not mean that SAITM is the remedy for all the issues in the tertiary education sector.

Multiple parties have raised concerns over its standards and suitability to offer medical degrees.

Professor Carlo Fonseka, a senior medical practitioner and the head of the Sri Lanka Medical Council, publicly claimed that SAITM did not meet their standards and refused to accept their suitability to grant medical degrees.

Many other veterans in the field of medicine held the same view: They had no issue with the private sector making investments in the field of medicine, but raised concerns over the practices of SAITM.

If this is the case, the Sri Lanka Medical Council, the body which has the authority to maintain the standards of medical practitioners in Sri Lanka, - or any other concerned party - can appeal against the Court of Appeal’s judgement.

If it doesn’t want to take that path, the SLMC can alternately liaise with the government to make the necessary policy decisions to regulate the standards of SAITM, and the GMOA and other parties can throw their weight behind the SLMC.

Street terrorism

Unfortunately, what’s happening right now is a “street terrorism” of sorts.

University students block roads and disrupt the day-to-day activities of the public and the GMOA holds patients to ransom.

Having done that, these doctors attached to the GMOA then engage in private practice at private hospitals and clinics that do not come under regulation mechanism.

This disastrous trend came to a head when two unidentified gunmen shot at the SAITM Chief Executive Officer on Monday night.

Although the CEO escaped the attack, unharmed, the incident showed the extent to which the SAITM issue has spun out of control.

The bigger issue, at this point, is the manner in which stakeholders have become a part of the problem in this SAITM: No one stakeholder is presenting a solution, but instead only vigorously defending its position. As a result, the country is nowhere near to dismantling the SAITM issue.

Indian example

The issue of private medical education is not unique to Sri Lanka. In India too- where the private sector’s involvement in medical education is vibrant – there have been issues about standards and best practices.

In India, the government has allowed private sector to establish medical colleges and the Medical Council of India (MCI) has been given the authority to regulate quality of this medical education.

The MCI – which is the equivalent of the Sri Lanka Medical Council - has been empowered to recognize medical colleges based on certain criteria and monitors private medical colleges to ensure they meet the requirements.

But although there is a system in place, there are allegations of corruption and malpractice in India and Indian medical experts claim that rampant corruption has led to the menace of mushrooming of private medical colleges in the country.

Critics claim the objective of private sector parties investing in medical education has shifted from providing quality education to earning profits from capitation fees and tuition fees.

A recent study shows that India has 579 medical colleges and teaching hospitals; but more than half of these had failed to produce a single peer-reviewed research paper in over a decade (2005-2014), and that almost half of all peer-reviewed papers were attributed to just 25 of those institutions.

An investigation by Reuters found that since 2010, “at least 69 Indian medical colleges and teaching hospitals have been accused of such transgressions or other significant failings, including rigging entrance exams or accepting bribes to admit students”, and that “one out of every six of the country’s 398 medical schools has been accused of cheating, according to Indian government records and court filings.”

The 2011 court case against Balwant Arora also uncovered many of the issues relating to this medical sector.

Arora pleaded guilty to issuing more than 50,000 fake medical degrees at around $100 apiece from his home.

He said each of the recipients had “some medical experience” and that he was in doing the country - that is in desperate needs for more doctors – a favour. He had previously served four months in jail, for similar offences.

This doesn’t mean that India hasn’t produced world-renowned doctors from many of its private medical colleges, but what requires emphasis here is the fact that Sri Lanka should impose stronger regulatory mechanism and better quality control on private medical colleges.

A country like Sri Lanka is in a far better position to regulate quality and maintain standards than federal India.