SAITM: towards consensus on medical standards

With signs of momentum towards a resolution of the SAITM problem, the report of the Presidential committee to study the SAITM issue will be awaited by all. Leave aside the fact that a medical degree can be a matter of life and death, a degree qualification for any of the scientific and technical professions must have a watertight guarantee of quality if society is to get the best from it.

That guarantee of quality is critical if any profession is to make its best contribution to sustaining and advancing society’s vital infra-structure. Human society’s progress to date – what we fondly call ‘civilization’ – has greatly benefited from the professions, from the most ancient to the vast array of newly evolved ones.

In addition to ensuring that its own contribution to society is up to the best standards, in today’s complex world the medical profession also has the opportunity to collaborate with the other professions and sciences in joint contributions with shared professional benefits. New and expanding avenues of inter-disciplinary collaborations have seen the evolution of hybrid disciplines and technical expertise. Bio-medical engineering is one (lucrative) example.

Each profession must, therefore, not only ensure minimum standards for its best professional output, but must also ensure that its professional standards are on par with standards of excellence of the other, parallel professions. This is why the controversy over the recognition of the medical degree issued by the South Asian Institute of Technology and Management (SAITM) is so complex with so many interested parties.

It is not simply a question of higher educational opportunities for young Sri Lankans. It is that and much more. The looming factor behind the immediate furore is the long-standing social use of education for upward mobility and the desperate search for such opportunities in a country where the education system simply cannot meet demand. Feeding into the SAITM controversy, then, is the politics of state-run free education and industry aspirations to enter a new sector in the search for new markets.

Woven into this conflict is the larger politics of social group interests: the interest of the mass of the people in maintaining the state-supported education system as against intermediary social classes that have the money, seek a quick step up the social ladder.

Trapped in between this interplay of ‘interests’ is the requirement to ensure quality standard in Sri Lanka’s medical degree - as defined by the country’s relevant professional standards body, the Sri Lanka Medical Council.

Sri Lanka’s medical degree began to be internationally respected almost from the inception of the state-run higher education system in the mid-twentieth century. But, the number of doctors migrating from the country were impressive not because of the global demand for specifically Sri Lankan medical expertise. This high outflow was, and is, simply because of the penchant for Sri Lankan doctors (and most other professional cadres) to depart their motherland for greener pastures. This is a typical Third World phenomenon of social migration, more pithily called ‘the brain drain’. The Sri Lankan desire to grab a degree and run, remains.

What this means is that the demand for medical professionals in Sri Lanka will remain high as a result of this continued outflow. A new dimension is the rapid expansion of the economy and the corollary expansion of the middle and upper classes. Far more Sri Lankans today have the cash to go beyond the crowded and un-embellished government clinics and hospitals than thirty years ago. At the same time, the population has also grown, further boosting the market for medical services outside the free health system. Hence, the phenomenal expansion of the private health care industry.

The growing social affluence has also opened up the market for private education which also has expanded phenomenally.

What has not expanded or advanced in step with such infra-structural and social growth is the system of quality regulation which remains under-developed in relation to both, the private health care industry as well as the private education industry. It is of vital importance to the country that these two dynamic and potentially highly innovative industries evolve from being mere industries to being proper service sectors that can actually guarantee quality standards to the nation.

This is why SAITM has got caught up in a tangle of politics and bureaucracy as well as professional concern.

The Sri Lanka Medical Council’s regulatory standards and, surveillance and enforcement capacities need rapid adjustment and upgrade to meet emerging new needs posed by the private health and education industries. And, both, the State-run and emerging private sector medical education systems need to consult and collaborate in devising standard systems for curriculum and training facilities that are mutually compatible.

If the private sector has the advantage of market driven innovation to lead in creativity, the state-supported medical sector has a flexibility of scope for research that is not bound by business bottom lines or diverted by market trends. The SLMC certainly must remain the decider in medical quality but the very process of ‘deciding’ has become complex with the arrival of private medical training, and the SLMC must establish new procedures and templates in its regulatory work.

The private medical training sector must be encouraged by such facilitation to expand even further. The credibility of the private sector depends on its own record of protecting nationally recognized medical education standards and systems. Any attempt to circumvent regulatory processes and cut corners to meet business budgets will not only undermine the private sector’s branding, but, worse, undermine confidence in the country’s quality of health care and professional standards.

Last month’s court ruling shows the intention of the judiciary of pushing the whole controversy along towards some resolution rather than allowing such an important matter to fester. The appointment of a committee by the President and the joint statement by the country’s eight medical faculties inspires confidence that a solution is not far away. Students, doctors and citizens all await it. 

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