‘Private medical education is not the answer to boosting the health service’ was the main message of a conference conducted by “Professionals for Free Education” regarding the SAITM issue in Colombo last week.
Dr. Upul Vidanagama, Dr. G.K. Munasinghe and Dr. Kumudu Bandara from the “Professionals for free education” said as a strong association they seek to abolish SAITM.
According to Prof. Indika Karunathilake, Professor in Medical Education, Faculty of Medicine, University of Colombo the common misconceptions of medical education and health in Sri Lanka are that: Sri Lanka unfairly restricts medical education opportunities, GCE A/L is a poor selection test, there is a severe dearth of doctors, having an excess number of doctors is beneficial, private medical schools benefits economy and the question that all fields are privatized-Why not medical Education?
Dr. G.K. Munasinghe said that in the A/L Biology stream, around 21,000 A/L students get minimum qualifications (three S passes or above) annually. About 7,000 students out of 21,000 enter the universities annually.
Therefore, about 33% of the biology students (1/3) with minimum qualifications enter the universities. The government medical faculties take about 1325 students out of 7000 students, who are selected by the universities annually. Therefore, one out of every 5th Biology stream university student is a medical student.
Dr. Munasinghe said, “Opportunities for all other health related state university courses are severely restricted. Only a total of 700 students are admitted all other health related state university courses annually.”
“If we look at higher performers in biology stream, 2388 students got 3 B s and above. Therefore approximately 55% of those who got 3 Bs and above were selected for medicine in state universities. Admission percentage for 3 As is almost always 100%,” he said.
He said that in the UK, the minimum entry criteria in the standard medical school entry pathway are 3 As. Out of those students with 3 As, only one out of every 5 students gets a chance to study medicine. For some high ranking universities like Oxford, this could be 1 out of 17 applicants. Entry into high standard medical education is competitive, anywhere in the world.
According to Prof. Indika Karunathilake the three broad reasons why A/L is a good selection test is Cognitive ability (for example, more than 90% of the A/L biology MCQ questions in 2015 were within the optimum difficulty index), Substantive content (A/L biology syllabus is broad and basically covers several subjects in the medical education) and Motivation and personality (A/L Biology student as well as future doctor need motivation and personality.)
“Worldwide evidence by researches is that A/L Biology score is the best predictor of medical school performance. Methods such as interviews, aptitude testing and letters of recommendation are poor predictors,” he says.
“Admission to higher education should be based on the merit and equity according to article 26.1 of the universal declaration of human rights,” said Dr. G.K. Munasinghe.
“The district quota system in Sri Lanka is an attempt to ensure equity in access to higher education. The current selection criteria to the universities is 40% of the students by all island merit, 55% of the students by district quota (according to the ratio of the population in each district) and 5% of the students from the educationally disadvantaged districts,” Dr. Munasinghe said.
Prof. Karunathilake says that Sri Lanka is a unique country of the world because of free education and free health. “According to the WHO ranking of the health systems of the world Sri Lanka is first in the South Asian region and 76 of the world out of 190 countries. However, Sri Lanka mainly produces doctors through eight government medical faculties.
India has 217 government medical faculties and 249 private medical faculties. But, according to the WHO ranking of the health systems, India is third in the South Asian region and 112 of the world. Therefore, we should protect and maintain our free education with a good quality and should act to improve its quality further,” he says.
He says that the number of SLMC registered doctors is about 25,600 in Sri Lanka with 70% of the doctors are working under the Health Ministry while 5% work in the university sector. About 12% work in the private sector. Therefore, the doctor-population ratio is 1:1000. However, the World Health Organization (WHO) does not recommend a universal doctor-population ratio. The optimum doctor-population ratio would be dependent on factors such as the health system of a country and its ability to expand, the economic state of a country and its growth and the disease patterns of the country.
The WHO does not identify Sri Lanka as a country with a critical shortage of doctors.
The future prediction in Sri Lanka is that new SLMC registrations - ~ 1,500/year in the last five years, within next 5 years active registrations with the SLMC will reach 35,000 and projected doctor: population ratio for the Sri Lankan population for 2022 is 1.6 per 1,000. Prof. Karunathilake questioned whether our health system can absorb more doctors because of slow expansion of physical resources and infrastructure in the health care system and unfavorable GDP growth rate and the curtailed allocation for healthcare (less than 3.5% of the GDP).
“The proportions are already skewed with 25,600 doctors, 50,000 nurses and just 800 physiotherapists. Even now some allied health courses struggle to fill the full quota of seats. For an example, there should be at least four nurses for a doctor according to the WHO guidelines. But, current doctor-nurse ratio is 1:2. Development of the health sector should be done overall, instead of increasing the number of doctors only,” he says.
“The main problem is the distribution of doctors throughout the country than the number of doctors in the country,” he says.
Higher quality and a higher profit usually do not go with each other. Free education is a unique feature in certain countries with high human development index (HDI) such as Germany, Norway, Sweden, Denmark, Austria, Finland, France, and Spain.