SAITM and private medical schools: One bad start should not lead to throwing away a good idea

Opposition to SAITM

SAITM, the abbreviation for Sri Lanka's newest private university, South Asian Institute of Technology and Medicine (available at: http://www.saitm.edu.lk/), has been denoting a derogatory meaning in Sri Lankans' present local vocabulary. 

It is a private initiative, done at private costs, to offer a solution to one of Sri Lanka's chronic problems relating to medical education. That problem is the failure of the Government to meet the aspirations of all students seeking to continue for a medical degree at a State university. 

Normally, when the private sector offers a solution for such a chronic issue, it should be appreciated, recognised and upheld. Yet, a large section of society has chosen to reject it. Criticisms have been levelled at it as a 'private sector degree shop' that produces low quality graduates, specifically, in medicine. 

Undergraduates in medical faculties of State sector universities in Sri Lanka have been up in arms against SAITM right from the very beginning. They have been supported, by word, deed and big brotherly protection, by the powerful Government Medical Officers' Association or GMOA, the trade union that holds monopoly power over the professionals who provide healthcare services to Sri Lankans through State sector healthcare facilities. Its website contains reports after reports calling it a 'corrupt institution' or 'illegal institution' making its stand on SAITM clear to its membership as well as to fellow citizens (available at: http://www.gmoa.lk/index.php/2016/01/issues-related-to-pmc-malabe-saitm/). 

A higher learning institution approved by BOI

According to GMOA, SAITM has cheated the Board of Investment or BOI, the Government and the community at large. It had got approval from BOI, says GMOA, to set up a higher learning outfit called South Asian Institute of Technology and Management. 

In the original application to BOI, there had not been mention about its offering medical degrees in Sri Lanka. The only indication in that application had been that it would offer training courses in a number of areas including nursing and healthcare services. But later, it had, alleges GMOA, surreptitiously substituted Medicine for Management so that its abbreviation could stand as it is and started to recruit students for its medical degree programmes.

Undergraduates in medical faculties of State sector universities in Sri Lanka have been up in arms against SAITM right from the very beginning – Pic by ShehanGunasekara

Offering a medical degree without approval by medical authorities

SAITM is silent on this allegation. But according to its website, it had got itself affiliated to a medical degree awarding academy in Russia called Nizhny Novgorod State Medical Academy or NNSMA, a medical college that had existed since around 1920 and is presently ranked at around seven among 46 odd Russian medical colleges. However, it is not in the list of global top medical schools. Thus, as far as the quality standards in Russia are concerned, NNSMA does not appear to have any shortcoming as a medical degree awarding higher learning institution in that country. 

According to the website of Sri Lanka Medical Council or SLMC, its current list of recognised foreign universities does not include NNSMA. But a letter purported to have been issued by its Secretary in 2009 and reproduced in a report filed by GMOA has confirmed that the six-year medical degree leading to the award of Doctor of Medicine by NNSMA had been a recognised medical qualification at that time.

It appears that this approval has now been withdrawn so that itsmedical graduates cannot practice as medical professionals in Sri Lanka. This applies to both the medical graduates proper from NNSMA and those who would pass out through the hybrid facility at SAITM. 

Thus, the first mistake done by SAITM has been that it had got itself affiliated to a foreign medical college which is yet to receive the nod of SLMC. Hence, the students joining SAITM for medical degrees were exposed to the risk of not being approved by SLMC even if they would get their medical degree after following one year's study programme in the final year at NNSMA. 

SLMC has no power to recognise a local private medical school

Apparently in order to overcome this problem and bypass SLMC, SAITM has got the approval from the Ministry of Higher Education at a later stage as an institution that can award medical degrees in Sri Lanka. Accordingly, SAITM can now award its own medical degree without having to get its students to follow a prescribed course at NNSMA. 

Though SAITM is a local approved university, SLMC has no business of approving its medical degrees since it has not been established under the Higher Education Act of 1966. But according to statutes, all medical graduates have to sit for a common eligibility examination and SLMC was required to allow SAITM graduates too to sit for this examination along with State university medical graduates and those passing out from the fee-levying medical school run by Kothalawala Defence University or KDU, a higher learning institution functioning under the Ministry of Defence rather than under the Ministry of Higher Education. 

SLMC, after examining the clinical training facilities available to SAITM students, has refused to register those graduates as qualified medical practitioners in Sri Lanka claiming that their clinical training is below the required standards. It would be interesting to see whether SLMC would apply the same yardstick to medical graduates passing out from KDU since it is also not a university established under the Higher Education Act of 1966.

GMOA is opposed to SAITM but not to KDU

There have been a lot of protests by medical students in State universities against SAITM functioning as a medical college right from the very beginning. GMOA says in its website referred to above that at the time SAITM started its medical education, it did not raise its voice loud enough to protest against what they have termed as an 'illegal institution'. It has regretfully admitted that not making its voice against SAITM at that initial stage was to its 'disadvantage'. 

But this was to change, according to the website, after its current President, Dr. Anuruddha Padeniya, returned to Sri Lanka after overseas training to assume its leadership once again. According to GMOA, it was Dr. Padeniya who had pressurised this otherwise militant trade union 'to take a clear stand on the issue'. What it means is that had it not been for Dr. Padeniya, GMOA would have accepted SAITM as a recognised medical college just like it had accepted the medical college run by KDU. Curiously, the website of GMOA does not bear any evidence that it had protested against that medical college at all.

Thus, allowing a single person to pressurise the membership to protest against SAITM poses serious issues relating to the governance structure of one of the prestigious associations made up of top professionals in the country.

GMOA’s inquiry into SAITM

However, GMOA had commissioned an inquiry in 2010 under the chairmanship of its President, Dr. Padeniya, into the medical degrees being awarded by what was known at that time as the Private Medical College at Malabe. This report, which could be called the Padeniya Report, is available in the website of GMOA for reference by the public. 

According to the correspondence between SAITM's founder Dr. Neville Fernando and SLMC and between BOI and SLMC as reproduced in the Padeniya Report, SAITM had been called at that time in its original name, namely, South Asian Institute of Technology and Management. Thus, its transformation into South Asian Institute of Technology and Medicine would have taken place much later as a marketing device. 

SLMC has written to Dr. Neville Fernando in 2009 that though it had recognised the six-year medical degree being awarded by NNSMA for registration of practitioners in Sri Lanka, it has no powers to recognise any degree being awarded by an institution not set up under the Higher Education Act of 1966.

What this means is that, since the Private Medical College had not been set up under this legislation, its degrees cannot be approved by SLMC. Thus, the management of the Private Medical College at Malabe had known as far back as 2009 that its graduates cannot register themselves in Sri Lanka as medical practitioners under the existing laws. Yet, this information had not been conveyed to parents or students who had chosen it to pursue medical studies. To the contrary, it had misinformed them that the particular college is being supervised by SLMC, prompting the latter to issue a public denial. 

SAITM is not approved to run a medical school

The correspondence between BOI and SLMC in 2010 has revealed that SAITM had been a BOI-approved private venture and allowed to conduct training courses, and not degree courses, in management, nursing, languages, vocational studies, health science and technology areas. BOI had confirmed that the original application had not asked for permission to run a medical school; nor had it indicated that it was affiliated to NNSMA which is a later development. 

It further reveals that BOI had granted approval to SAITM in 2008 without referring it to any Sri Lankan authority involved in the subject matter or verifying whether SAITM had got approval from such authorities. Thus, it appears that as far as BOI had been concerned it was another private business venture which should seek out its market as well as its success through its business operations. 

Padeniya Report is critical of SAITM

The Padeniya Report had not been kind to the private medical college at Malabe. It had criticised the college from many viewpoints, some relevant and most others irrelevant. 

The relevant criticisms had been based on the irregularities surrounding the establishment of the Private Medical College at Malabe. It was a training institution authorised to conduct training programmes in management and not in medicine. Thus, its entry into medical field had been an irregularity, according to Padeniya Report. 

It had not got approval from University Grants Commission or UGC to run a medical school in 2010. Its claimed-affiliation with NNSMA was suspicious since that had not been presented to BOI for approval and nor had it been established that Russian authorities had approved it. Thus, the Padeniya Report had concluded that SAITM had misled both parents and students; cheating them in this manner, the Padeniya Reportclaims, amounts to a financial fraud.

Some criticisms are irrelevant

However, most of the other criticisms levelled against the private medical college at Malabe in the Padeniya Report are irrelevant. 

Based on the presumption that these graduates are of inferior quality, the report had claimed that the medical graduates passing out from this college would erode the reputation of Sri Lanka's medical practitioners. It is indeed too much to say that a few graduates could do such damage to a profession which, according to the Padeniya Report, is of high standards and quality.

In a similar tone, the Padeniya Report had expressed the fear that those medical graduates could cause Sri Lanka's high healthcare indices to fall over time. That is also a presumptuous claim. 

They could also do much harm, says the Padeniya Report, to Sri Lanka's plan to set up a knowledge hub, an avowed goal of the previous as well as the present Government. In fact, if SAITM is a success, it would definitely help Sri Lanka to build its reputation as a knowledge hub. 

The Padeniya Report also charges SAITM for derailing Sri Lanka’s attempt at promoting medical tourism in the country. That again is too much to claim. The success of Sri Lanka as a medical tourism destination will depend on the quality of services provided by both the State and private healthcare facilities.

The issue was highlighted by this writer in a previous article in this series that Sri Lanka’s private healthcare service providers should benchmark their service to best global practices (available at: http://www.ft.lk/article/189900/Private-healthcare-providers-in-Sri-Lanka-should-benchmark-with-better-service-providers-abroad). This proposition in this article applies to state sector healthcare providers as well.

SAITM’s other operations are also at stake

The opposition to SAITM by a section of university students, GMOA and some political parties has been based exclusively on its involvement in medical education. In addition, SAITM is involved in offering both management and engineering degrees with affiliation with two foreign universities.

Its management degrees are awarded by UK’s Bucks New University. This university has a long history dating back to 1891 when it was started as School of Science and Arts. But, it was elevated to university status only in 2007 and therefore is yet to establish its reputation. Being a new university, it is not ranked very high among British universities today; in fact it is ranked close to the last few British universities on the league table. It is still not ranked globally by the Times Higher Education World University Rankings but it could happen in the days to come.

Its engineering degrees are awarded by Thailand based Asian Institute of Technology or AIT which is a reputed university in that subject area; students in engineering complete the first two years at SAITM and the last two years at AIT. About 200 SAITM students graduate in engineering subjects from AIT per annum. Almost all of them are immediately absorbed by many Thai and international companies operating in Thailand, a fact that testifies to the quality of these graduates. However, since AIT has stopped its undergraduate courses from 2017, SAITM will have to affiliate itself with another university to allow its engineering students to complete their degrees in the future. 

These are real issues which SAITM is facing as a private sector-sponsored higher learning institution in the country.

One bad start should not lead to throwing away a good idea

Private sector-sponsored universities are a must in Sri Lanka given its current level of economic development and fiscal issues its Government is facing. However, SAITM has given a bad start to this initiative. It has been set up without proper planning, without proper authority and without proper management at the top. Such approval had been obtained after it had admitted students and even then, that approval has not been complete. 

It has funding for both capital and running expenditure and is being supported by top politicians of the country. That alone is not sufficient for it to make its mark as a prestigious private university in the country. As a result, it is the private sector higher education initiative which has now suffered. It is inevitable that this black name would be adduced to other private initiatives that are planningto enter the field today.

Absorption by the State is not the solution

Some are suggesting that SAITM should be taken over by the State. That would complicate the problem since it would add an additional burden to the already-constrained State coffers. 

Instead, what the authorities should do now is to force SAITM to upgrade its standards in collaboration with the Ministry of Higher Education, Ministry of Health, SLMC and the warring trade union, GMOA. As it is, the fate of the students presently following medical degrees at SAITM is at stake. Resorting to legal channels as had been done by present students is not an option since SLMC is reported to have planned to appeal to Supreme Court against the judgment delivered by the Court of Appeal recently directing it to register SAITM graduates for medical practice in Sri Lanka. 

SLMC does not have powers at present to recognise these graduates, but Parliament could give it powers by approving the Gazette already issued by SLMC long ago in this regard. An early resolution is crucial in the interest of the students already following its medical courses. It would be a national tragedy if they are to lose both their money and hope.

One bad example does not mean Sri Lanka should throw away private sector-based higher education. It has to go for that, but before doing so, it is necessary to establish independent authorities to assure the quality and standards of all universities in the country, both State and private sector sponsored. 

Hence, it is a time when wisdom, patience and understanding are needed by all, specifically by those in the medical profession like the GMOA. 

(W.A. Wijewardena, a former Deputy Governor of the Central Bank of Sri Lanka, can be reached at [email protected].)