Pvt medical colleges: Focus on admissions, not on physicians

A visit was paid to the Shah Mokhdum Medical College & Hospital in Rajshahi at 9:00 in the morning on 25 May. The principal of the college was not present. No teachers turned up till 1:00 in the afternoon. It hardly seemed like an educational institution, let alone a medical college. The only evidence was the signboard.

This medical college is located in Kharkhari of Rajshahi city. The reception staff told this correspondent that he would have to wait till 10:00am to meet any responsible official.

This private medical college began functioning nine years ago in 2014. The health ministry suspended it several times. But the college authorities, with permission from the court, have been keeping up admission of students. So far, however, not a single student has been able to take the final MBBS test. The college has 40 students at the moment.

There are 77 private medical colleges in the country. Due to irregularities and mismanagement, the health education directorate did not give approval to six of these private medical colleges, including Shah Mokhdum Medical College, to admit students in the 2022-23 academic year. The other medical colleges on this list are Care, Northern, Aichi, and Nightingale in Dhaka; and Northern Medical College in Rangpur.

This correspondent also visited private medical colleges outside of this list -- two in Khulna city and three in Dhaka. None of these institutions had an adequate number of teachers. There was also a lack of practical studies.

The institution's managing director Md Muniruzzaman turned up at the medical college at 10:00am to meet this correspondent. He conducted a tour of the premises. The furniture and equipment in almost all the rooms of the three-storey building were covered with layers of dust. In one room there were several microscopes under plastic covers. It is difficult to say how long these rooms, furniture and equipment have been lying unused.

Md Muniruzzaman said, "There is no shortage of space in my college. I even have the required amount of land required for a hospital."

A college with 50 students requires a space of 100,000 sq ft in area and for a hospital, the require space is also 100,000 sq ft. But the Shah Mokhdum Medical College doesn't have that space. Practical classes for students require a college's hospital to have at least 250 beds with patients occupying at least 175 beds. This hospital has 112 beds, with not even 30 patients occupying the beds regularly.

To start up a medical college, conduct classes and tests, and register students, approval is required from the health directorate, the health ministry, Bangladesh Medical and Dental Council (BMDC) and the concerned university. Shah Mokhdum Medical College does not have approval from any of these four authorities. And yet students were admitted here for the 2020-21 and 2021-22 academic years.

Md Muniruzzaman told Prothom Alo he has experience in running a kindergarten. He was a contractor at one time and also would buy and sell land. A member of parliament was initially the chairman of the college's board of directors. He was dropped and Zillar Rahman was made chairman.

Zillar Rahman at one time had been additional secretary (administration) of the health ministry. According to Md Muniruzzaman, Zillar Rahman is trying to 'manage' the health ministry. The health ministry has already sent the health directorate a letter, asking it to conduct an inspection of the college. Md Muniruzzaman, in the meantime, is also going to the High Court, trying to get students admitted for the present academic year.

When asked about his involvement in the institution, Zillar Rahman told Prothom Alo, "My name is officially linked with the college, but I am not involved in any of its work."

A phone call was made on 8 June to the college's acting principal Fatima Siddiqua. She said, "I am part-time at the college." She does not know how many students there are at the college or how many teachers either. As to whether she regularly drew a salary from the college, she replied, "I am in Dhaka on some family work. I will speak directly in person if possible."

In the latest 2020 report of the health education directorate, it was said that the college does not have the minimum facilities required to provide medical education.

Many medical colleges are spurning the rules. Marks Medical College in Mirpur-14 of the capital city is an example. There are many private hospitals and clinics in the capital and in other large cities of the country that are bigger than this medical college in size. Everything of this college is small. The classrooms are small, the library is small, the balconies are small. Rooms 103, 104, 105 and 106 on the ground floor of the hospital are used for the surgery, paediatrics, medicine and obstetrics and gynaecology departments respectively. The rooms are all very small, with just enough room for a bed and a chair.

This institution, established in 2011, does not have the amount of land required for a college and hospital. It has permission to admit 70 students a year, but it is not adequately equipped. The health directorate's inquiry report states that during an inspection of this hospital, the directorate officials felt that the patients were not genuine patients.

Principal of the college Brig. Gen. (retd) Md Enamul Kabir, however, told Prothom Alo, he had retired from government service recently and had taken up responsibility of this college. He, therefore, was unwilling to comment.

In medical studies, written, oral and practical exams are all equally important. But practical classes are of topmost importance. From the third year students have to see patients directly, visits the wards and learn practically while observing the patients. But in many medical colleges, the hospitals do not have an adequate number of beds. According to the health education directorate officials, this problem exists in 40 per cent of the private medical colleges.

Concerning the inadequate practical classes, Chittagong Medical University's vice chancellor Ismail Khan told Prothom Alo, the last three and a half years of the five-year course are basically practical classes. These studies cannot be complete if there are not enough patients in the hospital. To be a skilled and confident physician, one must learn from the patients. In many cases, quality medical education is not ensured because of the crisis of patients in the hospitals.

Alongside regular classes, there are exams almost every day in medical education institutions. The lessons and practical classes must be intensive. This requires a good number of teachers. Bangladesh Medical and Dental Council (BMDC) determines the ratio between students and teachers. In every subject there must be one teacher per 10 students. It also determines the number of professors, associate professors, assistant professors and lecturers required.

The figures of the health education directorate indicate that in the 77 private medical colleges, there are no anatomy professors in 6, no physiology professors in 16, no biochemistry professors in 17, and no forensic medicine professors in 18 colleges. There are no professors for many other subjects. Similarly there are no associate professors. In some colleges there are no professors, associate professors or even assistant professors in the same subjects. The classes in these colleges are be run by lecturers.

Attempts are being made to address the problems in a different manner. In government medical colleges, the age of retirement for teachers is 60. In private medical colleges it is 65. Many physicians and officials unable to serve in government medical colleges due to age, join the private medical colleges.

A principal of the private medical college outside Dhaka, speaking to Prothom Alo, said the crisis of students is acute. That is why they are forced to keep on two professors who are over 65 years of age.

Khulna City Medical College authorities informed Prothom Alo that at least 10 professors recently retiring from government service have joined the college in Khulna city.

When asked about the state of medical education in view of the paucity of teachers, senior physician and former president of Bangladesh Medical Association, Professor Rashid-e-Mahbub, told Prothom Alo, "There is an effort for outward infrastructural improvements, and that is possible in a short time. But no initiative is being taken to create teachers and that is not even possible in a short span of time. So we cannot expect good physicians or quality human resources."

Regardless of whether they have teachers or patients in their hospitals, the private medical colleges are hell-bent on getting students admitted. The colleges rake in huge revenue every year from the admission fees. Many use the admission fees to pay the teachers' salaries and build the infrastructure.

In the 2022-23 academic year, there are 6,772 seats in the 71 private medical colleges. The health ministry fixes admission fees. Each student has to pay Tk 2 million (Tk 20 lakh) during admission. That means if students are admitted to all the seats, the revenue of the colleges will add up to Tk 13.54 billion (Tk 1,352 crore) in total.

The actual income from admissions is actually much higher. Many of the colleges have permission to admit foreign students. According to the health directorate, around 2500 foreign students are admitted every year. Their fees are higher than that of local students.

Bangladesh Medical College is the oldest private medical college in the country. It was established in 1986 in Dhanmondi of the capital. Every year 120 students are admitted to this college. This year the college will earn Tk 240 million (Tk 24 crore) from admissions. Other than that, every month the students pay a fee of Tk 10,000 each. This college can admit at least 50 foreign students, which means an even higher income. The college's hospital is also making profit.

One of the main requirements to establish a medical college is to have land in the college's name. Bangladesh Medical College does not have any land. The health directorate has issued several warnings. The college has been running for 37 years without following this rule.

President of the Private Medical College Owners Association, MA Mobin Khan, speaking to Prothom Alo, said, "Investment in private medical colleges is huge. The colleges are improving steadily. Our association is also striving to ensure that within a short period, all the shortcomings can be overcome."

With financial assistance from the UK government, a study was carried out under the health ministry's Health, Population and Nutrition Sector Development Programme in 2016, on the overall state of the newly established medical colleges. The study pinpointed various flaws in the medical colleges, both government and private.

The study indicated that the medical colleges in the private sector do not run in the same manner. Some are limited companies, some are run by foundations, and some by trusts. The buildings of some of the colleges are not fit for colleges. Many do not have medical journals. Many do not have adequate space. Many do not have an adequate number of teachers.

The study put forward some recommendations. These included: the efficiency of the government officials who inspect the medical colleges must be increased and that there must be teachers' training alongside the efforts to resolve the shortage of teachers. No public or private medical colleges can be set up unless certain criteria are met within a stipulated span of time. The government has done nothing in this regard.

Speaking to Prothom Alo, director general of the health education directorate Md Tito Miah said, "The private medical colleges must be brought under certain rules and regulations. We have shut down six colleges which did not abide by the rules. Regulations have been drawn up for running medical colleges. We hope the situation will improve."