A response to the Subcommittee on Higher Education of the Parliamentary Sectoral Oversight Committee:
On August 1, concerned academics and activists gathered at Speaker Karu Jayasuriya’s office at the parliament complex and handed over their response to the report on SAITM made by a sub-committee of the Oversight Committee on Education and Human Resources. Copies of the report to be given to all the members of the Oversight Committee, Prime Minister, Leader of the Opposition, Government Whip, Opposition Whip and the Minister of Higher Education and Highways were also handed over to the Speaker.
In 2015, Colombo District had 182.3 doctors per 100,000 population (employed by the Ministry of Health) compared with 37 doctors per 100,000 population in Nuwara Eliya District (Vallipuranathan 2017). That same year, Colombo District recorded the highest number of medical officers (5344), while the lowest number was recorded in Mullaitheevu District
EXTRACTS FROM THE REPORT:
SAITM: An ill-conceived response to the question of health and education in Sri Lanka.
The government appears ill prepared to address the unravelling situation around SAITM. Its current actions are mired in violence, bombastic rhetoric and unrealistic projections of great economic advances to be made in the business of education and health. The policy paper of the Subcommittee on Higher Education of the Parliamentary Sectoral Oversight Committee, Expansion of Medical Education in Sri Lanka with the Participation of the Private Sector: Adopting the South Asian Institute of Technology and Medicine (SAITM) as a Model is a justification of SAITM as an educational institution, offering it as a panacea for the supposed ills dogging the heels of the two sectors. SAITM is a poorly planned programme that barely addresses the problems that exist in the areas of health and education and creates new ones.
SAITM: Is it numbers?
Regarding Health, the paper says that SAITM will address the lacunae in the system presented by the inadequate number of doctors in the country. In other words, SAITM will be able to add to the number of doctors in the country. But, the problems besetting the health sector are an integral part of the structure of health care provision, namely distribution and specialization. As medical professionals and researchers will tell you:
SAITM is very clearly a ruse, an ill-conceived ruse maybe, to bring in privatization in education not ONLY in the form of a private university, but through the seemingly innocuous
a) The inadequate number of medical professionals lies in the areas of distribution of doctors across the country. In 2015, Colombo District had 182.3 doctors per 100,000 population (employed by the Ministry of Health) compared with 37 doctors per 100,000 population in Nuwara Eliya District (Vallipuranathan 2017). That same year, Colombo District recorded the highest number of medical officers (5344), while the lowest number was recorded in Mullaitheevu District (Health Information Unit, Ministry of Health 2015).
b) Doctors on completing their internship are posted to peripheral areas, but can leave those stations before they are eligible for transfer if they pass a screening exam for a course of specialization. There is no mechanism in place to retain non-specialist doctors in such areas, resulting in a large number of cadre positions remaining vacant.
The students of public medical universities seem to be a dispensable commodity and accommodated within the system only on sufferance.
c) To make matters worse, the Ministry of Health promotes specialization over strengthening primary care. But this drive for specialization has not been combined with greater provision of facilities in the regions. Specialists, owing to frustration with the meagre and inadequate facilities and other factors like lack of ‘good’ schools for their children, tend to turn towards urban centres, in many of which there is a glut of health care professionals, including doctors.
d) As healthcare professionals go, a severe dearth of caregivers exists in the nursing and midwifery sector, compounded by issues of distribution. Nursing and midwifery are an integral part of the provision of health care and this thriving sector needs to be nurtured. In 2015, there were 7436 nurses in the Colombo District compared with 44 in Mullaitheevu. That same year there were 853 midwives in the Kurunegala District versus 51 in Mullaitheevu. There is also a dearth of ancillary healthcare providers, including radiographers, lab technicians, pharmacists, physiotherapists, etc., particularly in the peripheries (Health Information Unit, Ministry of Health 2015). The over emphasis on having a large number of doctors belies the situation on the ground.
on what ground does the government assume that graduates of SAITM who have been educated with private funds and belong to a class of relative affluence will be willing to serve in peripheral areas in the country
e) Figures from the World Health Organization (WHO) are often bandied about by the pro-SAITM lobby to argue for more doctors. WHO does not recommend a gold standard for its member states in terms of physicians per population, the 2006 World Health Report estimated that a health system needed at least 2.5 doctors, nurses and midwives per 1000 population (or 250 per 100, 000) to function. According to the 2014 Annual Health Bulletin published by the Ministry of Health, in 2014, 85 medical officers and 185 nurses (totalling 270) per 100,000 population were employed by the Ministry of Health (Health Information Unit, Ministry of Health 2015).
f) The same WHO Report highlights migration of doctors and resulting in global and within country inequalities as a major issue. Sri Lanka too must address redistribution and implement measures to retain doctors in the public health sector.
The focus on doctor-numbers is terribly misplaced. Even so, on what ground does the government assume that graduates of SAITM who have been educated with private funds and belong to a class of relative affluence will be willing to serve in peripheral areas in the country, where one finds the largest need for more doctors?
Higher Education: The new site of struggle
The shift to privatisation rears its ugly head in the section on higher education that looks to formulate policy for the future. The report quite rightly laments the fact that 82% of students who qualify to enter the state university system are unable to secure places owing to the system’s inability to accommodate them all (pg. 7). This of course is a very grave concern and should be tackled with the seriousness and integrity it demands; but does the government have an informed solution?
SAITM is very clearly a ruse, an ill-conceived ruse maybe, to bring in privatization in education not ONLY in the form of a private university, but through the seemingly innocuous, but deadly mode of PPP: Private Public Partnership. Item 2 which deals with the SAITM – STATE interface is captioned, “Proposal to enhance the clinical exposure of SAITM medical students through Public-Private partnership” (8).In the details that follow, Private Public Partnership (PPP) is given as a facility that is designed to ease SAITM’s path to procuring and delivering a ‘standardized education’ to its students and gaining a reputation on par with that of state universities. Under this scheme, public universities and public hospitals will be endowed with the task of bestowing academic respectability on SAITM. Why? Why should the public support private education? What foolishness is this?
PPP: The spectre of privatization
The section on private medical establishment and PPP is fairly detailed in the document. PPP is understood as a partnership between public universities and private ones, particularly in the field of medicine. The universities of Peradeniya and Colombo are supposed to take the lead here. We are of the view that such thinking has real life and momentum for, in a recent announcement, the government gave voice to ideas of making the Universities of Peradeniya and Colombo transit to self-funding entities (The Island, 22nd July, 2017).
Under section 5 captioned “Establishment of Private Medical Education,” the report lays out the fundamental principle on which private medical education is formulated: Private medical education with “government involvement” (p.14). One is compelled to ask, “why government involvement,” and “what does that involvement entail?” As it turns out, the involvement of the government here means the establishment of units of private medical education within and affiliated to state universities, beginning with Colombo and Peradeniya, with other state universities to follow suit.
State universities come in with massive investment in knowledge production at multiple levels, the training of its staff from kindergarten to the PhD or its equivalent and further, heavy investments in infrastructure, development of sites of research - laboratories, libraries and archives, development of territory and a supporting community, and finally the political programme of social upliftment. Why should the state fund private education for the affluent? Spend on the larger mass of the people, please!
Private medical establishments in collaboration with public universities will actually be parasitic upon the resources of public universities, for they will bring little into the collaboration financially. There will be a greater ‘brain drain’ of doctors and professionals from the state sector to the private sector than what exists today with out-of-country migration, taking with it all that was deemed valuable and worth investing in. PPP here would mean the state financing and sponsoring private medical education. In turn, state investment in public institutions will be considered unviable, undesirable and untenable and the call for “Let private enterprises do the job of investing in education,” will prevail.
One of the obvious instances of this parasitic existence lies in the realm of staff and the sharing of trained personnel across the two streams. Pay attention to the laughable and yet sinister attempt to lease out the staff of public medical faculties to private enterprises:
Reduce the burden for the government for the salary increase of professors and lecturers in state universities who are at the moment disgusted about their salaries, this is the very reason why it is difficult to recruit medical teachers to the universities as the government medical officers salary with other allowances - such as overtime etc - is double that of a senior lecturer in a state medical faculty. They would be able to be visiting lecturers to these private medical schools. (p.15)
While one is slightly nonplussed as to where the extra hours for teaching in the private medical universities are going to come from, the policy makers’ abject indifference to the education at public universities and education as a social good is apparent. The teachers in the public university system will be teaching in private medical educational enterprises, severely undermining both the quality of education in the public sector and creating an unfair non level playing field, in which public education will be the loser. The students of public medical universities seem to be a dispensable commodity and accommodated within the system only on sufferance.
The government’s argument on SAITM can be summarised as follows:
The government does not have money for itself, but it has money to give the private sector.
How much more illogical can it get? This convoluted argument gives the lie to any idea that the government is here to serve the people. What one can infer from the report is that SAITM like many other recent moves in education and health, are a part of the neo-liberal agenda pursued by successive governments. Globally, there have been waves of resistance to aggressive privatization of public entities, particularly in the area of education. It is foolhardy for our government to push on without much forethought on these emerging trends and resistances. We need a visionary policy on education and higher education, not ad hoc measures that will lead to the destruction of much that has been fundamental to the welfare of the people. The take-over of the Neville Fernando Teaching Hospital might indeed be a great leap from the frying pan and into the fire as the government makes headway with its plans to establish PPPs in education! We hope we can begin an informed dialogue on SAITM, private universities in general, and the future of Free Education.
Prof. Sumathy Sivamohan - University of Peradeniya
Dr. Harini Amarasuriya - Open University of Sri Lanka (University Teachers for Free Education)
Dr. Ramya Kumar - University of Jaffna (University Teachers for Free Education)
A. Karunatileke- University of Kelaniya Dr. Athula Samarakoon - Open University of Sri Lanka (University Academics for Social Equity)
Upul Wickramasinghe, Waradas Thiyagarajah -Education Renaissance Programme, University of Colombo
Chinthaka Rajapakse, Shamila Ratnasuriya- Movement for Land and Agricultural Reform (MONLAR)
Amali Wedegedera, Niyanthini Kadirgamar - Alliance for Economic Democracy
S.Thanujan, M.Mayuran - Mass Movement for Social Justice
Sylvester Jayakody - General Secretary, Ceylon Industrial, Mercantile and General Workers Union