The debate on the legitimacy of the privately-owned medical faculty at the South Asian Institute of Technology and Management (SAITM) has once again risen to the top of national conscience. With the Appeal Court recently calling on the Sri Lanka Medical Council (SLMC) to renounce its double standards and allow for the registration of SAITM students, the SLMC’s decision to appeal to the Supreme Court and President Maithripala Sirisena recently saying that a political decision will be reached after consulting all stakeholders, Mirror Business spoke to Public Enterprise Development Deputy Minister Eran Wickramaratne, who remains passionate about education reforms, to get his views on private and hotly debated private medical education.
Following are the excerpts from the interview.
This government came into power with a plan to create soft infrastructure and a knowledge-based economy. Could you explain how private universities fit into your plan?
For Sri Lanka’s prosperity and progress, there are two key factors—our geographical location and our human resources. We have just 21 million people, the size of an Asian city basically. So, how do we, as a country, get ahead? Ultimately it has to be with the development of human resources.
In 2015, 210,000 students sat for A-levels. Out of that, 130,000 qualified to go to university. Out of which only 26,000 entered university. So, what we have to ask is what happens to the balance 104,000, who qualified and didn’t go? Another way to think is that there are 30,000 villages, so less than one per village goes to university.
Also, apart from university entrance, we have hundreds of thousands who drop out pre or post O-levels. Our government believes that every student should have higher education. So, our vision is to give 13 years of education. Currently parents are only compelled to start their child’s education.
We want a system where some will go through the traditional O-levels, A-levels and university while others will go through other routes like technical or vocational education. Everyone should have it. We are trying to break out of this situation where our people go to the Middle East for low-skilled labour.
A lot of people at the lower income level are driving three-wheelers and such really don’t want their children to go there. If we skill them up, then within the country or if they go overseas, they tend to go to higher levels. So, we take them out of the low-income trap. That’s our philosophy.
So, I think everybody has a fundamental right to education. But the Sri Lankan government, over a period of time has been cutting its investment in education, when calculated as a percentage of GDP (gross domestic product). It has dropped to the point of 1.5-1.6 percent of GDP.
Now our government has come and we’re trying to reverse that. We recognize that there’s a need for hard infrastructure, but if you look at it on the long term, we need investment in the soft infrastructure, which is really going to propel Sri Lanka to the top of the Asian tables—not South Asian—but
Can the Sri Lankan government provide this right to education, given the fiscal constraints it is facing for the next few years?
Well, governments all over the world are struggling with how to provide this education because governments have limited resources. We have to face the reality of the expectations of students and parents that they all want an education, whether the state can pay for it or not. This is a global aspiration, which is also strong in Asia. So, whether the state can or cannot provide it, the right should not be denied in any way. Therefore, you get to the issue of who supplies the education. The government supplies the education to the extent the government can.
Then we certainly must defend the right of non-governmental organisations providing education. In addition to non-governmental organisations, you can also have the private sector providing education. And I think that the right needs to be always defended because on the one hand, people will compete and get into the state sector and the others get left out. When they get left out, those who are economically powerful will anyway provide an education for their children, often by sending students overseas.
Now, if you take the students going overseas, more than 10,000 students go overseas in a year. But there’s a section in the middle who can’t afford to do it, who can’t get into the state system, so other means should be provided for them to locally obtain it.
So, it should be irrelevant who supplies the education. What is important is that it is education and it is education of a standard and the state has the responsibility to monitor the standard of education. Not just in medicine but in other areas of education, the state has the responsibility to monitor it, but not inhibit it.
So why are some state university students and other lobby groups against the right to education?
Now this is a social justice issue. We have to ask ourselves why the focus has generally been on those who are going to university. If you see all the protests on the roads normally—not only now but throughout the past few decades—those who already have the privilege are on the streets fighting for greater privileges for themselves.
But if you look at it like this, the number going into the university as a percentage of the number entering the schooling system in a year, it’s a very small percentage. You’re talking about probably 5 percent. So, is it fair for us to only be concerned about the 5 percent or should we be concerned about the 95 percent?
This is about social justice and what they’re trying to make out is that there is no social justice, right? But is that correct? What about the 95 percent? Doesn’t the state have a responsibility towards them?
There is no grudging that state universities are important. The government must spend more percentage of GDP on state universities; we must provide better facilities to those going to universities. There is no argument. But this debate must be balanced. How about the 95 percent?
Aren’t investors in higher education deterred from entering due to the number of protests?
I don’t think that the investors have to be too concerned because the protests are basically from a small group of students and it just happens to be a vocal group. The student population in this country is much bigger and the parents in this country understand exactly what we are talking about.
Then they are using the argument that education is not a tradable good. I think we need to get away from the slogans. This is about creating opportunity. And for sure, what can be given at the expense of the taxpayers of this country must be given. I will always be grateful that taxpayers, including poor taxpayers, paid for my education in a government school in this country. I was fortunate. But there are those who are not fortunate to get into a good school and education. Are we still going to deny them the opportunity?
The point I’m trying to make is that the private sector comes in and tries to fill the gap. In between the private sector providing it and the government providing it, there is a big space for social entrepreneurship. And if you look at education in other countries, the leading universities in the world, the world-class ones, are not government owned. Neither are they private profit making. They are fee levying but not profit distributing. That is what I would call a really nice social enterprise and there are schools like that
in this country.
It’s a sustainable business model. As a result, they are attracting people who don’t have the opportunity from the state and those who can’t afford to pay elsewhere, but it’s fee levying to make it sustainable; they won’t redistribute profits but reinvest in education and they give scholarships for others to come in.
We must encourage this model in education. I think we need to bring in a law for people who want to set up such institutions to actually make it possible to set up such institutions. There are many academics and professionals in this country who have very high professional and ethical standards. We often talk about those who don’t but there are those who have and they want to give something back to society and if we give them the right models, they can.
So, the 25,000 currently being catered to by the state sector, can easily become 100,000 if people are allowed the opportunity to come in and provide it.
Moving on to medicine, are the claims of the protestors true that the standards are low at SAITM?
I’m not in a position to really answer that question because I’m not a medical professional, but there have been reports from the SLMC that the standards have been poor and the standards need to be corrected. I think the SLMC is needed to maintain the medical standards. There’s no compromise on that.
We have Sri Lankan students who want to study medicine, can’t get into state universities and go to other countries. So there are a varying number of universities to get medical qualifications. Then what happens is that the SLMC holds an examination, if they want to practice medicine in this country, so that the professional standards are maintained. And they have to qualify to practice, which I think is good and proper to do. I said that for a reason because sometimes people take only my criticisms. I’m making a fair argument.
During the Rajapaksa regime, SAITM was set up. Then the government of the day gives it the University Grants Commission acceptance. The debate deteriorated into some kind of pseudo ideological debate without actually looking into what it was trying to achieve and for whom it was trying to achieve. That goes on, a new government is elected. Our government inherits the issue.
Our philosophy is the provider of education is of no consequence. The standard is what we are worried about. We are not bound in narrow ideology. For us, our valuable asset is the Sri Lankan student and we will do everything we possibly can to give them that opportunity.
Despite multiple court rulings in support of the institution, those who are opposed to SAITM are continuing to disrupt and undermine the government. What is the government going to do about this?
We are not here to dance to the economic, social or political philosophies of other parties. We have our own. We want to get all the parties together and figure out how these issues can be resolved. But unfortunately some parties don’t want it resolved like that. They stick to their position. So what happens to these helpless students and parents?
They go to the judiciary and the case goes on for a while and at one point the judiciary says yes, they can have access to government hospitals for clinical training. The most recent verdict is that these students who graduate from the university should be registered to practice their medicine.
Now, it’s a judicial verdict. Not the government. When the government gives a verdict, we can agree with it, we can disagree with it. Everyone has the right to agree or disagree. But a judicial verdict has to be complied with.
Some believe that parliament is supreme. But I believe that in matters pertaining to the law, the judiciary is supreme. What binds us together as a nation and a country is law, the rule of law and the adherence to it.
Some people might say ‘Oh, how can the judiciary decide on this?’ That argument has to be completely rejected because this is an argument which is used by extremists and in the past we had extremists like this who had to be dealt with by the state using state power.
If you disagree with a judicial verdict, there are ways to deal with it. The way to deal with is not on the street and inconveniencing everybody’s life. You could appeal to a higher court. And when the decision from the higher court comes, everyone has to abide by it, including the government. But we can’t go on saying that until we get the verdict we desire, we are going to disregard it.
The opposing factions are planning to go to the Supreme Court. So, if the Supreme Court gives a verdict adversely affecting the SAITM students, what is the government prepared to do?
Whatever happens, we have to adhere to the court ruling.
How will you manage them? Because they have already invested money and funds for their education, if they can’t practice, you’ll have to reskill them or resort to some other options.
Yes. As I said, the first principle is that even the government must adhere to a court ruling. But I think that judging by the situation, on the first court ruling that has come, everybody will be sensible and they will take into account the fact that qualified students—often this thing is thrown around that these students are not qualified—are in this system because if you look at the competitiveness of the Sri Lankan state system, you’re supposed to get in if you get the best results but that’s not what
What actually happens is there’s a weightage to underrepresented districts. So, from a district, a person could go with two Bs and a C, but if you’re in a more developed district, certainly you have much higher qualifications, and you still don’t go.
That the very best always goes is not true. So, when that student says, ‘I have got better results than those who are already in the medical faculty’, what’s the justice we have given them? So, some of them have gone and registered in places like SAITM. So, all that will be taken into account when making a decision.
But I should also point out that there needs to be a distinction between the quality of education and the quality of service. This came up in a discussion I was in. This person went to a private hospital, got a number and was told to come back at 4:00 p.m. But the doctor came and saw him very late at night. I don’t know whether this is a frequent occurrence or not. So, this raises the point that while you may have the best qualified physician in the world, you are also receiving a service. So, the quality of service needs to be clearly distinguished and understood.
This shows that people are not satisfied with the service levels. Any survey will also show this; the general feeling is that the doctor doesn’t spend enough time with the patient. Therefore, our doctors may be too pressed and have too many responsibilities that they actually can’t do it.
Is this due to a short supply of doctors in the labour pool?
Maybe, because I would make no value judgement. It would not be proper for me to do a value judgement because I’m a professional myself. I know people who make that value judgement of me all the time. This is no reflection on any individual doctor or consultant, but sometimes you hear people saying things like salakanne naha, katha karanne naha (not treating us well or talking to us). A doctor is a physician, so he’s a healer. Listening and explaining in layman’s terms is part of the medical process. The other problem is easy access to medical doctors.
Every profession has its own problems, but it also shows what you said, that it may be that few people are trying to deal with a huge number of people, issues and expectations, which they can’t. Doctors may be pressed between government service, private service, patients who are in hospital and then running to do clinical procedures and surgeries. Various pressures. So it may be the reason.
In the public’s eye, the service needs to improve, so then the supply needs to increase. So, we’re not arguing for a drop in medical standards. We’re asking for very high medical education standards but also the service quality needs to basically go up.
So, I think that all professionals should sensibly look at this and how we could take this forward. We should resolve these issues through discussions. We can’t resolve these issues on the streets and neither can we resolve these issues through strikes or work-to-rule, because the medical profession is dealing with people’s lives and like the security profession, they can’t resort to action that other professions can resort to. We have to resolve these things through discussions only.
I heard a politician say the other day that some doctors have talked about work to rule, and he said, “If you’re doing that, do it in the evening,” because they have to serve the poor in government hospitals in the morning and they go for private practice in the evening.
But I will say this. Unlike the trade unions, the heads of the medical faculties of state universities got together and they discussed this matter some time ago and they came up with some proposals.
I would say by and large, they have been very sensible proposals on the way forward. I would like to commend the doctors and the professors involved in that initiative because it is heartening that we have professionals like that.
Among the proposals, they said that all graduates must pass a licensing examination if they are going to practice in this country - those coming out of government universities, private sector and foreign universities. I would say that it is the sensible way forward. This has not taken away the judicial verdict but gone beyond it.
The other thing which they suggested was that there should be regulations prescribing minimum standards for education institutions and these must be gazetted and approved by parliament. But this needs to be transparent by saying that ‘This is the standard’ and ‘This is the way it is monitored’. So, you’re moving actually more into an accreditation system.
Is this only for private universities or state ones as well?
I think what they had in mind was private but I think your question is very valid because standards are standards, irrespective of who the provider is. So, if a state university is not coming up to a standard in providing medical education, it should get disaccredited or accredited as well.
It shouldn’t matter to me whether my one child goes to state university and my other child goes for training. It makes no difference. If we’re monitoring standards, we should monitor the standards of state universities and their faculties as well. This will give everyone in the industry benchmarks to adhere to.
Presently, the law gives certain powers to the Minister of Higher Education and they have suggested that laws be amended for professional bodies to issue compliance certificates and I think that’s a suggestion that certainly should be discussed, and in a wider context, I should say it doesn’t matter where the power lies.
We need to make sure—this doesn’t apply to just medicine—that we needs to raise the issue of who regulates the regulator, when we are talking about these issues.
Are these accreditation laws currently being formulated?
At the moment no, but the professionals in these fields have done their work in it. I don’t think it has come to law yet.
Does the government have the political will to create an independent accreditation body that regulates both state and private sector universities?
I think the accreditation must be independent to the suppliers of education. Otherwise its validity will be always questioned. I think it’s still at a discussion and debate stage. I think it’s about having a discussion and explaining to society, so that everybody understands why actually you are doing it.