Students in Limbo as Medical School’s Certification is Pulled Despite Government Approval

COLOMBO, SRI LANKA — Dilshan Fernando always dreamed of being a doctor, but his exam scores weren’t high enough to earn him a spot at a state-funded medical school.

That was in 2008, when only state-run universities offered medical degrees in Sri Lanka. Fernando says he didn’t want to go abroad for his education, so, out of options, he shelved his dream and enrolled to get a business degree at a local school affiliated with a London-based university.

A year later, Fernando’s options changed. The South Asian Institute of Technology and Management, now known as the South Asian Institute of Technology and Medicine (SAITM), introduced a program to award medical degrees. The school wasn’t accredited in Sri Lanka, but Fernando didn’t worry. It had an affiliation with a Russian school, and Fernando planned to finish up the program there.

“The plan was to complete four years in Sri Lanka and finish the fifth year in Russia,” he says. “So we didn’t need accreditation.”

There was more good news in 2011, or so it seemed. The University Grants Commission, the body tasked in Sri Lanka with ensuring quality standards at universities, decreed that SAITM, a private school, could award its own degrees.

This was a major change for Sri Lanka, where free public education has long been revered as a social equalizer.

For Fernando, the change meant that he wouldn’t need to spend a year in Russia. Instead, he says, he planned to complete all of his education in Sri Lanka.

But in 2015, just five months before he was set to graduate, Fernando’s dreams were dashed. The Sri Lanka Medical Council (SLMC), the organization that monitors quality standards for medical schools, withheld SAITM’s compliance certification.

The school didn’t offer its students enough clinical training, the council said in a report presented in August 2015.

Anyone practicing Western-style medicine in Sri Lanka must register with the council, and the council only allows students from certified schools to register. If SAITM does not earn that certification by the time Fernando graduates, he won’t be allowed to practice medicine in Sri Lanka. Even if SAITM does earn the certification, it is still unclear what would happen to students like Fernando who are attending school without the certification in place.

Now, Fernando hopes SAITM will get its certification in time for him to graduate this year.

Fernando had every reason to trust that SAITM would offer him a quality education. The school was among a handful that were fully accredited through a controversial policy set in August 2013 by a former minister of education.

The policy created a process for the government to accredit private higher education institutions, separate from the process used by the University Grants Commission to accredit programs at Sri Lanka’s public universities. Government officials say the policy was enacted to provide more options for students who don’t get into the country’s public universities, which only hold 17 percent of qualified students.

But the government has not established a framework to assess the quality of education offered at those newly accredited schools. And there’s no independent supervisory board to which students can file complaints, so students who attend the schools, all of whom have paid tuition in a country long devoted to free education for everyone, have no recourse.

SAITM has operated for six years without an SLMC compliance certificate — part of that time with foreign university affiliations, part of it without. All private institutions that award degrees are required by law to hold compliance certificates with relevant professional bodies. Experts say the caliber of health care in Sri Lanka hangs in the balance as the authorities engage in a tug-of-war regarding quality-control matters in higher education.

Ranepura, who was secretary of the Ministry of Higher Education between January and August 2015, says the ministry hasn’t accredited enough schools to warrant the creation of a quality assurance system. Ranepura was interviewed while he still held the office of ministry secretary.

“We will establish a mechanism later,” he says.

Despite an initial agreement to grant GPJ an interview, Dr. Renuke Sameera Senaratna, the director and dean of administrative affairs of SAITM’s Faculty of Medicine, did not meet a GPJ reporter as scheduled. Follow-up emails were not answered.

For generations, the only accredited higher education institutions in Sri Lanka were public universities, which were free. But space in those universities is so tight that many students whose scores qualify them for public university go abroad to study or enroll in private schools in Sri Lanka that offer, by proxy, degrees from foreign universities or certification programs.

Private schools have legally been able to apply for accreditation since 1985, when the government approved a law allowing them to do so through a rigorous process set by the University Grants Commission, the same body that accredits public university programs. But fewer than a dozen schools have been accredited via that process, due to widespread opposition to private universities. There are currently 15 state universities in Sri Lanka.

But in 2012, the then-minister of higher education pulled the University Grants Commission’s authority to accredit private schools and reserved that power for officials at the ministry. A year later, the minister created an in-house process to accredit private schools.

Those changes were all done behind closed doors, and only cursory details were made public. Experts say it’s still not clear why the minister changed the process.

Student advocates accuse the ministry of playing politics, to the detriment of higher education.

“They wanted to go ahead with the plan to establish a private education sector in the country,” says Ryan Jayalath, even if those private schools don’t fulfil the conditions required to complete a degree.

Jayalath is convener of the Medical Faculty Students’ Action Committee, a union formed by the students of all medical faculties in state-run universities.

Choosing a medical school to accredit, even retroactively for previously graduated students, was a way of making a point, Jayalath says.

The government had previously tried to establish a private medical school. Sri Lanka’s first private medical college, North Colombo Medical College, opened in 1981, via an affiliation with University of Colombo, a public university.  Once the 1985 law allowed private schools to establish on their own, North Colombo Medical College severed ties with the University of Colombo to operate independently.

That school was later taken over by the government and converted into a public school, due to pressure from academic and student groups. Even now, that school is often referenced as a failed attempt to establish private schools in Sri Lanka.

SAITM was the first private medical school to open since then, according to the SLMC.

Private schools approved by the ministry offer a quality education, Ranepura says. Every school accredited through the ministry must submit academic and administrative information that the ministry evaluates, he says.

“We can withdraw approval if needed,” he says.

So far, the ministry has not withdrawn approval for any school.

SAITM earned accreditation to award medical degrees from the University Grants Commission in 2011, but the commission noted some conditions: The school needed to provide clinical practice opportunities for its students, either at its own medical facility or at other teaching hospitals. Among other stipulations were upgrades of the library, a lecture hall, a laboratory, IT facilities and other places within six months after the August 2011 approval.

In 2013, after the Ministry of Higher Education established its own accreditation process, it conducted another review of SAITM. The report from that review, which GPJ obtained unofficially, noted that “the attention paid to [the] library was woefully inadequate.”

Even so, the ministry retroactively accredited degrees for students who had registered before the 2011 approval.

Medical schools must meet minimal quality standards, says one SLMC member, who spoke on condition of anonymity because that person is not authorized to speak to the media.

The SLMC and other members of the medical profession have been pushing for a formal set of minimum standards for the country’s medical schools for a long time, but a draft bill has been rejected by successive ministers, the SLMC member says.

No means have been established to allow students to submit grievances about private schools. The Quality Assurance and Accreditation Council of the University Grants Commission of Sri Lanka, the only body of its kind, has no authority over private institutions.

The Ministry of Higher Education, now known as the Ministry of Higher Education and Highways, “will investigate any complaints if we receive any,” Ranepura says. So far, he adds, the ministry has not gotten any complaints.

But it’s clear that some students aren’t happy with their experiences at SAITM. In 2014, a group of five students from the school sued SAITM and government officials — including the former minister of higher education and Maithripala Sirisena, the former minister of health who is now Sri Lanka’s president — stating they were denied a fundamental right to education because they weren’t able to conduct clinical practice in a government hospital.

The case was withdrawn when the Ministry of Health agreed to give students access to a hospital for clinical training, the SAITM students say. But they say that hasn’t happened, and they’ve pursued further court action.

The SLMC conducted an assessment of SAITM in July, says professor Carlo Fonseka, the SLMC president. But SLMC committee members could not agree on recommendations for quality improvements regarding the school.

Meanwhile, Health Minister Dr. Rajitha Senaratne promised in Sri Lanka’s Parliament that the school won’t be shut down, which some of its detractors have demanded.

Fernando, the student whose dream of a medical career was sidelined because of SAITM’s problems, says he has confidence that Senaratne will keep his word. SAITM’s students should be assessed by the same standards as medical students at state schools, he says, and they should enter the workforce with confidence that they have the needed skills.

“What is needed now is to help us get clinical practice,” he says.

 

 

Chathuri Dissanayake, GPJ, translated some interviews from Sinhala.