Is there a role for the private sector in medical education in Sri Lanka ?

May 2, 2012, 7:31 pm, The Island.


by Carlo Fonseka

Axiomatically, the goals of tertiary education should be independent of whether they are pursued in the state sector or in the private sector. For good or ill, the academic model of tertiary education in Sri Lanka including university education, was the British model, in particular the Oxbridge model. The first Vice Chancellor of the University of Ceylon (as Sri Lanka was then called) from 1942 to 1955 was the Cambridge scholarship wallah, the world famous constitutional lawyer, Sir Ivor Jennings who went on to become Vice Chancellor of Cambridge University (from 1961 to 1963). By way of preface, therefore, it may be useful to review briefly the history of the evolution of British Universities, which were our models.

Historical Survey

Broadly speaking, British Universities passed through three historical stages. They began in the Middle Ages, which are reckoned to have lasted from the 5th to the 15th century. Oxford began in the 12th century and Cambridge in the 13th century. In this first stage, the universities were simply training colleges for the clergy. The only subject studied in depth was theology.

The second stage was during the Renaissance, which began in the 16th century. During this stage the idea gained ground that every person ought to be educated, but of course, only the well-to-do could afford it. In the 17th, 18th and the 19th centuries, British Universities were mainly concerned with "the education of a gentleman". This stage depended upon the aristocracy and it could not survive the spread of democracy and industrial plutocracy. So the universities gradually became training colleges for the professions – law, medicine, science and so on.

The third historical stage cannot be sharply separated from the second stage and indeed overlaps with it. This stage saw the universities growing into centers of pure learning in which gifted scholars pursued learning for its own sake. In modern language, pursuit of pure learning is research, the search for new knowledge. New knowledge, needless to say, is the chief cause of progress and without research in its universities, a country will decline and decay. However important research is for real universities, the available evidence strongly suggests that private businessmen in Sri Lanka are not enthusiastic supporters of learning for its own sake. Therefore universities pursuing research will have to depend mainly on state funds rather than on benefactions of rich men.

Pure Learning

The state has the capacity and willingness to support research and pure learning for which there is no immediate use. A university that does no research is no university. Mathematics is perhaps the best example of apparently useless abstruse learning. According to Bertrand Russell, the famous Cambridge mathematician and philosopher, "mathematics is the subject in which we never know what we are talking about nor whether what we are saying is true". Legendary Cambridge mathematician G.H.Hardy went further and roundly declared: "a mathematician is someone who not only does not know what he is talking about but also does not care". He delighted in the pursuit of what he called "useless knowledge". The relevant question here is whether the private sector will promote and support the pursuit of "useless knowledge".

Functions of tertiary education

From our discussion so far, I draw the inference that in the modern world tertiary education serves two purposes:

(1) to train men and women for certain professions.

(2) to pursue learning and research without regard to immediate utility.

In the present stage of our development, it is unrealistic to expect the private sector in Sri Lanka to fund pure learning and basic research. So the private sector in Sri Lanka cannot by itself aspire to establish institutions of tertiary education, which will reach the level of proper universities. This does not mean, however, that the private sector cannot usefully involve itself in the business of training men and women for certain professions.

Role of private sector

One compelling reason why there is a role for the private sector in tertiary education in Sri Lanka has to do with the method used by the state during the past two or three decades for selecting students for tertiary education, specially university education. Nobody will deny that in a just social order, tertiary education should be open to everybody. However, historically it has been evident that in any society, only a minority of the population has the capacity to profit from a scholastic tertiary education. This immediately raises a critical question: on what principle should we select students for tertiary education, particularly for university education? There was a time when only children whose parents could afford to send their children to university, gained university education. The implicit principle of selection was that if you can’t afford tertiary education, you don’t deserve to have it. Gradually, however, under the impact of democracy, the principle of selection by wealth was modified by the scholarship system. There seems to be universal agreement now that the principle of selection for university education should be scholastic aptitude rather than financial clout. But scholastic aptitude and financial clout are not necessarily mutually exclusive, as some misguided state university students in Sri Lanka seem to believe. "Either, you are brainy or you are rich, you can’t be both" is their brainless slogan.

Criteria of selection

I remarked a little while ago, that universities exist for two purposes. One is to train students for certain professions. The other is to promote learning and research. Rationally, therefore, we should select students for tertiary education who have aptitudes for different professions they have chosen, as well as students with that special kind of ability that enables them to pursue learning and research. There is no universally acknowledged, foolproof, sure-fire method available for selecting such students, but the method Sri Lanka uses is far from satisfactory. Our selection process is primarily based on the results of a written test consisting largely of so-called objective type questions. A formula, based on the principle of reverse discrimination is then applied to make the final selection of students for all faculties except the Arts Faculties. Admission to the Arts Faculties is on an all-island merit basis. In the case of the other faculties:

40% are admitted on an all-island merit basis.

55% are admitted on a district quota basis, and

5% of admissions are allocated to certain "underprivileged areas" of which there are 13. The philosophy underlining this formula is that in the present stage of our social evolution, social equity is a more desirable goal than the level of academic achievement.

Because I am most familiar with tertiary medical education, let me briefly state my perceptions of how our method of selection has worked in practice in respect of selection of medical students.

Equalizers of educational opportunity

As I have remarked already, selection is based solely on the results of a written test consisting of two, 3 - hour papers comprising largely objective type questions. Preparation for this selection test (which happens to be the GCE A/L Examination) is largely a drill involving rote learning of answers to questions set at previous examinations. There is a set of expert professional tutors in the country who are available by and large to almost all students aspiring to do medicine. These skilled professional tutors have virtually become the equalizers of educational opportunity in the country. It is true that the state schools themselves are highly unequal in regard to the availability of facilities. But the fact is that even in science education, facilities don’t matter very much at all, because the selection test is entirely a paper and ballpoint pen affair.

Stark truth

Let me give you some facts and figures to make more effectively the point I am going to make. About 20,000 students aspire to do medicine every year and for many years until 2004, the state selected about 900 students for medicine by applying the formula of 40% on all-island merit, 55% on district quota and 5% for under privileged areas. From 2005 the number of students admitted to the medical faculties annually was increased to about 1,000. Every year, there is one student admitted to a medical faculty who fits the description: lowest achiever. The lowest achiever is the student who is at the bottom of the list of medical students admitted in a given year. At my request, the officials of the UGC found out the number of students in the biological stream aspiring to do medicine, who had a mark higher than that of the lowest achiever. Believe it or not, for the five years from 2000 to 2004, the average number who had a mark higher than that of the lowest achiever was about 2,000. This was the consequence of the application of the reverse discrimination formula. In other words, every year there have been about 2,000 students aspiring to do medicine, who had a higher level of achievement than the lowest achiever admitted to a state medical faculty. These students feel cheated by their educational system and they are deeply disappointed and frustrated. The state cannot satisfy their legitimate aspiration for a medical education at present and I believe that the private sector has a role in supplying the demand the state is unable to satisfy at present. The same is true of all other faculties for which there is a demand. What then should be done? It must be remembered that ours is a mixed economy with a state sector and a private sector. We are also a democracy and people should have the freedom to spend their wealth in legitimate ways of their choice such as giving their children an education for which they have a demonstrated aptitude. The private sector under proper regulation can play a role in tertiary education, which is concerned essentially with the training of professionals.

Monopoly

The way tertiary education evolved in Sri Lanka, made it a state monopoly and in some fields like medicine, an absolute state monopoly. I believe the time has come for this monopoly to end. For several decades I firmly believed that in the interest of maintaining academic standards, the state should monopolize tertiary education, in particular university education. I have changed my mind recently because the facts on which I had based my previous position are no longer valid. The North Colombo Medical College demonstrated beyond doubt that the private sector is able to produce doctors who have proved themselves to be as well-trained and as competent as those produced by the state sector.

Capitalism vs. Socialism

For many decades, there were two opposing camps: the capitalist camp which was for a role in the private sector on tertiary education; and the socialist camp to which I belonged, that stood for state monopoly of tertiary education. The principal ground for that position was that the entry of the private sector into tertiary education would serve to widen existing social inequalities. But socialism and capitalism are no longer a matter of either/or; it is a matter of more or less. In the interest of socialism, the existing universities in Sri Lanka should not be privatized; their capacity should be expanded and strengthened. That would be more socialism. The private sector should be allowed a role in professional tertiary education, preferably in partnership with the state sector. That would be a little more capitalism. Let us remember that even Karl Marx did not underestimate the productive power of capitalism.