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.
