Private production of human resources for health: geographic distribution, students intake and course fees

Abstract

Introduction: After 1990 change of government in Nepal, private sector's role in health care system became increasingly prominent. However, in absence of scientific evidence doldrums and conundrums characterised major debates around the perceived and projected roles of the sector. This work reflects on the findings of a research commissioned by the Ministry of Health and Population as part of the private health sector assessment. Here three aspects of the private sector's role in production of human resources for health - geographic distribution, students’ intake and course fees are reported.

Methods: A stratified random sample of 44 out of 122 private Health Science Institutes was taken for inclusion in the study. Telephone contact with the principals and administrative chiefs of the selected Institutes was followed by data collection using structured interviews based on questionnaires developed through a consultative process. Guided conversation with officials of professional councils and policy makers in the Ministry of Health and Population was conducted. Data were quantitatively analysed to calculate summary measures and distribution.

Results: A third (36.89%) of Institutes was in Kathmandu valley, with 23.77% within Kathmandu city area of the valley, exlcuding parts of Bhaktapur and Lalitpur. Next was Parsa and Chitwan (15.57%), followed by Morang (9.02%) and Kaski (7.38%). Rest of the country had less than a third of total Institutes (31.14%). More than a half (59.84%) were in central region, 17.21% in eastern region, 13.11 % in western region, 7.38 in far western region and 2.46% in mid-western region.

A dominant fraction of the Institutes fed on fees by domestic students only (79.55%), with only a fifth (20.45%) of the Institutes having domestic as well as foreign students. Among this fifth of the Institutes foreign students were enrolled only in Bachelor of Medicine and Bachelor of Surgery and Bachelor of Homeopathic Medicine and Surgery.

Tuition fees among the Institutes had two-fold gap between the lowest and the highest for the same degree programmes ranging from auxiliary to masters levels.

Conclusions: We urge the government to utilise scientific evidence coming from this work and previous local and international examples in prioritising the revision of existing policies, plans and regulations regarding private sector's role in the development of human resources for health. We also recommend further research to contest, verify or extend the knowledge coming from this work.