Karnali Cultivating Own Skilled Health Workers

Local governments in Karnali Province are offering scholarships to aspiring local students to study medicine, engineering and chartered accountancy, among other courses, to address the shortage of skilled human resource. 

The Aathbis Municipality of Dailekh is connected to the Karnali Highway, but it lags far behind in terms of health facilities. With a spread of 168 square kilometers, there is not a single doctor in the municipality. When residents fall ill, they have to be taken to Achham or Surkhet for treatment. The municipality advertised for doctors for the first time in 2074 BS (2017), but no doctors applied to provide expert health services to the citizens in their own villages. "We searched for a doctor for almost a year. We published advertisements in newspapers and spread the word through acquaintances," said former Mayor Khadraj Upadhyaya. "No doctor came forward to serve our village."

The municipality consists of six previous village development committees and is connected to Kalikot and Achham, but so far, no one in the municipality has studied medicine. When doctors refused to work there, despite the vacancy advertisements, the municipality decided to take matters into its own hands and invest in producing its own doctors. Four years ago, during an executive meeting, the municipality passed a procedure to help locals study medicine. Those who previously lacked the finances or courage to study medicine began participating in MBBS entrance examinations.

Following the policy of educating the local student who obtains the highest marks in the entrance examination to become a doctor each year, two young individuals from Aathbis Municipality are presently studying MBBS. "Studying medicine with internal resources is difficult, but there is a need for doctors to provide specialized health services to the residents of the municipality," former Mayor Upadhyaya stated. "As physicians refused to come to our villages to work, the municipality established a procedure allowing local residents to study medicine and provide free services to the villages for at least three years after completing their education."

Jeevlal Baduwal, a resident of Aathbis Municipality-9, is currently in his third year of studying MBBS at Kathmandu University. Without the scholarship provided by the municipality, Jeevlal would not have been able to pursue a career in medicine due to his weak financial condition. He only started preparing for the MBBS program after the municipality invited him to apply for the scholarship, and he fortunately passed the entrance exams. By the time he completes his studies, the municipality will have spent Rs 2.98 million on his medical education. “The municipality pays 75 percent of my tuition fees. I pay the remaining 25 percent,” he said. Along with Jeevlal, Rajkumar Sijapati of Aathbis Municipality is also studying MBBS under the same scheme. In the next two years, he will complete his studies. "After completing my studies, I will go back to my village and serve the people there," he said. 

Similarly, Jyotsana Karki of Kushe Rural Municipality of Jajarkot is studying MBBS at Patan Academy of Health Sciences. Although she appeared in the MBBS entrance examinations several times, she was unable to study due to the lack of finances. She said, "Even though I passed the entrance exam many times, I was not able to enroll in the MBBS course due to the lack of finances. After the support of the rural municipality, my dream of studying medicine is being fulfilled," she said. 

Kushe Rural Municipality has established the first chairman's scholarship fund for sponsoring the medical education of the most deserving locals. Through this fund, the rural municipality has supported Karki with Rs 3.8 million for MBBS studies. Until a few years ago, diarrhea was epidemic in Jajarkot. Many people lost their lives in Jajarkot due to the disease. There was neither medicine nor health workers in the village. “As soon as we were elected as people's representatives, we decided to help worthy students study medicine and engineering," said Harish Chandra Basnet, chairman of the rural municipality. “Now, the investment made by the rural municipality will increase health awareness among the residents and it will be easy for them to receive medical services in the village." 

Likewise, Chhaya Nath Rara Municipality of Mugu is funding local resident Devi Krishna Bishwakarma for his medical education in Bangladesh. The municipality Mayor Bishnu Kumar Bam said that as the doctors do not want to work in the district, they have started sponsoring the most deserving locals to study medicine. "The students we have sent to study medicine in Bangladesh will be coming back next year after completing their studies. They will serve at the District Hospital Mugu for at least five years," he said.

Bam said that since it is a municipality of the district headquarters, it will be a relief for the entire district to come to study as a doctor. "Doctors don't come to Mugu. Even if they come, they don't stay for long," he said.

Bishwakarma's family was not financially strong enough to fund their son's higher education in the village. His family earns a daily living by doing daily wage work at the headquarters. “It was a dream for us to send our son to Bangladesh and he becoming a doctor. That dream has been fulfilled by the local government, “Bishwakarma’s mother Kali said,” My son will come back home as a doctor!” 

Chhaya Nath Municipality sponsors the most deserving locals to study not only medicine but also chartered accountancy (CA), engineering and paramedical education such as health assistant (HA). “We have emphasized technical higher education to make the municipality excel in technical manpower," Chairman Bam said, “We are currently sponsoring two students to study CA, 21 students for engineering and some are studying the HA course.” 

The parents of the students who are good at studies but cannot afford their child’s tuition fees mentioned that they are greatly relieved by the support of the local government. Sudha Karki, mother of Jyotsana of Kushe Rural Municipality, said that the rural municipality has fulfilled her daughter's dream of becoming a doctor. "My daughter wanted to become a doctor. She had passed the entrance exam before, but we could not fund her education due to our poor financial condition," she said.

Lekbeshi Municipality is connected with Birendranagar, the capital of Karnali Province. Consisting of five former village development committees, this municipality is spread from the beautiful plains of Bheri to the hills. Although it was declared a municipality by the government, there is not a single doctor (MBBS) here. Although the municipality has repeatedly opened applications for doctors for the Dasharathpur health center, no one has shown any willingness to come here. 

After the doctors refused to work here, the municipality decided to invest in the medical education of its own residents. Lekbeshi Municipality has decided to provide a scholarship to one person every year to study MBBS from the current financial year to the financial year 2028/29. The goal of the municipality is to produce five doctors with its own investment in five years.

The municipality has also set some conditions that must be met, to get the scholarship. One of these major conditions being after the completion of the education, one has to stay and work in the municipality for at least two years. In this way, if the doctor funded by the municipality complies with the conditions, at least one doctor will serve in the municipality regularly for the next 10 years.

Nitesh Paudel of Lekbeshi Municipality-1, who excelled in his studies, had the dream of becoming a doctor. With this dream, he studied science after SEE. He also proved to be an excellent student. After that, he participated in the entrance examination conducted by the School of Medical Sciences of Kathmandu University for studying MBBS. He passed the entrance with a score of 155 and won the scholarship provided by the municipality.

From this current financial year, Lekbeshi Municipal Corporation decided to fund one student for the MBBS program every year for five consecutive years. In the first year 2022/23, three people within the municipality applied for the scholarship. Among the three, Nitesh got the scholarship. He is currently studying MBBS first year at Kathmandu University. He has won a full scholarship for his studies.

"My son had been insisting on studying medicine for a long time. As parents, we had to fulfill our children's wishes,” said Nitesh's father, Netra Prasad Paudel, “I was thinking of getting loans or selling my land to fulfill my son’s wish. However, after the municipality provided the scholarship, I am very happy.” Paudel works in the cooperative sector.

The scholarship amount given by the municipality will be provided in four installments. Nitesh has already received the first installment amount of Rs 1.4 million after completing all the documents. Although the municipality will bear all the expenses incurred by the university in the form of scholarships, the external expenses including the hostel will have to be raised by the Nitesh himself.

Nitesh said that he will not let the support of the municipality go to waste. "My father had encouraged me to study medicine despite our weak financial condition. Now that the local government has given me a scholarship, my family is no longer burdened," he said.

Nitesh said that after completion of his studies, he will work for the municipality. “As the municipality has spent so much on my studies, I will not hesitate to work for the municipality. I am grateful and will happily serve the municipality,” he said. 

While providing scholarships in this way, the municipality selects the students based on their scores. Among those who apply for the scholarship awarded by the municipality every year, the municipality selects the applicant with the highest score in the MBBS entrance exam.

There are 316 health posts in Karnali. Similarly, there are 26 hospitals with 15 to 25 beds. President of Nepal Medical Association, Karnali Province, Dr Navraj KC, said that rather than funding students to study medicine, emphasis should be given to impel the federal and the province to make better policies. "The federal government should make a policy for doctors who have studied MBBS to serve at the local health post for two years," he said. 

After the agreement with anti-corruption crusader Dr Govinda KC, there is now a wave of doctors coming to serve in the remote areas, he said, adding that the provincial and federal governments should make good policies and implement them. "To study medicine, one has to spend at least five million rupees. MBBS doctors trained by the local level are not always able to serve within the municipality," he said. “On the one hand, the expenses of the local governments are increasing; on the other hand, there is a compulsion to stay for some time and go abroad for an MD course.” KC mentioned that there will be no shortage of doctors in Karnali even if the policy of increasing the grades of doctors serving here is adopted. At present there are around 100 doctors who have completed MBBS and MD in Karnali.
Provincial govt joins hands 

The Karnali Province government is set to produce 50 doctors every year. Karnali Province, which lags behind in terms of the health sector, as specialist doctors from outside districts do not want to work in the province. The provincial government has decided to give scholarships to the local residents of Karnali to study medicine with the aim of creating an environment where they can serve in Karnali.

According to Binod Acharya, undersecretary of the Ministry of Social Development, the budget has been allocated to produce doctors at the rate of five each from the 10 districts of Karnali. "At present, doctors coming from outside are not willing to stay in Karnali. However, the provincial government is producing manpower itself to provide specialist health services even in the remote areas," he said, "From the current financial year, we are funding five people each from all 10 districts to become doctors on scholarships."

Doctors who have studied with the scholarship of the provincial government have to stay and serve in Karnali for at least five years. The provincial government has set a slogan for this, 'Manpower of Karnali, Service in Karnali'. The doctors who have studied under the federal government scholarship do not want to work in Karnali and even if they come, they do not stay for a long period.  The provincial government has arranged a scholarship to study medicine. "The purpose of this program is to allow manpower of the specific area to provide their service in the same area,” Acharya said. “Through this program, within a few years, the provincial government's goal of providing access to health services to the people will be realized.”