Nepal’s medical education sector is far from being healthy and is headed towards a crisis
KATHMANDU, Oct 18: On September 1, the Medical Education Commission (MEC) published the integrated results of the Medical Education Common Entrance Examination - Bachelor Level (MECEE-BL), 2025, qualifying as many as 7,847 candidates who had taken the entrance exam as eligible for pursuing a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree. The 50 percentile cut-off score for the merit list was determined to be 49.5 points in the entrance exam.
All seemed well at first glance.
As he checked the integrated result, Jeevan Singh, a resident of Golbazar Municipality, Siraha, found out he had made it to the merit list, ranked 3704, securing a result in the top 24 percentile. His score and rank would open up the avenue for him to study MBBS in Nepal so he had no qualms with what he had scored. In 15 minutes, however, his conscious acceptance of the result metamorphosed into concern as he found his rank pushed down to 3725.
The concern mutated into a serious doubt about the validity of the results when he checked his individual score by entering his serial number on the examinee’s result portal of the MEC. To his bewilderment, he found some other examinee’s name and result tied up to his registration number. He wondered what registration number his result had been tied up with as he started to question whether the score he had secured as per the integrated results was even his own score in the first place.
When he opened up the Facebook group of MBBS aspirants, his doubts were multiplied as he found more aspiring medical students going through the same experience with their result. Together, they formed a WhatsApp group of students who smelled foul play in the publication of the entrance exam results.
Amna Ansari, from Kalaiya Sub-metropolitan City, Bara, was an initial entrant of the group. She took the entrance for the second time after she was determined to have made a bubbling error in the MECEE-BL 2024. After consistently scoring above 130 in her mock examinations, she did not make it to the merit list, apparently having scored a meager score of 9 in the MECEE-BL 2025. The entire group finds this score not just surprising but impossible.
In another instance, the ranking of results of the entrance exam for Bachelors of Public Health (BPH) was flung into chaos as an examinee who was ranked 1 in one moment was outrightly discarded from the merit list the very next moment. Soni Kumari Kushwaha was dejected by the working mechanism for the publication of the results as she found her rank 1 swiftly buried up by a result stating failure in the examination. Instead of her, another examinee Kumar Oli occupied the top spot in the BPH result. With the exposure to these two cases, Singh’s serious doubt about the result evolved into its final stage of outright rejection.
“I am sure that there is some sort of scam going on in the medical education entrance examination,” Singh told this scribe, “I will not accept this score as my result unless I get my hands on the original copy of my Optical Mark Recognition (OMR) answer sheet and the question paper.”
Singh, whose father is a public servant, has been on a protest against the MEC for a month and half now. Initially, a group of more than 150 concerned students like Singh who had assembled through the WhatsApp group started to protest against the irregularity in the result the very next day of its publication. The protest of September 2 bore the result the following day in a meeting of the National Assembly (NA).
On September 3, lawmakers expressed concerns over the alleged irregularities in the results of the MEC, demanding an investigation to find the facts over the issue. Airing their views in the zero hour of the upper house meeting, lawmakers said that the details emerged thus far suggested irregularities in the results and the matter should be thoroughly investigated.
Krishna Prasad Paudel of the ruling CPN-UML accused the MEC of negligence in the results while Goma Devi Timilsina of the CPN (Unified Socialist) said the integrated results made public on September 1 were enough to raise questions over the credibility of the entrance exam. Bhuwan Bahadur Sunuwar of the CPN (Maoist Center) said that the alleged anomalies in medical education should be probed and action should be taken against the MEC if the existence of the irregularities is proven in the investigation.
Following a continued protest from the concerned students and the heaping pressure from lawmakers, the MEC decided to implement a half-measure to satisfy the two proponents of the protest. It opened up a short-timed portal whereby the students unsatisfied with the result could ask for their OMR sheets and answer key but not the question paper. Due to the short lifespan of the portal, only around 600 students of the almost 50 thousand students who had appeared on the MECEE-BL 2025 filed for acquiring their exam materials. And when they did get their hands on the OMR sheet, they were disturbed by the state of the sheet: a soft copy of the original, not even in color.
According to Singh, the OMR sheet has been tampered by photo editing software. “We have found at least three papers where the soft copy released by the MEC has been tampered electronically to get new results,” Singh told Republica, “So I will not accept a tampered photocopy of my answer sheet either.” The group of protesting students, now reduced to a few dozen (courtesy of dwindling health conditions, including high fever, of at least a dozen aspirant medical students due to exposure to high heat during protests), are now demanding either a physical copy of their OMR or a scanned copy of their OMR in the original color (pink). A total of 78 aspiring medical students including Singh have filed a writ petition against the MEC with the said demand, at the Supreme Court. Senior Advocate Bhimarjun Acharya has affirmed that he will represent the students pro bono at the court. The hearing on the case has been postponed twice, with the new date fixed on October 18.
Why did the MEC only publish the OMR and answer key?
When asked why the MEC decided not to publish the question paper, a physical copy of the OMR or a scanned copy of the original OMR, officials from the MEC cited the limitations of the working procedure of the MECEE. However, the working procedure of the MECEE points otherwise.
Paragraph 8, Clause 27, of the Working Procedure of Medical Education Common Entrance Examination and Student Admission (2079), states that the answer sheets and question paper of the examinations under the MECEE will have to be kept private by the MEC. If the MEC were adhering to the procedure, they should not have even published the scanned OMR sheets to the 600 students who filed online forms to acquire their exam materials.
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“They are not even sticking fast to the working procedure yet they are citing the working procedure as the limiting factor behind the proper publication of the results,” Singh commented. He added his concern over the percentile system used in the MECEE, claiming that it has eased the access to Nepali medical institutions for foreign students.
“It seems the dwindling cut-off as per the percentile system has invited substandard students into the merit list, often paving way for some unqualified foreign students to enter Nepali medical institutions,” Singh told Republica, “This system has also enabled underqualified Nepali students to study medicine abroad at substandard medical institutions, eventually returning to Nepal to practice the low quality medical education they’ve acquired elsewhere.”
Privy to percentile system?
Clause 5 of the Medical Education Common Entrance Examination and Student Admission Procedure (First Amendment) 2022 introduced a system whereby the top 50 percent of students who take the MECEE-BL entrance examinations are placed in the merit list, providing them the eligibility to pursue medical education in Nepal or abroad. This means that if 10,000 examinees appear in the MECEE for any bachelor's program, the top 5,000 gain the eligibility to pursue the said program in any country, given that a medical institution enrolls them as a student. According to the vice-chairperson of the MEC, Dr Anjani Kumar Jha, as many as 50,000 aspiring medical students took the MECEE-BL 2025 which means that around 25,000 students made it to the merit list for various programs such as MBBS, BPH, Bachelors of Dental Surgery (BDS), Bachelor of Science (BSc) in Nursing, and BSc in Medical Laboratory Technology.
Prior to the introduction of the procedure, the entrance examinations used a strict 50 point cut-off which resulted in qualifying significantly less number of students as compared to the number of seats in Nepali medical colleges. Medical colleges such as Janaki Medical College recorded more than half seats empty in some years. Medical college aspirants would go awry every time they would see those empty seats. The discussion among the stakeholders revolved around filling up these seats, and eventually the percentile system was supposedly introduced as a solution to this problem.
Decrease in the cut-off
In the initial edition of the percentile-based MECEE in 2023, the 50 percentile cut-off score for the MBBS entrance examination was set at 58.25 and as many as 6,669 individuals appeared on the merit list of the result. The highest scorer Pratik Bhandari scored 178.75 points as per the integrated result. However, he does not appear in the categorized merit list. In the BSc Nursing program, the cut-off score was determined to be 44.25 where Grishma Dallakoti secured the topmost rank by scoring 165.5. For the BDS program, the 50 percentile system cut-off was set at 55.75 and the highest scorer in the entrance exam was Subhash Acharya who had scored 172.
These result numbers remained steadfast in the MECEE-BL 2024 as the 50 percentile saw a miniscule improvement. For the entrance of the MBBS program, the 50 percentile cut-off was determined to be 59, qualifying 6,832 in the merit list. The highest scorer Kritagya Raj Pandey scored 182.5. In the BDS program, the cut-off was determined to be 55, qualifying 2,682 examinees in the merit list, with the highest scorer Malbika Chaudhary scoring 162.75. In the Bsc Nursing program, the cut-off was determined to be 42, qualifying 3,922 examinees in the merit list, with the highest scorer Shraddha Basnet scoring 171.25.
The results for the MECEE-BL 2025 dwindled sharply as compared to previous years. The cut-off score for the merit list of the MBBS program decreased to 49.5 qualifying 7,847 students and for the Bsc Nursing program to 39.75 qualifying 5,533 examinees. The highest scorer in the MBBS entrance Anish Raj Prajapati scored 178 while the highest scorer in the BSc Nursing entrance Aayusha Dhakal scored 164.
Officials from the MEC attributed this sharp decrease to the inclusion of students who are awaiting their result for the +2 board examinations conducted by the National Examination Board. According to the Director of Examinations at the MEC, Prof Dr Sarala Shrestha, the unpreparedness of such examinees has resulted in the lower cut-off in the MECEE-BL 2025.
“Many of the students who are awaiting their results of the +2 examinations are not well prepared to take the MECEE-BL,” Dr Shrestha told Republica, “When such students sit for the examinations, they are prone to score low, thereby decreasing the cut-off score.”
However, that does not seem to be the only reason behind the low cut-off score.
Loophole in the percentile system
The MECEE uses a 50 percentile cut-off for bachelor level programs which has resulted in students scoring as low as 25 percent (or a score of 49.5) in the entrance exam for MBBS and less than 20 percent (or a score of 39) for BSc Nursing. It cannot be argued that the exam was extremely difficult this year or that any random student without academic caliber attempted the exam, since the highest scorer still scored about 90 percent in the entrance exam and the requirement for taking the exam is still intact.
Experts in the medical education field have expressed concerns over the low cut-off for 50 percentile, suggesting that the entrance exam may have proxy exam-takers who are scoring low in addition to the +2 students who are awaiting their board examination but are now eligible to take the entrance examination.
Former Dean of the Maharajgunj-based Institute of Medicine under Tribhuvan University, Prof Dr Jagadish Prasad Agrawal, expressed surprise over the very fact that examinees who have scored less than 25 percent in the entrance exam are eligible to pursue an MBBS degree in Nepal or elsewhere.
“This might be a case of proxy seats creation at the expense of the quality of medical students,” Dr Agrawal told Republica, “If there are students who are simply registering for the entrance but not appearing in the examination, or students who simply attend the examination but do not answer any questions, then these students might be artificially creating the lower 50 percentile, thereby decreasing the cut-off score.”
For example, if there are 2,000 examinees, the top 50 percentile or 1,000 examinees would be eligible to pursue their degrees. When an additional 1,000 proxy examinees are added to the examination, the total number of students increases to 3000 and the top 50 percentile, now 1500 examinees, get an eligibility certificate. Thus, an extra 500 students who would not have gotten into the eligibility list get a chance to pursue a career in medicine.
A high-level source who has access to the OMR sheets of the examinee has confirmed to Republica that they have indeed come across a number of OMR sheets where the examinees have simply stated their names on the sheet or shaded the bubble for the same option (for example option A) in all questions. “There are OMR sheets in storage where the examinees have stated their names but not answered any of the questions,” the source told Republica, “As per my knowledge, these types of OMR sheets appear once in every 10 OMR sheets.”
In addition, the MEC refrains from publishing any information about the lower 50 percentile of examinees thereby raising suspicion that there are also registrants for the entrance who never show up at the exam. When asked whether such registrants are also counted in the calculation of the 50 percentile and the ensuing cut-off score, Dr Shrestha claimed that the security system of the MEC storage of the statistics of the examination is such that even she, as the director of examination, does not have access to such data.
“Even when I have to enter the room, I have to register my fingerprint under strict surveillance of IT officials at the MEC,” she told Republica, “Any data about the proxy examinees is therefore, locked behind closed doors as mandated by our regulations.”
Lost faith in MEC
When the MEC published the integrated result for the common entrance examination on September 1, aspiring medical students like Singh became privy to the sudden reshuffle in the ranking and marks, something that has been happening for the last three editions of the MECEE. Every year, the MEC defends the sudden reshuffle as a correction of mistakes in the publication of the result. This year, however, the examinees found a data mistake whereby their registration numbers were tied with the score of other students.
Similar to the case of Singh, numerous students have lost confidence in the credibility of the entrance examination, often culminating in street protests. When students do make it to the MEC with qualms about the entrance, they are met with aggression and inattention from the authorities.
Rewati Raman Raut, from Rajbiraj Municipality, Saptari, scored 123 in the MECEE- 2024, placing him just a couple of ranks shy of a good scholarship placement for medical college. He retook the examination this year to improve his score. Lo and behold, he did not make it to the merit list. When he checked his individual result online, he was amused to see that he had scored only 47.5.
One of the early entrants of the WhatsApp group, Raut recalls his experience demanding his OMR sheet from an IT official at the MEC as one of the most disrespectful encounters of his life.
After being directed by the IT official to go to various rooms at the MEC to get the OMR sheet, Raut finally received the sheet from the same IT official towards the final 10 minutes of office hours.
“Sir, when will everyone else get their OMR?” he asked the IT official out of concern that the remaining students might not receive their answer sheets due to time constraints. In return, the IT official bombarded him with yells and slurs. Raut still does not understand what was wrong about the question.
Consultancies or Cartels?
Due to the decreasing cut-off score triggered by the creation of proxy examinees, the number of eligible students keeps increasing every year. But the seats for medical programs at Nepali medical colleges allocated by the MECEE are sparse.
Under the MECEE 2024, as many as 6,832 students made it to the merit list of the MBBS entrance. However, only 1,925 seats were allocated in medical colleges in Nepal for the program in 2024, leaving 4,907 students looking for alternative options to pursue higher education. This year, 7,847 students made it to the merit list of the same program but the seats are limited to 2,140. As many as 5,707 students are looking for alternative options this year.
One might wonder, who or what group of people derive optimum gain from increasing the number of eligible students in the MECEE. The experience of any aspiring medical student who makes it to the merit list but is not allocated a seat sheds light on this question.
Durganand Shah, from Rajbiraj Municipality, Saptari, made it to the merit list of MECEE-BL 2025 in the MBBS program, scoring 53 points. While he was not able to digest the result, he started exploring alternative options. Along with his two other friends, Shah ventured into educational consultancies in the Kathmandu valley, and chanced upon Newtonian Science Counseling Institute Private Limited in Gyaneshwar.
“If you get a No Objection Certificate (NOC) from the MEC, I will send you to China,” the operator of institute told the trio, “However, you will first have to pay Rs 50,000 as processing fees followed by Rs 1 million for open seat or Rs 2 million for scholarship seats.” The trio were also offered a total package requiring Rs 5.5 million payment for their entire stay in China. While Shah opted out of the offer, his friend paid the amount and is currently pursuing MBBS in china, having simply scored a little higher score than the cut-off.
Medical education experts prefer calling the group of consultancies like Newtonian who levy fees for sending students abroad for studying MBBS, “medical cartel”. Under the strict condition that their names will not be disclosed, as they fear their life might be under threat if their opinions are attributed to themselves, some medical education experts claimed that these “cartels” are the main proponents of the creation of proxy examinees.
“They search for +2 science students who meet the criteria to take the examination, albeit their disinterest in the medical field,” one former high-level official at the Institute of Medicine told Republica, “They pay such students to register for the entrance and ask them to either not attend the entrance or simply state their names on the OMR.”
One student currently pursuing a civil engineering degree at TU Thapathali Engineering Campus confessed to this scribe that he had appeared for the MECEE-BL 2024 for a cash incentive of Rs 3,000 right after he took the entrance for the engineering program.
“I had to register and appear in the exam but not answer any question,” he told this scribe, “I could make a quick buck for doing nothing, so I accepted the offer.” According to them, recruiters for such activity tend to flock around entrance exam centers for Engineering programs.
Nepal’s medical sector heading towards a crisis
According to the result of the MECEE-BL 2025, students who scored as less as 25 percent in the entrance exams have received the eligibility certificate for attending medical institutions. While such students rarely get admission into Nepali medical colleges, they can acquire an NOC from the Ministry of Education, Science and Technology, to study medicine abroad. Under the influence of educational consultancies that have their own ulterior financial motives, these students venture into countries such as Bangladesh and China to pursue a degree in medicine. Upon the completion of their courses, most of them return to Nepal to practice medicine and attempt the theory-based licensing exam. The situation has led experts in the field to warn of an imminent disaster in the medical sector.
Since the inception of the percentile system, the number of eligible students has consistently outrightly outnumbered the number of seats at Nepali medical institutions. While the cream of the batch and the financially well-off students will pursue their medical education in Nepal, the lower tier students, who barely acquired the eligibility will generally venture to foreign nations, especially Bangladesh and China, to pursue a degree in medical institutions without proper hands-on training.
Upon completion of their bachelor’s programs, they return to Nepal where they get a fair chance to clear the theory-based National Medical Council Licensing Examination (NMCLE) without adequate knowledge of practical application of the theory. Those who don’t clear the NMCLE run their private MBBS clinic in the Terai-Madhesh belt. Those who do clear the NMCLE are not actually adequately prepared to take on the role of a doctor.
Multiple experts are concerned that, in such a scenario, the medical sector as a whole might be affected. “With rising errors made by such medical practitioners, the public belief in Nepal’s medical institutions will be degraded and we might observe a pattern of venturing to India to get even the most miniscule of treatment,” Dr Agrawal told Republica, “This trend has already started.”
Prof Dr Arjun Karki, a former vice-chancellor of Patan Academy of Health Sciences, was dismayed at the probability of such an ill-practice in medical entrance examinations. “The creation of proxy seats could have led to the decrease in the cut-off score,” Dr Karki said.
As per the Investment Board Nepal, the total health expenditure in Nepal is around Rs 200 billion, almost 5.8 percent of the Gross Domestic Product. Dr Agrawal added that a medical field saturated by such inexperienced practitioners will eventually affect the entire economy of the nation.
“This is a very sensitive matter concerning the future of the country but no authority concerned seems to be serious about it,” Dr Agrawal told Republica, “There is no concern for vigilance of the entrance examination, or the mechanism that qualifies students who score as less as 25 percent on the examination.” He added that in such conditions, the medical sector will be in a crisis within the next two decades.
“Who will even consider doing a medical checkup in Nepal after 20 years?”
