Health Secretary’s Gujrat visit triggers major health shake-up

Islamabad: A heated parliamentary debate over private medical college fees has exposed a conflict between the Pakistan Medical and Dental Council and members of the National Health Services Standing Committee. Lawmakers questioned why students are being asked to pay millions of rupees for medical education while some colleges seeking fee increases allegedly have incomplete documents and audit reports. The controversy became more serious when Member Aliya Kamran questioned the approval of higher fees for colleges whose facilities and records were allegedly not good enough to justify such increases. She specifically referred to Rawal Institute of Health Sciences and claimed that photographs showed standing water in classrooms and students unable to attend classes because of poor infrastructure. She questioned how such an institution could qualify for a fee increase and said colleges with poor standards should face action rather than receive permission to charge more. The debate also revealed a major disagreement over whether high fees are responsible for vacant seats in private medical and dental colleges. One PMDC official argued that fees alone cannot explain the vacant seats, pointing out that some colleges charging Rs3.5 million have no vacant seats. The official said students also consider the quality of education, facilities and the reputation of institutions before choosing a college. But the Vice Chancellor of Jinnah Sindh Medical University presented a very different picture. He told the committee that around 8,000 students who passed the Medical and Dental College Admission Test did not take admission because they could not afford the fees. He said many of these students could have joined if more public sector seats had been available. The disagreement over fees comes as the committee is examining a fee range of Rs1.8 million to Rs2.5 million for private medical colleges. According to the PMDC briefing, 61 colleges applied for permission to charge more than the Rs1.8 million baseline. After checking their balance sheets, third party audit reports, specifications and inspection reports, only 35 were declared eligible for fee enhancement. However, eligibility did not mean that all 35 colleges were allowed to charge Rs2.5 million. Some were allowed to charge Rs1.9 million, Rs1.95 million or Rs2 million. The issue of quality also came under strong criticism. Aliya Kamran questioned the argument that better quality should automatically allow a college to charge higher fees. She warned that allowing some institutions to charge Rs2.5 million while keeping others at Rs1.8 million could create the impression that students studying at lower fee colleges belong to inferior institutions. Minister for National Health Syed Mustufa Kamal defended the fee difference by saying that institutions have different facilities and levels of exposure. He cited Aga Khan, which was described as charging Rs3.5 million, and Ziauddin, which was described as charging Rs2 million. He said some colleges hire professors from abroad and provide additional practical training; their audited accounts are used to show their higher operating costs. The debate then turned into a bigger question: should medical education be treated as a business or as a social service? Member Gul Asghar Khan openly argued that medical education is a business and that private investors put money into medical colleges because they expect a return. He warned that imposing strict fee controls could force private colleges to close. He claimed that a major audit could show the actual cost of educating one medical student is more than Rs4 million a year in the public sector. Another member rejected this argument, pointing out that government medical institutions may spend much more on a student while charging students only around Rs5,000 to Rs50,000 in fees. The member said private medical college fees ranging from Rs1.8 million to Rs2.5 million are simply beyond the reach of ordinary families. The committee also heard that medical education fees have increased sharply over the years. A university vice chancellor said the cost per student at a public medical college had earlier been estimated at around Rs750,000 to Rs800,000. An audit conducted after Justice Saqib Nisar sought data had put the private college figure at around Rs900,000, but the fee later increased to Rs1.8 million. The vice chancellor said the higher fee is beyond the ability of most students to pay and stressed that fees are a major factor behind the problem. Another member said medical college fees had earlier been around Rs640,000 before increasing to Rs900,000 and then suddenly reaching Rs1.8 million. The member argued that colleges struggling to fill seats should reduce fees to Rs1.5 million or even Rs1 million rather than leave seats empty. The BDS programme also came under discussion. Officials said the programme is being increased from four years to five years to meet international recognition requirements. This means students will have to pay for an additional year. Officials warned that students already struggling to pay around Rs10 million for four years could face another Rs2.5 million burden for the fifth year, potentially leading to even more vacant seats. The committee was also told about serious questions regarding documentation submitted by colleges seeking fee increases. Aliya Kamran pointed out that Peshawar Medical, Sahara, Liaquat National and Rawal were among colleges whose documents were allegedly incomplete in the list provided to the committee. She questioned how colleges could be included in the fee enhancement process when some did not have audit reports. The PMDC official responded that audit reports had not been demanded from colleges in the past. According to the official, PMDC started demanding third party audit reports after the January 2023 Act. The official said colleges that failed to provide the required documents were rejected, while the 35 colleges approved for fee enhancement had submitted third party audits. The chairman of the committee, Dr. Mahesh Kumar Malani, said the committee had already decided that medical colleges should generally charge between Rs1.8 million and Rs2.5 million and had sought lists of colleges charging higher fees. Complaints had been received that some colleges were charging more than what their standards justified. The discussion also highlighted a major difference between high