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A transfer by the junta to decrease admission requirements at universities that prepare docs and different healthcare professionals has raised issues in regards to the high quality of future medics
By FRONTIER
Because the February 2021 coup d’état, Myanmar’s public well being system has been in disaster. The army takeover prompted tens of hundreds of medical workers to hitch the Civil Disobedience Motion, refusing to work till the regime handed again energy to elected representatives.
However docs and different professionals say the system is going through a brand new risk: junta insurance policies that would decrease the requirements of coaching for medical docs.
Well being sector sources, together with former high-level well being ministry officers, say that greater than 18 months after the coup, state-run hospitals all through the nation proceed to be affected by shortages of healthcare professionals.
“Since greater than half of the workers underneath the well being ministry joined the CDM, the federal government hospitals can’t operate correctly,” stated a former senior well being division official in June of this 12 months. He stop his job within the division after the army took over.
However changing well being staff is not any straightforward job. Myanmar has six medical universities, together with one run by the army. The 5 civilian universities take greater than 1,300 of the highest scorers from the highschool matriculation exams annually, and entry has historically been extremely aggressive.
Medical colleges have additionally been closely impacted, with round half of medical college students and departmental and instructing workers estimated to have joined the mass strike in protest of the coup. Simply as importantly, the state training system has confronted a large boycott. Solely 300,000 college students sat for the matriculation examination in March 2022, down from 900,000 in 2020 in line with training ministry figures.
This has left the junta with restricted choices to replenish the dwindling ranks of docs within the well being sector.
The state of affairs threatens to exacerbate a scarcity of docs that has lengthy affected Myanmar. World Well being Group figures present that with a inhabitants of about 52 million in line with the 2014 census, Myanmar had 0.57 docs for each 1,000 individuals. The typical in Southeast Asia is 0.72 per 1,000 and for a developed nation like Singapore, the typical is 2.5 docs per 1,000 individuals.
The regime seems to have responded to the scarcity of medical college students at universities by decreasing admission requirements.
Junta chief Senior Basic Min Aung Hlaing informed a gathering of the State Administration Council in Nay Pyi Taw on December 13 that they might be easing the eligibility necessities for graduating highschool college students to get into medical colleges. Entrance is normally primarily based on the ultimate rating of all six matriculation topics mixed, with college students who rating excessive sufficient eligible to use to medical universities.
This 12 months, nonetheless, the method for figuring out eligible college students has modified. As an alternative, college students with the best complete scores from simply three topic areas – English, Biology and Chemistry – will likely be chosen. Altering the entry rating calculation on this means eliminates poorer topic outcomes and permits many college students who would in any other case not qualify to abruptly be eligible.
The junta has not publicised a cut-off rating, probably to masks the decline in admission requirements. Frontier’s sources say that the medical universities have nonetheless not been capable of hit enrolment targets and are permitting giant numbers of scholars to switch in from different levels to fill the locations.
The junta can be demanding college students serve in government-appointed medical roles for 10 years after graduating, somewhat than getting into the personal sector.
“Medical college students will likely be supplied with a stipend however they need to serve the State as service personnel for 10 years after they graduate,” Min Aung Hlaing stated in December.
This marks a return to the coverage underneath the earlier army regime, which required medical faculty graduates to work in authorities establishments, usually in rural and distant areas, for a minimum of three years in the event that they wished to obtain a Medical Practitioner License.
Resulting from this requirement, some graduates by no means grew to become docs however labored within the well being ministry as a substitute. Reforms underneath the quasi-civilian authorities of U Thein Sein, a former common who took workplace in 2011, allowed graduates to obtain their licence with out working for the federal government by attending a further month-long course, which rapidly grew to become the norm.
Many Myanmar medical professionals and public well being specialists have criticised the junta’s coverage change on medical college admissions, in addition to the shortage of academics and scientific supervisors in instructing hospitals, saying it is going to lead to poorly educated docs and different healthcare professionals.
“I’m very fearful that if the academics can’t prepare medical college students on the excessive degree required, they gained’t turn out to be correctly certified docs,” stated a former professor at a college of medication who requested to not be recognized for causes of non-public security.
A stoop in enrolments
Dr Michelle Khine*, a public well being skilled who labored within the well being ministry earlier than the coup, stated admission numbers at medical colleges are a lot decrease than earlier than the coup. The regime’s answer, although, would have probably critical penalties, she stated.
“Decreasing admission requirements [to address it] will have an effect on the standard of medical college students,” she warned.
College students and educational workers at medical colleges in Yangon and Mandalay confirmed to Frontier there had been a decline in new admissions because the coup, and enrolment targets had not been reached.
A spokesperson for the well being ministry declined to offer enrolment figures when contacted by Frontier. Frontier additionally contacted 5 college students who’re eligible to use to medical universities in Yangon this 12 months, and all declined to reply.
However the regime’s personal statements seem to verify the problem it’s having in attracting college students.
On June 9, six weeks after an April deadline for purposes, the junta’s Division of Human Assets for Well being once more urged these eligible to go to medical universities to use. The announcement stated deadlines have been being prolonged for a second time, and that college students might be able to switch from different universities into medical levels relying on the vacancies.
On August 2, the identical division confirmed that 211 college students had already acquired approval to switch into the 5 non-military medical universities from different levels. Eligibility necessities for these transfers weren’t made clear in public statements or in response to Frontier’s queries, however junta officers painted a optimistic image.
“It may be stated that the variety of college students who apply for admission to medical universities is giant basically,” stated Dr Than Naing Soe, a spokesperson for the junta’s well being ministry who can be director of the Well being Literacy Promotion Unit.
“Generally human useful resource administration means making do with what we’ve. There are additionally loads of academics [recently] appointed by the ministry. However the primary factor is to make sure the standard of medical graduates produced by medical universities doesn’t decline,” Than Naing Soe added. He didn’t make clear what number of college students had utilized or what human useful resource limitations the regime was going through.
The junta’s well being ministry has additionally not revealed what number of of its personnel have gone on strike and joined the CDM. Nevertheless, CDM Medical Community member Dr Sitt Min Naing informed Frontier in April that out of greater than 110,000 authorities healthcare workers earlier than the coup, about 40,000 are nonetheless out on strike.
There’s additionally been a pointy fall within the variety of educational workers at medical universities and associated establishments.
A well being sector supply stated that earlier than the coup, there have been 6,940 workers on the head workplace of the Division of Human Assets for Well being in Nay Pyi Taw and on the 15 universities of medicines and allied universities, resembling midwifery and nursing. Michelle Khine informed Frontier on July 6 that just about half of these departmental and instructing workers had joined the CDM, whereas college students who had boycotted research on the two universities of medication in Yangon informed Frontier that just about 60 p.c of medical college students have been refusing to attend courses.
Shift from high quality to amount
Throughout the 2018-19 educational 12 months, the Central Committee for Built-in Curriculum Improvement underneath the Nationwide League for Democracy authorities up to date the medical training curriculum. The change was primarily based on inputs from specialists, in addition to a comparative assessment of six overseas medical universities. The revamp was aimed toward bringing the curriculum extra into line with worldwide medical training requirements.
The brand new curriculum, known as an outcome-based, built-in curriculum, is an strategy to instructing through which college students be taught and combine fundamental medical science topics with scientific topics, along with skilled ethics, public and household well being, social and behavioural sciences, and analysis.
The target of the brand new curriculum was to supply “totally certified, ethically-minded medical docs tailored for the conditions in Myanmar and elsewhere around the globe”, in line with one of many medical college web sites. A pilot of the brand new curriculum started with college students who enrolled at medical universities in 2020.
“As a result of efforts of Myanmar well being professionals, the built-in curriculum was 95 p.c full previous to the coup,” stated Michelle Khine. “However although current academics will likely be proficient within the built-in curriculum instructing strategies, academics who transferred from different departments after the coup won’t.”
She stated quite a lot of docs with out instructing expertise have been transferred from different departments, such because the Meals and Drug Administration, into the schools of medical universities to fill the shortfall in instructing workers.
Frontier tried unsuccessfully to hunt remark from 4 of the medical universities in regards to the built-in curriculum and supply of programs.
Qualifying as a physician in Myanmar requires six years of research however underneath the NLD authorities, the well being ministry prolonged that by one 12 months. Some medical college students who’re boycotting courses in protest of the coup predict that the army regime’s well being ministry could cut back the variety of years wanted to check for a medical diploma.
Well being specialists and docs are additionally involved that the scientific coaching of medical college students could also be substandard due to the shortages of healthcare professionals at authorities hospitals.
“The shortage of well being professionals at hospitals can have a huge impact on scientific instructing,” stated Dr Aung Myo Thu*, a medical practitioner in Yangon, referring to the professors, consultants, specialists, physicians and others who function medical officers at authorities hospitals.
The NUG tries to fill the void
In a report issued in April overlaying its first 12 months of actions, the Nationwide Unity Authorities’s well being ministry stated it had been conducting steady and additional training for college kids and well being professionals by holding webinars and on-line lectures. The NUG is a cupboard appointed by lawmakers elected within the 2020 polls, which the army annulled citing unsubstantiated allegations of large voter fraud.
The NUG established Interim College Councils quickly after the coup, aimed toward offering different training to college students that mirrors or is drawn from the curriculum of three of the medical universities. These councils are actually concerned in delivering among the NUG’s on-line coaching choices.
One council, generally known as the Interim College Council, College of Drugs (1) Yangon, lists on its web site a six-year M.B.B.S. medical diploma together with scientific placements at main junta-run instructing hospitals in Yangon. In apply, the councils are unable to ship placements or sensible coaching for docs and their course choices for medication stays restricted.
The NUG well being ministry has additionally been offering common well being training programmes, together with exams, the report stated. It’s not but offering full size levels, however the NUG’s Interim Council of Myanmar Nursing and Midwifery Coaching Faculties just lately introduced the commencement of 63 Girls Well being Guests, well being staff who present maternal youngster well being and different providers to girls of their house. The 63 graduates had all attended a nine-month course on-line.
The NUG well being ministry has additionally stepped in to situation non permanent commencement certificates to medical college students who have been imagined to graduate from their medical levels in mid-2021, however who left college after the coup with out ending their ultimate scientific placements or attending their commencement ceremony.
NUG well being minister Dr Zaw Wai Soe informed the 21st Worldwide Convention on Emergency Drugs in Melbourne remotely in June that successive army rulers in Myanmar had left a legacy of poverty, inequality and essentially the most insufficient healthcare and training programs on the earth.
“We can’t return to the darkish ages,” Zaw Wai Soe informed the gathering. “We’re preventing not just for freedom and democracy; we’re preventing for justice and rights, rights to vaccines, rights to training.”
The NUG’s Interim President’s Workplace declined to remark additional on the well being ministry’s coaching actions.
Prior the coup, Dr Ye Kyaw Thu* returned to postgraduate research to coach as a psychiatrist on the College of Drugs (2) in Yangon, having beforehand labored on the Public Well being Division at Hpa-an in Kayin State as a medical officer. He helps the CDM, and because the coup has refused to attend college and gone into hiding.
Ye Kyaw Thu informed Frontier that he was collaborating in a web based coaching course offered by CDM well being professionals, with courses two days per week. He stated he’s grateful to have the ability to proceed his medical training although he’s doing so whereas hiding from junta safety forces.
“Many medical college students, together with me, have created a Fb group to have the ability to proceed our medical training. It permits us to check on a regular basis,” Ye Kyaw Thu stated, including that eight of the 14 postgraduate college students in his course are boycotting courses.
Previous to the coup, Myanmar well being professionals and well being authorities have been making an attempt to get the nation’s six universities of medication included on the World Accreditation Institute’s listing of universities of medication, however now their efforts are in useless.
“Earlier than the coup, I used to be conscious that two of the six universities of medication, together with the army medical college, have been on the street to inclusion on the accreditation listing,” stated Michelle Khine. “Now, it’s throughout.”
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