Imagine completing a hunger strike for the benefit of others: inspiring yes, dangerous of course, and possibly deadly. It’s hard to think of a cause that would make one begin such a protest. Now imagine completing seven hunger strikes. This is exactly what one Nepalese senior orthopaedic surgeon has done.

Close to death on numerous occasions, Dr Govinda K.C. has protested against corruption in the medical education system. At the centre of the system are 19 private medical colleges that dominate via a range of practices from lobbying to bribery. Despite students paying admission prices equivalent to £25,000 for the privilege, the results are inadequate colleges producing underqualified doctors.

In Nepal the healthcare system is notoriously weak, as was terrifyingly displayed by the massive earthquake that struck the country earlier this year. A 2011 WHO report showed that there are only 2.1 physicians for every 10,000 people. As a country that ranks extremely low on the corruption perceptions index it is likely that corruption occurs at multiple stages in healthcare provision, including medical education, limiting the effectiveness of healthcare provision.

There are two clear corruption pathways that result in under resourced colleges and poorly trained doctors in Nepal:

1) Nexus between college owners, politicians and government officials allow colleges to gain accreditation despite not having suitable facilities. For example, the owners of both the Birat Medical College and the KIST Medical College are related to the chief of the Nepalese anti-corruption body, the Commission for the Investigation of Abuse of Authority (CIAA).

2) Rampant bribery by private medical colleges result in inspections and court cases go their way. For example, a recent undercover investigation recorded an official from the Universal Medical College in Bhairawa claiming they had bribed Nepal Medical Council officials, the Health Secretary Pravin Mishra and members of the judiciary.

Supported by demonstrators, Dr K.C.’s efforts led the government to create a commission to implement reform proposals drawn up in the Mathema Report. The proposals included the limitation of college admission fees and a decrease in the number of students each college can take.

However, there have been recent setbacks. The government’s decision to appoint the then Education Minister as the Commission Chairman, rather than the Prime Minister who would represent the highest level of government action on the issue, led the Doctor to commence his most recent hunger strike; this ended recently with the government not agreeing to his demands. In turn a number of private medical colleges have complained that they were being punished for the bad behaviour of others, with a numberthreatening to close if all points of the proposal are implemented.

But to improve the quality of training in the medical education sector the government must not only implement the reforms in the Mathema Report, it must also tackle key corruption pathways within the sector. This should include investigating possible conflicts of interest, sanctioning those involved in bribery, and strengthening the transparency and accountability of regulatory bodies. Only then will the two corruption pathways discussed be diminished.

Ultimately, it is vitally important that corruption is mitigated in the medical education system. If Nepal is to have an effective and efficient healthcare system, properly trained doctors are the foundation.