Tuesday, June 30, 2015

Medical Education in Cameroon

By Tazoacha Asonganyi * in Yaounde. 
We are informed by the press that the National commission for medical education (with french acronym CNFMP) has taken a decision to organize one entrance examination for all faculties of medicine in Cameroon with candidates choosing only one institution and one filiation of general medicine, dentistry, or pharmacy. CNFMP will select candidates for each institution; the state will no longer interfere with charging of training fees in private institutions, and will no longer pay part of the fees for students in private institutions.
     This brings to an end the half-thought-out programme of not only imposing fees to be paid in private universities, but also fooling the children of the poor that they would get medical training in private universities in Cameroon on state scholarship. When at the end of the 2013/2014 academic year the Minister of Higher Education abandoned the children that he had admitted to study medicine in private institutions to their parents after just one year of cacophony and chaotic payment of their fees, most of the poor parents were left with the difficult task of convincing their children that they could not afford the fees for them to continue their medical education in the private universities.
     This failed programme of “harmonization” does not seem to have dampened the “leveling” zeal of the minister. It is not surprising that the University of Buea Chapter of the National Union of Teachers of Higher Education (SYNES),recently wrote a letter of protest to the Minister of Higher Education against his intended “Harmonisation of university programmes to enhance the mobility of students from one University to another.”The minister seems to abhor diversity which necessarily breeds competition that is always the mother of individual and group genius and intelligence – and excellence!
     It will be recalled that in 2013, when the Minister of Higher Education, Grand Chancellor of Academic Orders, etc. started toying with what he called “reforms” of Medical education in Cameroon, I wrote an article expressing doubt about the wisdom of what he was about to do. Most of the reforms have now come to naught after causing so much pain and hardship to many households. Unfortunately, the new dispositions announced by CNFMP still have a lot of shortcomings. This is because the dispositions ignore the fact that every Cameroonian child that wants to study medicine has the right to compete for a place in a low-fee-paying state university faculty first; when theyn fail to get a place, they can then elect to study in a private, high-fee-paying university faculty. Therefore I still think that the best the state should do is organize a national common entrance examination for candidates who would like to study medicine in Cameroon.
     Such an exam should be marked nationally, and those who score marks that class them in a group with the highest aptitude to study medicine (List A) should be so classified, and the role of the state should end there. Each Faculty, of private or public universities, should then proceed to organize interviews/oral examinations for admission of candidates from “List A” into its Faculty. To be fair to the candidates and give all of them an equal opportunity to benefit from state sponsorship, Faculties of state universities should first conduct their interviews before the private universities follow suit.From my personal knowledge of the performance of such candidates over a period of some 30 years, I have no doubt that even if we multiply the present number of Faculties of medicine by 10, they will still be unable to absorb all those who will qualify for “List A” each year.
    This said, since I think that what I wrote in 2013 is still very pertinent to what CNFMP is presently engaged in, I have decided to make it available as part of this new article.

Medical Education in Cameroon Needs Product Approval and Certification, Not Disruption! (Yaounde, December 2, 2013).

“Vision-2035” that has since become the mantra of the Cameroon government promises in the area of health, education, science, and technology that “A national product approval and certification system will be established.” Such products, one would hope, include goods, services, and trained manpower. The system should include an oversight on the production process. If well executed, the system would prevent people from settling on the notion that “anything goes.” The system should be based on special codes to reduce complexity and establish behavioral expectations. It should not threaten the autonomy of society and the vibrancy of the private sector. It should be robust enough to avoid being abused or being used for strategic ends of groups or individuals, whoever they may be. To increase their robustness, such codes should be constantly acted on through plural democratic processes that not only put into question the established “norms,” but also help to legitimate, concretize, or improve them.

     When government policy is not well thought out and appropriately communicated to society, public opinion is easily dominated by general, speculative ideas. If policy that should be shared through processes of participation and communication becomes subject to the organizational logic of administrative power, this leads to confusion, demobilization, distrust, and poor implementation.
    The recent activities of the ministry of Higher Education in relation to medical education in Cameroon were an effort at fighting against an old error which the ministry was a willing accomplice in perpetuating. The ministry gave authorization to persons to start medical training institutions without clear rules of engagement; without enforceable codes of conduct. So when the ministry started playing the catch-up game, it left the impression of the desperation of someone trying to catch a train that was already in motion. It also left the perception of theatrical actions that did not seem to have been well thought out, and so lacked a well laid out plan. In the process, it appeared to the public like the settling of personal or group scores because it ended up with decisions that were not only extremely disruptive, but were also certainly unsustainable.
    Citizens usually want well-being not only in body but also in mind; they want both health and happiness. It is because of this that we are clamouring for “development;” for “emergence.” To achieve these, they need to be powered mainly by science, and by the things that science has already delivered to us, and will surely deliver to our children, our grandchildren and beyond. This is why all education systems of the 21st century have the “STEM” component – Science, Technology, Engineering and Mathematics – as their centerpiece. Since Medicine that the ministry of Higher Education seems to be grappling with is a well-deserved component, we can say that it is “STEMM.”  But medicine is just part of a broad spectrum, and should not be allowed, as the ministry seems to be trying to do, to distract attention from other important components of STEMM.
     It is the place we give the STEMM component in our education system that will permit our universities to become knowledge centres of excellence, and generators of knowledge, entrepreneurship and innovation - elements that will impact the economy and general policy development. It is STEMM that should drive our university system and ensure that the universities, private and public alike, produce highly skilled manpower that is internationally competitive; manpower that is disciplined because it pays attention to details induced by careful and rigorous training received from highly motivated staff. Such skilled, disciplined and highly competitive manpower is obviously not the “semi-skilled workers and second-line managers” our universities are presently spinning out as holders of “professional” diplomas and degrees.
    The theatrics engaged by the minister of Higher Education in the medical education sector should not distract attention from the fact that our universities lack infrastructure and a friendly environment to support teaching and research in all domains; that university leadership is appointed, not based on merit but on nepotism, tribalism, and cronyism; that university administration is tele-guided from a central control point in Yaounde that has a penchant for leveling and cutting every institution to size, thus, usually blocking the individual genius and human intelligence that invariably make one country different from the other, one institution different from the other, and one university different from the other.
     If “product approval and certification” means merging the public and private sectors into one unit under the diktats of the government, it will obviously be more destructive than constructive. In the pursuit of the goals of “approval and certification,” the public and private spheres should co-exist and depend on each other, but should operate as different units. The goodness in the private sector is usually the strength of a sure factor – the human factor - which, in the exercise of free choices and actions in an open society, can give birth to competitive institutions that set the bar high on what universities can achieve. Indeed, the goodness of the private sector is in the generation of competition, which has always been the surest means to bring all human capacities to full development. The private sector works on the imperative of efficiency that rejects advancement by personal favour, tribalism, regionalism, corruption or party affiliation that have become the hallmarks of the public sector in Cameroon.
   In what looks like a confused effort to streamline medical education in Cameroon, government is being perceived as an actor among other actors rather than as the provider of the framework that makes possible the competitive operation of university institutions in the public and private realms. The government is perceived as attempting to impose itself on private actors, who, in reaction, seek to resist it because government is believed to have lost its proper function by being reduced to an object of social competition, and a prey to real interests. Such a posture denies government the autonomy and responsibility of judgment in the formulation of just and sustainable policies for medical education in Cameroon. The posture has led to a lack of trust in what government is doing because it is believed that it is tainted with personal, selfish considerations. Indeed, it has led to actors looking for somebody to rescue them from the government!
     National product approval and certification is obviously good for any country engaged in the great catch-up development race of the 21st century. But it should be a system that encourages competition and excellence, not blocks them. What we urgently need today is not the sort of confused actions the ministry of Higher Education has engaged in the medical education sector. We need an all-encompassing approach defined in a national education forum that charts out strategies for an education system that can make Cameroon a talented player in the biotechnology, technology, medical and other professional and industrial sectors.
 *Tazoacha Asonganyi is professor ,teaching at the Faculty of Biomedical Sciences, University of Yaounde 1,Cameroon.

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