AUTHOR=Mahat Agya , Zimmerman Mark , Shakya Rabina , Gerzoff Robert B. 

TITLE=Medical Scholarships Linked to Mandatory Service: The Nepal Experience

JOURNAL=Frontiers in Public Health

VOLUME=Volume 8 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2020.546382

DOI=10.3389/fpubh.2020.546382

ISSN=2296-2565

ABSTRACT=Introduction: Nepal has one of the world’s lowest physician to population ratios and a critical shortage of rural physicians. The Nepal Government leverages the private sector to address this rural physician shortage.  All private medical colleges must offer total scholarships, free of cost, to a proportion of their annual MBBS student intake. These scholarships come with a compulsory two-year service contract, which is to be completed at public hospitals post-graduation. The mandatory service requirement was implemented in 2005/2006 once the government provided funds for the scholarship doctors’ salary. This paper evaluates the scholarship program’s first decade of the mandatory service requirement.
Methods: We collected data on MBBS scholarship awardees from the Scholarship Section at Ministry of Education, Department of Health Services, and the Ministry of Health and evaluated trends and service completion and location. 
Results: Initially, because of poor monitoring, the mandatory service completion rate was low. Rates increased to 74% - 98% when strict rules tied service completion certificates to obtaining medical registration. In the past four years, scholarship doctors who completed their service requirements served 78% of their service-days in rural hospitals (primary healthcare centers and district hospitals). Yet, geographic inequities in physician distribution persist: In the past four years, only 51% of district hospitals had at least one scholarship doctor; 31% of the district hospitals had more than 1.5 scholarship doctors while 7% had none. The district hospitals in the Central region, which includes the capital city, had twice the number of scholarship doctors compared to the Mid-western region that includes some of the most remote areas of the country
Conclusion: The scholarship program has partially succeeded in reducing the physician shortage in Nepal’s rural hospitals. To correct the remaining inequities in physician distribution, efficient management systems, appropriate medical training, and support for rural practice are vital.