Thank god, I made a right decision not to be a doctor. No life. work work and money money.

This Brain drain can be a serious problem for country like Nepal. Lets not just talk about doctors. Most of the intellectual people are not willing to stay in Nepal. Either they are coming as a Skilled Migrant or coming for their higher education and never returning to the country. Unless there is a government with a very strict rule, maintaing peace and security, having lots of job opening, this Brain drain will not stop. At least for a decade or so there is no chance of forming such a government in Nepal. No any hope for better Nepal.

Well, thats why  there should be legal binding while giving a scholarship. Nepalese government can ill afford to give scholarship to the people who are not going to work at all.

There should be a bond that  the people should work at least 2 years in Nepal. Only deserved candidate will get  the funding. This is very nice article.

MOE has already started bonding for those who graduated under scholarship program of MOE to private medical college in Nepal and abroad. I guess its five years for now.

If you analyze the single face of the problem, yes, you are right. On this, I would like to thank you for pulling this immense issue here in sajha. However,  I would like to expose another face of the reason why they migrate. As you said, government  don't have enough openings for the medical graduates that mushrooming medical schools produce every year. They must move abroad.  Regardless of the country's need and situation they must move abroad. This gives me the belief:

1. Paramedics have been providing extensive health care services in Nepal. In another term they are called "quack". They are taught symptoms, prevention, Control and generic and brand name of the drugs and its doses. Few keeps information about side effects and all with their own interest.

2. The economic situation of overall Nepali is low, they can't afford 500 NRs for general treatment. Yes, they do spent thousands and even lakh  Rs for Major problems of surgery and etc but there are people who die of "Diarrhea" and "Cold" flu what we call it here in US.

3. The government health services ( health posts, One in every VDC, may be not in all) has very few stock of medicine and vaccines to be given free. Paramedics can give you the drug in health post. Observing signs and hearing symptoms is not a big job ( believe me its not a big job, i had tried it on me). Same is  prescribing drug.
People can't afford for serology and blood histochemistry. Don't even dream about PCR and Blot that are modern tool of confirmatory diagnosis. Then why do you need a MBBS? They are pushed to the Uraban regions.

4. In urban region, they do have serology, imaging and blood histochemistry faciltiy where interested doctors and make use of the knowledge they have. Yet, they don't have PCR and such. Governement have one or 2 hospital (District and Regional)  which will consume 20-25 doctors each. Now, there are few medical colleges and nursing homes in big cities which consumes 100 doctors in each. Yet, production is more then that. They must move abroad.

Why graduates from MOE scholarship scheme and IOM move abroad?
1. They are competant.
2. The private nursing homes and Health Research Centre( I read somewhere that they write at the end in order to escape from tax repsonsibility) are owned by MONEYMEN and obviously employ there kids (mostly) who graduate from KU medical colleges, china, russia and pakistan.
Who is left? a competant graduate from IOM and other who graduate under MOE scholarship.

Are graduates from KU medical colleges good?
My ans is YES. How?
1. KU syllabus is also good, they do have hospitals to practice.
2 They pass Nepal Medical Coucil exam, if you believe in that.

Oh ya! I forgot to mention one more thing. We have doctors coming from foregin country whom we belive more than our own doctors. and I believe our own sajha doctor like Bikash KC moved to US for advancement of his knowledge and use his skill to full potential.

How can you keep Medical graduates in country?
You can't. Why? let me frame like this:
1. All above reasons.
2. You can't keep them from earning and having luxurious life as other graduates like IT, Sciences, Vet,Forestry, agriculture, engineering and so on. Governement spends for them as well.

Is this a problem?
NO. and never.

Then what we do to improve health care in Nepal?
Make health service affordable. Give subsidy. Provide cheap health insurance. Is it possible? Yes, if we have something like SSN. Is it possible? Yes, if we can maintain law and order? Is it possible? Yes, if we can counter check leaders and beureacracy. Is it possible? Yes, if people are not corrupt? Is it possible? Yes, we can provide basic needs for everyone and make them equally capable. Is it possible? yes, if we provide education and link each part of the country.
So, first lets make roadways to every corner of the country and educate people. Everyone will have excess to education and can go abroad and in 10-15 years we can start our own in Nepal. See, indian people go back to india after graduation.

Is this possible? Yes, we CAN and everything is possible if Nepali people stope acting DUMB and running after few leaders and asking for superiority over the one who deserves.

Unfortunately, I don't see it happening. Why?
Nepali people acted DUMB recently and voted Prachande et al..........and continued the Indian supremacy in the country.

you are right guy's.. there has to be a potential to live a comfortable life if we decide to go back, doesn't have to be AC and car and shitt but.. essential stuff has to be affordable, it will never happen, unless people realize, it's about nepal and the country and their caste or clan or creed..

right here in sajha people are hung up on language and calendar, I am supreme over you, my belief is better than your's.. give it up.. if most of us went back, nepal would be a wonderful country to live in...

yes we need roads and schools in every corner or nepal above anything else, that is what will bring prosperity in a country like ours.. every person should have access to education and roadway's  and yes, the teaching has to be better not only about communism and the freaking redbook,

as soon as some radical being becomes the leader wants to change the education system of nepal, like it was broken, what I read as a kid was far superior than what they are trying to teach today. there is only more confusion now, as long as we have undecuated and radical people leading nepal, there will never be change, we have a phd and a masters guy leading the country to darkness, how can we trust others who are slc pass.. some can't even read and write their names. How can we trust them to lead us out of the darkness.

I am not saying uneducated people are dumb, only a few are smart, rest will be dumb, education enlighten's a persons mind and makes him think deeper and harder.. Education and Transportaion is a must for the transformation of our country otherwise, there will be braindrain everyday and eveyhour... who want's to go back with an american degree just to be pushed ashide by a minister's cousin with a tailor made degree from bihar....

mero 2 paisa..

interesting

but many things can be argued for and against

anyway thanx for brining up the issue

Hey doc! sup? long time no see. Congrats on your success !!!

Each year over four hundred Nepali doctors are moving to US and another half of that to other countries like UK, Australia and others. At the same time, when government calls for vacancy for doctors, there are few doctors who apply. Government again complains of brain drain. The question arises here, as who is accountable for enormous brain drain?
Let's discuss what types of doctors are leaving the country. First of all, majority of the doctors are those who studied under government scholarship. Government had borne the expenditure on their education. They were selected by government either directly into medical colleges or by Ministry of Education. Some of them received either full scholarships or subsidized tuition fee grants. The country bears the cost of each medical graduates, which is from 8,000 US$ to 10,000 US$. But after graduation, how many of them contribute to Nepal. They were provided scholarship to build professionals in the country and to serve the people of Nepal. But in reality, they migrate to other countries without working or contributing anything to the mother country. Straight away, after graduation they prepared for the licensing examination of other countries and then they migrate there for better future. However, that is their right to decide where to work. But if country is investing on them, then, the country should as well anticipate some inputs from them. The accountability for this situation goes to the Government of Nepal, predominantly with Ministry of Education and Ministry of Health.
Let's see the impact of this kind of migration. Firstly, the total loss of resources invested on them. Some may think that they are generating foreign currency by working abroad. However, this is negligible at a cost of health of people of Nepal. If they were in Nepal, they could have satisfied the professional human resource gaps in the country and could have contributed to improve health status of the country. In every Primary Health Care Center there are positions of medical doctors. But if we look at the existing situation, there are many PHC, where we don't have doctors. To fulfill this position Ministry of Health has to hire the paramedics, which is another investment. For the same position government has to invest two people; one for sending abroad and one for that position.
Next is the impact on quality of health services. People are supposed to get the services from the qualified medical doctor which is their basic health rights; as an alternative, they are receiving services from others. I don't signify that the paramedics who are serving in those areas are not competent. They are competent but with some limitations. Nevertheless, there are some differences in six years of intensive trainings of medical graduation and the six months to two years training for paramedics. However, the backbone of health services of Nepal is still the paramedics, who have been working in rural, remote and inaccessible areas and contributing to the health care of Nepal.
Thirdly, let's discuss on economic impact of this situation. It costs almost around 10,000 US$ per medical graduate to the government. After graduation they migrate to other countries. Let's see if two hundred doctors migrate in a year then government has a loss of two million dollars per year in a country, whose per capita income is less than 200 US $. This is only direct cost, which is a tip of iceberg only. Let's discuss on submerged part of the iceberg. Nepal has one of the highest infant, child and maternal mortality. These high rates of mortality contribute to less years of life expectancy of the people of Nepal. Beside that we don't have an account of total morbidity (Being an ill) and impact on economy of the country. 37% of population and 82 % of population are living below 1$ per day and 2 US$ per day respectively. When these people get sick, apparently they have to spend there hard earned money for health and they become poorer. There are other factors, which contribute to their poverty and illness. But when they don't receive the appropriate treatment, they have to travel to the places where the doctors are available. Thus you can calculate the extra cost people have to bear like; cost of absenteeism from work (daily income source), cost on traveling, cost of accommodation and extra expenditure on doctors and access to other facilities. Sometimes these costs are so high for these people that all the family members including children have to work leaving the schools for survival. Then you can envisage the net loss of resources to the country. Researches are revealing the centrality, the catalytic role, and this oomph that population health has on the related processes through which national incomes increase and through which poverty and human misery are mitigated. Population health appears to be an exceedingly robust a powerful predictor of economic growth. By rule of thumb, 10 years gain in life expectancy translates into nearly 1 additional percentage point in annual income growth and which is within the grasp of our country.
Who is accountable for this loss of the country's human and economic resources? Whole responsibility exclusively goes to Government of Nepal, not those doctors who have migrated. There is no legislation for these people to work for the country at least for some duration. Government provides them scholarship and without making them to contribute to the country and allows them to migrate. Of course, there are limited resources in the country and government cannot employ all of them, however, they can contribute working in different places like medical colleges, organizations and wherever they like to do. Why everyone has to stay in major cities. Some have to work in rest of the areas also. Already there is scarcity of doctors in many sectors. Almost many of these doctors will definitely get the opportunity either in government sector or private sector. Wherever they work either in private or government sector they will contribute to people of Nepal. 
Government should revise the scholarship criteria (MBBS)by giving points according to the region and ask for certified letter about the home income from their respective VDC or Municipality.The points should be account of student permanent address school/college who has passed their SLC and +2/I.Sc rather than the total percentage average. This will improve the system and many minority, low home income students will get chance to study, further less chance of brain drain. They will also work in their respective regions. Every scholarship students who passed Medical college goverment, private in Nepal or abroad or through Embassy  who wants to register at Nepal Medical council, should have to do at least 2 years work at Primary Health Center level.
Accordingly, I have only one suggestion to the government of Nepal to keep them in the country in order to get return of the investment by providing services to the people of Nepal. This is high politics and should be done from all levels and ministries. There must be legislation that after graduation under scholarship completely or partially, they have to work in the country for two years. To implement such regulation government has to make decisions at all levels even at diplomatic forums. In order to implement this regulation medical council has to play a pivotal role. They have to issue the license for those who have worked two years in the country. With this regulation, there won't be shortage of skilled manpower and in the long run we can expect a healthy Nepal and necessary further steps from Ministry of Health and population , Ministry of Education.

 

Country Medical School:

From East to West:

1. BPKIHS, Dharan

2. Janaki Medical college, Janakpur

3.Nobel Academy, Biratnagar

4.KIST medical college, KTM

5.IOM,KTM

6.Royal Medical college, KTM*

7.Kathmandu Medical college

8.Nepal Medical college, ktm

9.Bharatpur medical college- now 2

10.Manipal, Pokhara,

11. Universal  Medical college, Bhairawa

12. Dhangadhi Medical college, Kailali *

13. KUMS, kathmandu

14. 9 New medical colleges license are pending in Ministry of Education and Ministry of health for approval.

Scholarship rules: Nepali founder: total students 10% scholarship to Ministry of Education.

Foreign founder: 20% scholarship

Students: 100 per batch, 100x13=1300 per year graduation, approx if all pass.

From other country: 2 Boeing 777 china = ~ 600 students

Russia, India, Bangladesh, Philipines, Pakistan, cuba*, turkey* etc......So per year at least 2000 medical graduation.

source of list, www dot moe dot gov dot np/