Sunday Times 2
Dr Neville Fernando and fee-levying medical education in Sri Lanka: The vision, the agony and the future
Once Dr Neville Fernando wrote me an email wishing for my death by lightning. The next day he sent me another apologising for what he had said in a fit of anger. He was angry and he was upset.
He had founded the South Asian Institute for Technology and Medicine to (SAITM) to provide opportunities for local students to obtain medical degrees for a fee. He had got all approvals and SAITM had been provided ‘degree-awarding status’.
Dr. Neville Fernando
But with the first batch passing out with their MBBS degrees the whole structure had begun to crumble. The young graduates were not being recognised by the regulator even though the Court had directed otherwise. There was massive opposition from certain sections of society and politically motivated trade unions. They wanted SAITM shut. The rallying cry was Dr Fernando was producing low quality medical graduates and profiting from selling medical degrees. The Government Medical Officers Association (GMOA) had crippled the country with days of total shutdown of the health sector. Teaching at medical faculties of state universities had been halted for months.
Dr Fernando’s anger towards me was understandable. I was in the middle of negotiating a settlement having been appointed to Chair the Presidential Committee to resolve the ‘SAITM Issue’. He was not happy with what was going on.
Dr Fernando was adamant that SAITM should be allowed to continue. He had already built the Neville Fernando Teaching Hospital (NFTH) for clinical training requirements when the GMOA scuttled his already approved plan to train them at select government hospitals.
Before I met him during the SAITM issue I had only heard of the legend: That good doctor who had a thriving practice in Panadura but gave it up to enter Parliament in 1977 beating Leslie Gunawardene. The strong UNP man opposed leader JR Jayewardene on matters of principle and walked away from the party. That entrepreneur who created JF&I, Royal Fernwood, Asha Central and perhaps others that I am not aware of. He was a hero to anyone starting out on one’s own.
I decided to write this appreciation of Dr Fernando who passed away recently because I want people of this country to know how vested interests shut the door on what he attempted to do for them.
My association with Dr Fernando took place during the last phase of the SAITM issue. President Maithripala Sirisena had just appointed me Chairman of the ‘Presidential Committee to Resolve Issues Related to SAITM’ in late August 2017. At the time I was Deputy Minister of National Policies and Economic Affairs. My committee consisted of D.C. Dissanayake, Secretary, Ministry of Higher Education; Janaka Sugathadasa, Secretary, Ministry of Health; Hon Jayantha Jayasuriya, Attorney-General (he was Represented by Sanjay Rajaratnam, Additional Solicitor General) and Prof Mohan de Silva, Chairman, University Grants Commission (UGC).
The committee met on five occasions and deliberated at length. We, in some cases, me and a several members, also met with all other stakeholders. Dr Fernando came to the meetings with his grand-daughter Himali Jayathilake who he was very comfortable with. A finance professional she was Deputy Chairperson of SAITM. We met academics and key administrative staff of SAITM. We met representatives of Sri Lanka Medical Council (SLMC). We met with academics and decision makers of almost all state university medical faculties including their Deans. We met with representatives of the Association of Medical Specialists (AMS). Even though the GMOA was unable to meet us on two agreed appointments, I had already met with the office bearers separately along with Higher Education Minister Lakshman Kiriella. I had also met with representatives from the Federation of Faculty of Medicine Teachers Associations (FFMTA). None of the meetings was easy. At a personal level I learnt a lot on negotiation.
After much deliberation and serious give and take with stakeholders and with in-principle agreement with the SLMC representatives and Dr Neville Fernando, my committee submitted its report to the President in mid-September 2017. We proposed a compromise solution that would be equitable to all stakeholders and no financial burden to the Government. It kept alive the government policy of high-quality non-state and not-for-profit medical education. It was also financially viable almost immediately and sustainable in the long term.
The solution in essence was to change the shareholding and management structure of SAITM and convert the for-profit Fernando family owned SAITM in to a not-for-profit institution with a broad-based ownership structure. So technically SAITM would cease to exist over a period of time (Sunset) but a new entity would be established conforming to the Minimum Standards of Medical Education and Training with improved governance over a specified period of time (Sunrise).
We strongly urged to expedite the establishment of the proposed Independent Quality Assurance and Accreditation Authority (IQAAA) to determine quality assurance and accreditation of all degrees (state and non-state) including those that require professional recognition to practise. For medical degree programmes, the SLMC was to be the statutory body which was to work in collaboration with IQAAA.
This was a major breakthrough. The strikes ended and students agreed to get back to lectures. I recall that evening my visit to the Dental Institute at Ward Place. Hundreds of medical students and their parents were protesting outside the premises. A couple of police officers escorted me inside and I sat with about fifty students in a hall upstairs and explained what we had come up with. I remember that discussion vividly. Not everyone was in agreement. But the more moderate protesters were willing to listen.
That day, I spoke about how the world over fee levying yet not-for-profit non-state universities were working in tandem with state universities. We looked at the list of some of the world’s top medical schools; Harvard, Stanford, Johns Hopkins, Yale in the United States. They were all private not-for-profit institutions run mainly by the investment income from their endowments. There were others around the world. I said we could also think of such models; where perhaps one top-quality university could be created with endowment funds and how what Dr Fernando started should not be dismissed outright. After all, Dr Fernando had agreed to sacrifice in financial terms because he wanted his venture to succeed in whichever way possible.
In late October, President Sirisena issued a communiqué explaining the proposed solution and appointed a second Presidential Committee tasked with implementing the recommendations of the report we had submitted. Again, I chaired this committee that included Secretaries to Ministries of Health and Higher Education, the SLMC President; the UGC Chairman; Vice Chancellors of Universities of Colombo and Sri Jayewardenepura; and Medical Faculty Deans of Universities of Colombo and Kelaniya. In addition, the President also appointed as observers AMS, Sri Lanka Medical Association (SLMA), GMOA, FFMTA, Government Medical Students’ Parents’ Association, and SAITM Medical Students’ Parents’ Association. The committee had three long sessions to debate and improve the original solution. It was not easy as the diverse views of the observers also had to be taken in to consideration.
In the meantime, we started discussions with Sri Lanka Institute of Information Technology (SLIIT) which expressed serious interest in coming on board. SLIIT had a very good reputation of having started small to become a highly respected fee-levying non-state institution of higher education offering degree courses in IT, sciences, business, engineering and so on.
While all this was happening, Dr Fernando was getting edgy, to put it mildly. A directive had gone out from the Higher Education Ministry stopping admissions to SAITM and that was causing cash flow problems. We were now entering a rather intricate phase. We had to ensure the 900 innocent students’ futures were not disrupted while resolving the complex financial and legal issues; not just with SAITM but also NFTH which ran in to several billion rupees in bank facilities. I recall with gratitude the participation of the CEO and top management of Bank of Ceylon, including the personal involvement of Ranel T Wijesinha, at the time a director of the bank, to arrive at an innovative mechanism to implement the multifaceted plan.
After several sessions with the lawyers at FJ and G de Saram led by Partner Ayomi Aluvihare and with technical advisors Thilan Wijesinghe and Nirosh de Silva who voluntarily contributed to structure the transaction along with Prof Lakshman Ratnayake and Prof Lalith Gamage of SLIIT, the committee was finally able to arrive at a final Memorandum of Understanding (MOU) that Dr Fernando was willing to sign.
I had multiple conversations with Dr Fernando over the several weeks we took to arrive at this MOU. He was not a willing participant. SAITM was his dream. He had invested billions to establish SAITM and NFTH. He was responsible for 900 young lives. But, for reasons that would perhaps someday will be known, those who didn’t oppose beyond a whimper Dr Fernando when he established SAITM in 2008 nor when it received degree awarding status in 2013, came out in full force to oppose the same Dr Fernando from 2015. To the independent observer the ugly politics of this whole episode was more than obvious. But he knew he had to make a choice. Was he going to agree to the new model where he would have to give up control or, was he going to fight the solution? I understood his agony and his disappointment. For him to wish my death by lightning was, however, unintended!
After several days of studying the draft and revisions he told me he was ready to sign. The MOU spelled out the solution to establish the Sunset and Sunrise institutions with the approval of SLMC on Minimum Standards. SLIIT was in agreement to establish the two institutions after taking over all the assets and liabilities of SAITM along with its entire medical programme. It was willing to make a significant investment. The NFTH was to be legally transferred to the Government with the undertaking to offer clinical training for students. All financial facilities were to be restructured and an agreed upon nominal amount would be paid to shareholders of SAITM.
All this was fine, but Dr Fernando insisted that we include in the preamble the sentence, “Whereas SAITM and the shareholders represents that SAITM was established with a significant initial capital investment and it has not declared dividends or distributed profits to its shareholders since its establishment but has offered approximately Rs. 600 million as scholarships to its students”. He wanted it because the anti-SAITM groups accused him of ‘profiting’ from it. Now that he is no more, it is important to note the truth; that Dr Fernando had never profited from SAITM. In fact, he poured billions of his own and borrowed money to build and run SAITM and NFTH.
The day he was to sign the MoU, he refused. He didn’t give a reason. But the next morning he called me. I recall it was early and was the weekend. He told me “Harsha you better sign the damn thing first. It’s your idea. Once you and Kiriella sign, I will sign”. And finally, it materialised. I and Minister Kiriella signed for the Government. Professors Ratnayaka and Gamage signed on behalf of SLIIT. All shareholders of SAITM signed. I don’t know exactly how Dr Neville Fernando got the rest of his family to agree, but all seven shareholders did sign the document.
And so, we had a win-win. The due diligence started and the lawyers and bankers were finalising the details. Dr Fernando was being very difficult but he was still going along with the decision to let go of his prized posession for the good of Sri Lanka. Non-state not-for-profit medical education was to be established where many would benefit; a large scholarship programme was structured as part of the solution where money would not have been a barrier to entry.
And then it happened! Excreta hit the rotating blades, as they say. It was a late afternoon in February 2018. I got a call from Defence Ministry Secretary Kapila Waidyaratne. He said he was at the Presidential Secretariat and needed to speak with me urgently. So, I asked him to come over to my Office at the World Trade Centre. Then he broke the news. The President had decided to direct General Sir John Kotelawala Defence University (KDU) to take over all activities and students of SAITM and he (Waidyaratne) was asked to implement it. Subsequently I found that ‘certain people’ who were unhappy with the proposed plan to keep non-state not-for-profit medical education alive had convinced President Sirisena to U-turn what had earlier agreed upon. He had no consultation with me nor my committee. So ended the SAITM saga and fee-levying medical education in Sri Lanka. Just like that.
Dr Neville Fernando was a maverick. He contributed much to this nation. My hope is that someday those who killed his (restructured) dream would realise that they were wrong and would start from where it stopped. I would be happy to offer my services to make it happen.
May Dr Neville Fernando attain the supreme bliss of Nirvana.