Medical Education in Afghanistan

Khushal A. Stanisai MD FACG  August 4, 2002

Past Background:

  • There were 2 WHO recognized medical schools in the early 70’s. One in Kabul and one in Nangarhar.
  • Both schools were part of the universities and the Ministry of Education.
  • The student enrollment was limited to < 150 /class.
  • The faculty, teaching facilities and teaching hospitals were proportionally adequate to the student ratio.

Medical Schools:

  • The war and government changes brought profound change to medical education in last 25 years.
  • The Kabul Medical School became Kabul Medical Institute (KMI) with three schools of Curative Medicine, Pediatrics and Stomatology.
  • In Peshawar one female and 3 male medical schools were opened by different Mujahedin factions during the soviet occupation
  • The warlords inside Afghanistan opened Medical Schools in Kandahar, Herat, Mazar and later on in Bamyan, Faiz Abad and Parwan provinces.
  • The Schools were opened on the basis of ethnic or religious rivalry rather then for the needs of Afghanistan.
  • No consideration was given to the availability of teaching staff or facilities.

Teaching Staff:

  • Most of the teaching staff retired, were deceased or took refuge elsewhere.
  • The remaining teachers were frozen in time with regard to medical knowledge.
  • Some of the medical staff were not paid for months. They worked as venders in the streets to feed their families in addition to teaching.
  • In most schools, the number of teachers was inadequate or non existent.

Students:

  • The number of students increased from less then 1000 to more then 10,000.
  • Many of the students were veterans who spent years in school without graduating.
  • > 2800 student were studying in KMI .
  • Some students had not even graduated from high school. They were enrolled by those in power.

Facilities & Hospital:

  • Inspection by the AMAA delegate in Peshawar, Nangarhar and Kabul found a lack or absence of teaching material, destroyed buildings and non functioning teaching hospitals specifically the famous Ali Abad teaching hospital.
  • Only non teaching surgery departments for trauma and orthopedics were functioning better with the help of NGO’s.
  • There were no teaching hospitals close to the schools.

Aid For Medical Education

  • With the exception of limited aid by NGO’s to female medical schools in Peshawar and later to the Afghan university in Peshawar, no significant medical education aid had been provided except by the AMAA and LLU.
  • LLU built living quarters for visiting teaching staff, a library center, a pathology lab & teachers.
  • The AMAA donated materials & books & provided funds for basic science teachers & students.

AMAA Past Resolutions

  • The AMAA was concerned with the number of schools & students & the lack of teaching staff & teaching facilities inside Afghanistan.
  • The AMAA resolutions annually forwarded to the authority in Kabul has asked for a drastic reduction in the number of medical schools & students, participation of females & improvement in the education environment.

 Present:

  • There are still more than 10 schools in existence. Some in name only.
  • The warlords are trying to keep their own schools with the help of agents in the west.
  • There are at least 10,000 students currently enrolled in Afghanistan.
  • About 900 more student has been added by the new administration to KMI this year. Total = 3700
  1. Only the schools in Peshawar have ceased.
  2. Reconstruction of teaching amphitheater and delivery of electricity to KMI is in progress.
  3. More books have been donated.
  4. The AMAA survey of student has been completed.
  5. Shortage of funds & lack of adequate payment to teachers still exist.
  6. Recent AMAA survey showed only a small number of female students and employees at KMI campus.
  7. Unfortunately the ethnicity and religion polarization is dividing the staff and students.
  8. The Band-Aid approach to maintaining status quo is in progress with no consideration for a solid foundation or possibility for change.
  9. The political forces are not in favor of drastic action to change.
  10. The ongoing aid and planning is not focused on higher education.

 Future proposal:

The Ministry of Higher Education needs to convene a grand council (similar to Loya Jirga) to decide the future of medical education with staff from medical schools, student representatives, foreign medical education consultants, officials from the Ministries of Public Health, Education, AMAA leadership, LLU, representatives of local government and WHO in Kabul to discuss and decide the future of medical education in Afghanistan.

The AMAA could play a leadership role to coordinate such meeting and to try for a national consensus on medical education with the following proposals in mind.

  • Drastic reduction in number of medical schools.
  • Drastic reduction in the number of medical students.
  • Accept English as standard for teaching Medicine.
  • Availability of computers and use of Internet in medical schools.
  • Availability of scholarships for training of graduates for leadership roles in medical schools (LLU).
  • Sponsorship of medical staff in Kabul by counterparts in the US (AMAA).
  • Mechanism to assure no gender discrimination for medical education.
  • Licensure examination by Ministry of Public Health.
  • Creation of Medical Quality Assurance Board by Ministry of Public Health.
  • CME course requirements to maintain licensure.
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