Inside NCHE-KIU medical students’ enrolment battle

Disagreements worsened after Prof Mary Jossy Nakhanda Okwakol, the NCHE executive director, cited an error in the KIU enrolment number even after the March 2023 NCHE Physical Verification Report on resources and facilities available to offer these programmes, approved 600 students.   

Dr Abas Agaba, one of the NCHE member representing the public, wrote in a four-page-letter to Prof Eli Katunguka Rwakishaya, the chairperson of NCHE board, questioning “erroneous decision” to cut KIU enrolment numbers without the approval of a six-member physical verification committee approval.

“We were surprised with the change from the stated annual enrolment numbers for the KIU Bachelor of Medicine and Bachelor of Surgery (MBChB) from 600 to 250 students,” Dr Agaba wrote on August 23.  

He added: “When we inquired about the basis of the figure of 250, we were informed by the ED (executive director) that a technical committee appointed by the NCHE that included experts in education and medicine from the Uganda Medical and Dental Practitioners Council (UMDPC) and a member from NCHE secretariat to do physical verification of the resources and facilities at KIU to teach MBChB, made a report in which they recommended enrolment of 600 students per year.”     

In March this year, NCHE technical committee led by Dr Katumba Ssentongo, registrar of UMDPC, visited all the nine KIU clinical teaching hospitals and inspected the available facilities and resources.

The team visited KIU Teaching Hospital in Ishaka, KIU clinical training facilities at Lira Regional Hospital, Hoima Regional Referral Hospital, Kayunga Hospital, Kiryandongo Hospital, Jinja Regional Referral Hospital and Mubende Regional Referral Hospital. 

The NCHE technical team observed that KIU had all the necessary departments required for a medical school in place, along with an adequate number of staff.

The March report from the NCHE team stated: “Considering that the current capacity in terms of human resources and infrastructure can permit the university to admit the number requested, the verification team recommends that KIU can admit up to 600 students per year. This is in line with the numbers approved by the EAC medical councils.”

However, Dr Agaba told Prof Katunguka that Prof Okwakol informed aggrieved NCHE members that the Quality Assurance and Accreditation Committee was allegedly not satisfied with the recommendation of the technical committee and decided to maintain KIU enrolment at 250 students per year. 

The aggrieved members, however, rejected Prof Okwakol explanation and maintained that “over the years, it has been the practice that NCHE Committees rely on recommendations of the Inspection Technical Committees, which are appointed by the NCHE Secretariat to do the technical and physical verifications on behalf of the Council.  

“It was, therefore, a major departure from the norm that an NCHE Committee, without a scientific basis, rejected a report of its own verification committee that included National Medical and Dental Practitioners Regulatory Board, which is the line regulatory body in medical studies,” Dr Agaba’s petition reads in part.  

Dr Agaba and other members also rejected Prof Okwakol’s explanation and wondered why Quality Assurance and Accreditation Directorate approved programmes for more than 20 universities for accreditation, and only KIU had an error in its enrolment numbers.

The director of Quality Assurance and Accreditation Committee, Dr Vincent Ssembatya, refused to say anything about what happened to KIU enrolment. He instead revealed that the NCHE will be sitting on October 13 “to make a final decision on the numbers”.

Bribery Claims

Without delving into details, Dr Agaba told Prof Katunguka that in one of the Council meeting on August 21, the chairperson of the meeting, whose name was withheld, informed members that they had received information about the Technical Verification Committee being compromised but the allegations were disregarded in the report.

“This being a major allegation, we requested for the said report of the Technical (Verification) Committee but this was watered down under the guise of ‘let’s trust the Committees of the Council in doing their work’,” Dr Agaba said.

He added: “Such an allegation wouldn’t have been left to pass and affect the decision of Council without the authors being required to substantiate it, especially that it was made against a credible Technical Committee of Council.”   

When contacted yesterday to explain the bribery allegations and the disagreements over KIU enrolment, Prof Okwakol refused to provide any details. She, however, requested Daily Monitor to be patient since “Council is yet to make a final decision on the matter”.

The NCHE was established as the regulator of higher education to implement the Universities and Other Tertiary Institutions Act of Parliament (UOTIA, 2001). By the provisions of the Act, NCHE is mandated to guide the establishment of institutions of higher learning, as well as ensure the delivery of quality and relevant education to all qualified persons.

Prof Katunguka responds

When contacted last evening, Prof Katunguka confirmed the Dr Agaba petition and said he was still studying it before making his submission to the Council. He also told Daily Monitor that the August 21 meeting was chaired by his deputy, who was not available last evening.

“The report raises serious issues and I am making my comments, which I will present to the Council meeting. After, we shall make official communication to KIU about the outcome from the meeting,” Prof Katunguka said.

A senior official at NCHE told Daily Monitor that the matter at hand is complicated because KIU has been admitting more than 500 students since 2015 and that even this academic year, they admitted the same numbers. The UMDPC and NCHE teams have also recommended the same number.

KIU deficiencies

In 2015, the East African Partner States National Medical and Dental Practitioners Regulatory Board conducted a joint inspection of various regional institutions, including KIU, to assess their compliance with established standards for medical programmes.

According to the November 14, 2015 report, which Daily Monitor obtained, the members of regional medical board identified several deficiencies that KIU needed to address before admitting more medical students on the programmes. Every year, KIU was admitting 569 medical students but the regional board ordered the institution to halt new admissions until they received clearance.

The deficiencies at KIU included a shortage of laboratory equipment, understaffing, limited laboratory space, and insufficient number of patients at the hospitals, where students conducted their training.

The regional medical board issued an ultimatum, giving KIU only six months to rectify all the issues raised in the technical report. The university owned by City businessman Hassan Basajjabalaba, was also directed to ensure an adequate number of patients in the casualty department to facilitate proper training of medical students.

Additionally, the institution was instructed to hire more academic staff to accommodate the student population and either construct new classrooms or reduce the number of enrolled students. Other recommendations included expanding library facilities, employing more qualified library staff, and procuring up-to-date standard textbooks.

The inspection was conducted by five chairpersons representing medical and dental practitioners’ councils from Uganda, Kenya, Tanzania, Rwanda, and Burundi with representation from NCHE.

Follow-up inspection

In 2016, the same Council conducted another inspection of KIU and its affiliated teaching hospitals to assess their compliance with the recommendations made during the November 2015 inspection.

On July 4, 2016, Prof George Magoha, the head of the EAC Council delegation, wrote to the KIU Vice Chancellor, Prof Mouhammad Mpezamihigo, indicating that the institution had made significant improvements in fixing the identified gaps in its medical programmes.  In the same latter, the regional medical board allowed KIU to carry on with the admission of medical students, with the condition that the number of students admitted must align with the available resources.

“This letter serves to confirm and direct that based on the inspection report of 2015 and subsequent re-inspection of KIU, an annual intake into medical programmes shall not exceed 600 students. This is the number commensurate with the facilities and human resources,” Prof Magoha wrote.

After seven years, a joint team consisting of representatives from the UMDPC and the NCHE inspected KIU again and most of their recommendations closely mirrored those previously conducted by the regional medical board.

What’s happening at KIU?

Prof Mpezamihingo told Daily Monitor last evening that KIU has over the past 10 years undergone significant transformation in its governance, academic and administrative systems.

He said it has enhanced its compliance with all the minimum standards and performed beyond expectations, strengthened its collaboration with higher education regulatory agencies and professional bodies across the world.

“Regarding the capacities of KIU, I can proudly say the university has broken the myth that a private university such as KIU can take the lead and demonstrate excellence. The case in point is how the KIU medical school has grown to become one of the leaders in Uganda,” Prof Mpezamihingo said.

“The biomedical sciences are taught at KIU western campus, while clinical years are conducted in more than seven recognised government regional referral hospitals including Fort Portal, Hoima, Mubende, Lira, and Jinja,” he added.

He further said: “The capacity of the university has always been over 500 per year since the early 2010. Although to date, with increased investment by the Board of Trustees, we can train more than 800. We keep our quality checked and assessed on a regular and continuous basis.”

The vice chancellor explained that the Faculty Examiners Board, Campus Academic Management Board, and the Senate, are adequately informed of all academic matters of each individual student through a rigorous and robust quality assurance mechanisms of the university.   He said KIU is inspected by NCHE and other professional bodies and consistently produces top-tier medical professionals, who excel during internships and receive praise for their contributions in healthcare facilities across East Africa and beyond.

What it take to train a doctor

The NCHE has standardised guidelines for accreditation of medical schools and teaching hospitals in order to ensure these training institutions meet the minimum requirements needed to successfully train competent medical practitioners and to ensure the provision of quality healthcare.

In an interview with Daily Monitor yesterday, the acting registrar of UMDPC, Dr Ivan Kisuule, said an institution requires adequate staffing to train medical students.

According to him, institutions are supposed to follow the set lecturer to student ratio. 

The NCHE recommends a lecturer to student ratio between 1:8 and 1:15. However, if an institution has a lecturer to student ratio of 1:20, it is also acceptable under the student ratio quality assurance framework.

The NCHE ratio is slightly different from the one set by the regional body. According to the EAC Medical and Dental Council, the lecturer to student ratio should be 1:7 for clinical and 1:12 for pre-clinical students.

During the first inspection in 2015, KIU had a student ratio of 1:31 and when the regional board returned there in 2016, the institution had a lecturer to student ratio of 1:6 in clinical programmes.      

The March 2023 physical verification report on available resources to offer Bachelor of Medicine and Bachelor of Surgery by NCHE, established that KIU had a lecturer to student ratio of 1:6 in clinical programmes.

Dr Kisuule explained that a viable medical school should have enough training equipment for training of students, including laboratories, X-rays and ultrasound machines in hospitals where students train from.

He also indicated that infrastructure in terms of lecture rooms, libraries, and student accommodation should be adequate to match with the number of admitted students.

NCHE report

1. 58 lecture rooms at Ishaka campus.

2. 287 lecturers (45 PhD, 118 Masters and 104 Bachelors.

3. 500 sitting capacity library.

4. 209 computers in four computer labs for medical students.

5. 9 Teaching hospitals/centres.

6. KIU Teaching Hospital Ishaka with 700-bed capacity and 460 patient loads.

7. MOU with Lira, Hoima, Fort portal, Kayunga, Kiryandongo, Jinja and Mubende regional hospitals train-ing KIU students.