Nepal has many provisions in place to safeguard public health. All health facilities, and health-related educational and training institutions in Nepal need to follow strict regulations of several statutory bodies. Medical Education Commission serves as the central authority for regulating domestic health professional education institutions. Those seeking accreditation must first obtain a Letter of Intent, fulfill required infrastructural and academic standards, submit a self-evaluation report, and undergo periodic evaluation. Institutions are graded based on performance, with continued underperformance potentially resulting in de-accreditation.

Academic institutions need accreditations from concerned councils. Nepal Medical Council recognizes medical colleges and manages the registration and licensure of doctors, including dentists. Nepal Nursing Council accredits nursing education providers, conducts licensing exams and maintains the nursing registry. Nepal Ayurvedic Medical Council regulates traditional medicine programs. Nepal Pharmacy Council works in the field of pharmacy. Accreditation for allied health programs such as public health, physiotherapy, and medical laboratory sciences is handled by the Nepal Health Professional Council.

Students have to pass domestic entrance examinations before they can join such educational programs, whether they join domestic or foreign schools. The graduates are allowed to practice only after registration with respective councils, for which they have to pass the licensure tests. Implemented properly, these criteria ensure quality of registered health workers.

Whether the state, philanthropic institutions or the students themselves pay, producing health workers costs a huge amount of money, time and effort. In this age of global village, we cannot and should not bar such human resources from seeking a career abroad. But we should do everything to attract the workforce the country badly needs.

Look at the figures. From 2020 to 2023, the NMC issued Good Standing Certificates to 1,087 doctors in 2020, 1,502 in 2021, 2,189 in 2022, and 2,582 in 2023, totaling 7,360 certificates over the four-year period. Concurrently, between 2002 and early 2025, approximately 45,000 nurses received certificates to migrate abroad. Although about 45,000 doctors were registered with the council as of Jan 2024, fewer than 15,000 remained actively practicing in Nepal. This stark contrast underscores an accelerating brain drain, particularly acute in rural areas.

While better work environments and higher salaries are major factors, bureaucratic hurdles prevalent in our regulatory bodies and councils are not less responsible for accelerating brain drain, especially by failing to facilitate human resources educated abroad in getting registered in Nepal. These manifest in the forms of equivalence certificates and no objection certificates.

Issue of equivalence

Currently, all foreign graduates, including domestic products in some cases, need their educational degrees recognized by relevant Nepali institutions. Common practice is, instead of issuing recognition letters, these institutions issue equivalence certificates, frequently mentioning ‘in relevant field’, keeping open a space for future misunderstandings and conflicts.

Up to now, Tribhuvan University Curriculum Development Center (TUCDC) is trusted with this task for higher education degrees. The duty may look both as the state recognition and a lucrative income for TU, but CDC faces a myriad of challenges. Among HEIs ranging from high-end to low-end, there are innumerable differences in their performances, thanks to their available resources, institutional capabilities, philosophical outlook and autonomy in framing academic programs. Quality issues are not limited to poorly-performing, weak universities. A renowned university strong in other fields can have poor performance in health sciences.

Let us try to simplify the procedures. Universities and their academic programs do reflect sociopolitical values and technological stages of their countries and societies; their products may not exactly match our products. MIT graduates may excel in physics, Oxbridge products may outperform in history, but TU graduates are the best yardstick for Nepal. So, based on program and subject-specific parameters, the country needs to develop a high-ranking dynamic list of HEIs and programs whose products would be ‘recognized’ automatically, only those who wanted ‘equivalence’ would need to apply with the TU. For others, let us ask them to obtain ‘recognition’ or ‘equivalence’ letters for their degrees. ‘Recognition letters’ fulfil two purposes: prevent the use of fake degrees, and avoid unnecessary torture to graduates from foreign HEIs. As to educational criteria for employment, let the employers decide. Like other countries, we can fix minimum durations of study and entry criteria. We should also be specific on degrees earned with lateral entries, credit transfers and online learnings. As for faculty-wise duration, the country should make the total duration of vertical degrees postschool one of the parameters. 

Many a time, products of domestic institutions have objected to applying to TUCDC for equivalence, questioning why TU should evaluate degrees offered by other Nepali institutions. Against such a background, the University Grant Commission is trusted to shoulder the task from the beginning of the next fiscal year (July 17). Compared with TU, which alone hosts about 80 percent of all students against 20 percent shared by all remaining 27 HEIs, the UGC is an insignificant bureaucratic unit. The problems facing TUCDC will not go away just like that. Needed are policy reforms, not replacements of regulating hands.

Issue of NOCs

The No Objection Certificate (NOC) policy, originally meant to regulate foreign exchange, now unnecessarily obstructs students who do not require financial support from Nepal Rastra Bank. Many students fund their studies through scholarships or families abroad, yet face delays due to mandatory NOC processing, often missing admissions or visa deadlines. With over 110,000 NOC applications last year, the system is overloaded and outdated. Most countries do not require such clearances unless public funds are involved. We should make NOC optional for non-forex applicants, easing bureaucratic friction and empowering students to pursue global education without such obstacles.

Requiring foreign medical graduates to produce an NOC for degree equivalence or professional council registration is both illogical and unjust. Denying students equivalence or licensure for failure to produce a pre-departure NOC punishes them for a procedural formality that holds no relevance to their qualifications. Academic merit, not outdated paperwork, should guide professional recognition.

Nepal is in urgent need of such reforms to cope with alarming brain drain.