Medical education has long been viewed as one of the most prestigious and respected pathways in Nepal. Families from all backgrounds consider the medical profession a gateway to job stability, social recognition, and opportunities for international careers. Because of this high demand and limited supply of government medical seats, aspiring students frequently turn toward private medical colleges to pursue the MBBS degree. However, the private sector brings with it a controversial aspect of medical education in Nepal, commonly referred to as the donation system. This practice, though unofficial and often criticized, has shaped the structure, economics, and accessibility of MBBS education for many years.
The donation system, sometimes called capitation or hidden admission fee, is an additional amount paid by students and families to secure a seat in a private medical college. Despite regulatory efforts to control it, the system still persists in different visible and invisible forms. Understanding how this system works, why it emerged, and how it affects students and society is important for anyone interested in the future of medical education in the country.
For many decades, Nepal relied heavily on foreign countries for medical education. Large numbers of Nepali students traveled to nations such as India, Bangladesh, and Pakistan for undergraduate medical studies. The need for medical professionals inside Nepal, combined with the desire to reduce dependence on foreign institutions, led to the establishment of private medical colleges beginning in the late twentieth century.
As private colleges grew in number, they created more opportunities for students who could not secure seats in the highly competitive government institutions. However, the rapid expansion of private colleges was not always paired with strict regulatory oversight. Over time, a pattern emerged where financially well-off families could purchase medical seats through heavy donation payments, while students with strong academic qualifications sometimes struggled due to limited affordable options. This trend gradually shaped the educational environment and influenced public perception.
The donation system is not advertised openly, nor is it documented officially, but its existence is widely acknowledged across the country. The process usually involves a college accepting a student who does not meet the merit cut-off set by the entrance examination authority. To compensate for the lower academic ranking, the student is required to pay an extra amount on top of the regular tuition fee. This amount varies significantly based on the reputation of the college, the number of available seats, the demand for MBBS courses in a particular year, and the influence of intermediaries.
The donation is typically requested during the admission phase after entrance examinations have concluded. Families may negotiate the amount directly with the institution or through agents who work informally as middlemen. These intermediaries are often responsible for connecting colleges with potential students, making admissions appear smoother for families seeking seats.
Although the government regulates official tuition fees, private institutions argue that the high cost of running medical programs forces them to rely on extra payments. They cite reasons such as the need to maintain modern equipment, pay highly qualified faculty, and meet infrastructure standards. Still, many critics believe that the donation system has more to do with profit motives than operational needs.
Several factors contribute to the continuation of the donation culture in Nepali private medical colleges:
Government medical colleges offer only a small number of MBBS seats every year. Entrance examinations are extremely competitive, and only the top ranking students receive placement. This scarcity drives many students toward private colleges, increasing demand far beyond the available supply.
The desire to become a doctor is deeply embedded in Nepali society. Families view the medical field as a symbol of achievement and long-term financial security. When aspirations run high, even families with moderate incomes try to arrange funds for donation payments, often through loans or selling property.
Although the government of Nepal has introduced guidelines, fee structures, and monitoring bodies to control unfair admission practices, enforcement remains inconsistent. Colleges often find ways around regulations, making it difficult to completely eliminate capitation fees.
Private institutions rely heavily on revenue from student fees. Because medical education involves high operational costs, institutions use donations to increase profits or cover expenses beyond what the official fee structure allows. The lucrative nature of the donation system encourages its continuation.
Lack of transparent communication between colleges and the public fuels confusion. Many students are unsure about official fees, scholarship quotas, and seat allocations. This lack of clarity creates a breeding ground for hidden charges and unregulated payments.
The donation system in private medical colleges has far-reaching consequences that extend beyond the admission process.
One of the most visible impacts is the immense financial burden placed on families. Donation amounts can reach several million Nepali rupees, making MBBS education accessible only to the wealthy or those willing to incur huge debts. This reinforces socio-economic disparities and creates emotional strain on both students and parents.
The existence of donation-based admissions undermines the principle of merit. Students who perform well academically may find themselves unable to secure seats because they cannot afford extra payments, while academically average students with financial resources may enter the field more easily. This raises questions about fairness and long-term professional competence.
When the public becomes aware that some doctors entered medical school through financial influence rather than academic ability, trust in the health care system diminishes. People may question the quality of medical professionals, creating skepticism and tension in patient-doctor relationships.
The donation system pushes many academically strong but financially constrained students to seek education abroad where the cost may be lower or the system more transparent. Many of these students settle abroad after completing their studies, contributing to the ongoing challenge of medical brain drain in Nepal.
Private colleges that prioritize financial gain may invest less in academic quality and infrastructure. When management focuses heavily on revenue from donations, there is a risk that educational standards may be compromised, affecting the overall quality of future health professionals.
Over the years, many steps have been taken to reduce or eliminate donation-based admissions in Nepal.
The introduction of a centralized entrance examination system managed by national authorities aims to ensure fairness. Under this system, all students compete on equal grounds, and merit lists are used for admissions. This reduces opportunities for colleges to offer seats unofficially.
The government occasionally introduces standardized tuition fees for medical courses. These guidelines create an upper limit on what colleges can legally charge. Although colleges sometimes find ways around these limits, the policy helps make the system more transparent.
Various acts and regulations have been introduced to discourage unethical admission practices. These include penalties for colleges that violate admission rules and stricter monitoring through regulatory boards.
Students, parents, and civil society groups often advocate for transparency and fairness in medical education. Increased public awareness puts pressure on institutions to adhere to ethical standards.
A percentage of seats in private medical colleges are reserved for scholarship students. These quotas benefit academically strong but financially disadvantaged students, helping balance the system.
To address the donation system more effectively, several long-term solutions can be considered.
Increasing the number of government-run medical institutions would create more affordable seats for students. This would reduce reliance on private colleges and lower the demand that fuels donation payments.
Monitoring bodies must function independently and consistently. Regular audits, transparent reporting, and strict penalties can discourage unethical practices.
Partnering with reputable foreign universities can help maintain educational quality while offering more student seats through joint programs or branch campuses.
Colleges must openly communicate their admission criteria, fee structures, and scholarship policies. Making this information publicly available reduces confusion and limits opportunities for hidden charges.
Increasing scholarship opportunities based on academic performance ensures that deserving students receive support without facing financial barriers.
The donation system in private medical colleges for MBBS in Nepal remains a significant and complex issue. Rooted in the high demand for medical degrees, limited government seats, and the profit-oriented structure of private education, it continues to shape the academic and social landscape of the country. While the system offers opportunities for some students who might otherwise be unable to join medical school, it also creates deep financial burdens, undermines meritocracy, and raises concerns about the quality and fairness of medical education.
Reforms have been introduced over the years, but true change requires continued cooperation between government authorities, academic institutions, students, and the public. Only through strong regulation, transparency, and expanded educational opportunities can Nepal move toward a more ethical and equitable medical admission system. The future of the nation’s health care depends not only on increasing the number of doctors but also on ensuring that they are trained through a system that values fairness, competence, and integrity.
WHO
Course Duration:
Average Fees:
Universities:
Medium:
6 years
$3,000 - $7,000 per year
2+
English