SPECIALISTS’ EXODUS CAN BE STOPPED

Several years ago government embarked on a strategy to train and retain more local doctors in our public health sector to address a critical shortage, particularly specialists. This was aimed at, among other things, reducing the exorbitant fees being paid by taxpayers for specialist treatment in neighbouring South Africa, which has depleted the resources allocated to the Phalala Fund that facilitates such referrals. The fund has, at some point, raked up debt of over E1 billion.

However, while the doctor recruitment and retention plan seems to have generated more general practitioners than it can afford to pay decent wages, it seems to be failing to keep the specialist doctors who are slipping away, one by one. Health Minister Lizzie Nkosi told senators this week that there was nothing her ministry could do to stop doctors from leaving government. She said the high staff turnover was a result of a change in the pay structure, where on-call allowances were scrapped and replaced with a 24-hour system, which is one of the strategies adopted to reduce the wage bill as recommended by the auditor general’s report.

The minister was responding to Senator Magudvulela’s concerns regarding the state of the country’s healthcare system, citing the doctor exodus and, among other things, the conduct of doctors, some of whom allegedly go to work drunk, which is a story for another day. The senator also decried the Intensive Care Unit’s (ICU) mortality rate of 33 per cent, which is regarded as higher than the global average of between 10 and 29 per cent. It is hard enough that patients have to contend with drug shortages, but not being able to see a specialist doctor can be a life-threatening experience. This situation calls for a review of the previous strategy, taking into account the country’s fiscal situation.

It is undeniable that the on-call allowances were a very attractive incentive for doctors, but also a huge burden on the taxpayer. It certainly raised the question; can you put a price tag on a human life? The reality, though, is that the medical brain drain is being witnessed the world over and governments have been adopting various means to try and retain their medical staff.

Project

Yesterday, for instance, the Government of Bangladesh began a pilot project that will allow government doctors to engage in private practice in order to help them generate more income. According to that country’s media reports, the service is initially scheduled to start in the public hospitals of 10 districts and 20 sub-districts. The Health and Family Welfare Minister, Zahid Maleque, was expected to inaugurate the private practice of doctors in government hospitals, titled ‘institutional practice in government hospitals’.

According to the Daily Sun newspaper, the doctors will give consultation services to patients at their private chambers set-up in selected public hospitals with an extra fee from 3pm to 6pm. The policy also sets out the fees to be paid by patients, of which the doctor gets to take 80 per cent, while the doctor’s assistant gets 10 per cent with the rest going towards the government, as a service charge. This is more or less what we see locally, where doctors alternate between their own surgeries and private clinics. It is a practice that prevails in other countries, but not without its fair share of challenges. Some countries discourage it, as it invites the temptation by the doctors in public hospitals to refer patients to their private clinics for treatment in order to make more money off them.

To counter this, the Bangladesh Government announced it would form a body called the ‘Institutional Practice Monitoring Committee’, which will monitor the activities of the private chambers of doctors in public hospitals to curb malpractice. Other countries provide a non-practicing allowance meant to compensate the doctors for not doing private practice while working in public hospitals. Could this approach work for Eswatini?

I don’t see why not. Government’s general orders barring public servants from private business would have to be amended to make an exception for the rare skills that these professionals provide. It is a better option, for now at least, than having to compromise the health and lives of emaSwati, who are now subjected to extremely painful long waits for their turn under the Phalala Fund, some of whom never make it to the operation table, let alone on the list for consideration.

With an ICU mortality rate higher than the global average, as well as an equally alarming maternal mortality rate, one should expect the Health Ministry to seriously engage on this matter because it doesn’t make sense to have a country that can afford to pay specialist fees in neighbouring countries through Phalala Fund, but is unable to retain a specialist doctor in its own backyard. The medical carnage must stop! We should never lose sight of the famous proverb ‘the presence of the doctor is the beginning of the cure’.    

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