- Our government must invest more in our doctors because it costs up to Sh5 million to keep one foreign volunteer doctor--as a host country
ACCORDING to recent reports in the media, President Jakaya
Kikwete, while on tour in Shandong Province in China, appreciated
efforts of the Chinese government of posting volunteer doctors to
Tanzania for the last 50 years. He also used the opportunity to ask for
more such doctors to be sent to Tanzania to help curb the existing
shortage.
At the same time, the Health and Social Welfare
ministry announced last week it plans to review its recruitment policy
so that it would be possible to employ directly qualified local health
cadres soon after completing their studies. Whilst it was entirely
appropriate for the President to ask the Chinese government for their
support, I believe that the time has come for our government to invest
more in our doctors.
Indeed, Tanzania faces a shortage of human
resources in the health sector, whereby existing statistics, such as the
Health Sector Strategic Plan III (2013) shows that there is 0.5 doctors
for every 10,000 people, whereas the lowest acceptable standard by the
World Health Organisation (WHO) is two doctors for every 10,000 people.
But what is not captured or rather widely publicized is that, despite
this shortage, Tanzania has a large number of qualified local doctors
who are not working as “doctors” for a number of reasons including a
lack of good strategies from the government to absorb them into the
public health system.
In 2012, Sikika in collaboration with the Medical
Association of Tanzania (MAT) conducted a study to find the whereabouts
of doctors. Results showed that, about 40 per cent of qualified doctors
do not work as “doctors”, that is, they do not work in a clinical
setting. They work in other areas, sometimes those not related with
health issues.
Deploying foreign volunteer doctors is a
short-term approach to solving the shortage crisis but also potentially
has the effect of diverting the meagre resources we have which could be
better utilized if they were directed to recruiting and attracting local
doctors. Foreign doctors, even if they are volunteers, have other
associated costs that are usually borne by the host country. These may
include accommodation, international air travel tickets, local
transport, sustenance and language skills training, all these could add
up to substantial amounts; looking at the 2012/13 and 2014/15 budget
books for the Health ministry, the cost estimates can range from Sh2
million to Sh5 million per foreign doctor. Furthermore, these doctors
are primarily deployed in the secondary and tertiary level facilities as
opposed to the primary level facilities (dispensaries and health
centres) where there is more critical need for health care workers,
particularly in rural areas.
A number of factors have perpetuated local doctors
from disengaging in the sector. Some of these include: poor working
conditions, delayed and unpaid salary arrears, delayed salaries for new
employees and delayed promotion. All these could be symptoms of a lack
of coordination between key ministries during planning and budgeting for
recruitment and distribution of health care workers which is one of the
key challenges mentioned by the Health Sector Strategic Plan III
(2013).
These key ministries include: Finance that
allocates budget for recruitment, distribution and salaries; the
President’s Office Public Services Management which authorizes
vacancies;, the Health and Social Welfare ministry that recruits and
distributes the authorized number of posts; and the Prime Minister’s
Office Regional Administration and Local Government Authority which
requests for posting from Health ministry. So, the challenges must be
dealt with. The long waiting time between completion of studies and
start of job application process, and then the prolonged time for
recruitment and deployment process creates loopholes where many
qualified health professionals find alternative jobs which may not
necessarily be related to health. Sikika certainly welcomes the review
of the employment process with a view of addressing the identified
challenges, and would urge a similar kind of review to address the other
factors discussed in this article.
Sikika would like to call upon the government to
start addressing the human resources crisis in the country by focusing
on local solutions. It is wise to start addressing the factors that are a
hindrance to the absorption of available health workers, in particular
doctors, to the formal public health sector rather than encourage
continued dependence on temporary solutions such as the foreign
volunteer doctors.
Published by The CITIZEN on Saturday, November 8 2014
Zakayo Mahindi works with Sikika, a health advocacy organization based in Dar es Salaam
No comments:
Post a Comment