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Blog
Locum, Private Health Facilities and the Law

It is difficult to determine the number of health workers employed by government and work in private health facilities during their spare time. Obviously they do not inform any authority and at times, not even their friends, so it is difficult to know the number involve.  Again it is difficult to know public sector health workers behind private establishment such as pharmaceutical shops, hospitals and laboratory services among others.   It's all good since rendering services to people who hitherto might have gone to queue at specific health facilities, get the chance to be attended to. Arguably rendering medical services for people in private institutions cannot be avoided. This is more so when people approach health workers in communities for medical attention. This system called CHPS, is mostly practiced at the rural areas. Further, government health facilities do not provide some services which have become the specialties of private health facilities in and around their places of work. In addition, bureaucratic procedures do not allow smooth running of some services at the government health facilities as medical consumables are not supply on time.

Despite the above, there is the need to recognize that, there are laws governing the usage of spare time when you are employee of an establishment in Ghana. The popular test case that the Institute of Human Resource Management Practitioners (IHRMP), stresses on is "Arkhurst vrs Ghana Museum and Monuments Board (1975) 2GLR 1" In this case, Arkhurst was employed to produce artifacts and wall hangings by the board for export. In his spare time, he produced similar museum objects, which, without license, he exported.

The board dismissed Arkhurst since his private job conflicted with the interest of his employers. He sued the board for wrongful dismissal. Justice Abban dismissed his claim as follows:

"an employee owes a duty of fidelity to his employers even in his spare time and where an employee knowingly, deliberately and secretly in his spare time does any act, that is likely to be prejudicial to the interests of the employers, they are entitled to dismiss him".

 This ruling has become a test case where conflicts are referred to. The judgment is clear. The interpretation is also clear. It is up to all health workers to watch and not foul of the law. Page Content goes here

Doctors practicing Administration in Ghana

 Commentary

The current national debate concerning medical doctors and dentists practicing administration in the various health institutions seems to have divided our opinion leaders. As at 2006, 94 medical doctors and dentists out of 2450 occupied various administrative positions in the country according the 2005 Audit Report of the Health Sector. These include: medical superintendents of hospitals (CEO of hospitals), district directors of health services, directors of regional health directorates and the head quarters of the health services including the Ministry of Health. This was revealed in the 2005 Audit Report presented to Parliament by the Auditor General. The Select Committee on Health in Parliament was not happy to hear that, as debate on the issue was telecast live on national TV

The report thus seems to suggest that these medical and dental professionals do not practice medicine and dentistry once they occupied administrative positions. This is where I believe the misinformation comes from. It is a common knowledge that doctors do offer clinical services in the various institutions apart from the few in head quarters. CEOs of the various health facilities have professional Administrators who are incharge of the non-clinical duties.

Therefore I do not agree entirely that Managerial positions in the health services should not include clinician even if they hold Management degrees or training as additional qualifications. In Korle Bu Teaching Hospital for instance, clinicians occupying headship of departments and specialize units offer 40% of their time for office duties. They do not shelve their clinical duties in any way.

The question still remains whether their presence in administration is desirable. My answer is yes. Medical Doctors and Dentists are most needed in Management in the Health Service. This is because they bring years of experience and empirical research of problems in the theatres and clinics to Management. I can understand why the focus is on clinicians. They are classified as essential staff for now. I believe their total withdrawal from Management will be suicidal.

Apparently those who speak against doctors in Managerial positions refer to different countries whose political economy makes private sector reign supreme (profit is the watch word). Even those countries have managerial problems with their health systems and cannot offer good example.

Management of the entire health systems in Ghana is very complex. Clinicians with their compulsory research / studies to enable them renew their license to practice medicine and dentistry annually places them in a better position to understand the pattern of diseases. Taking decision concerning preventive and curative medicine therefore require everybody's input including clinicians with requisite qualification.

 

The Single Spine Salary Structure
by A.  Kwame Apedzi, 

Monthly salary forms part of entire conditions of service of a worker. But higher attention has been given to salary these days by public and civil servants. Other conditions to facilitate smooth work are not ignored, but salary seems to solve major financial problems hence the attention it is receiving. There are several salary structures for Public and Civil servants with different level of progression. This has been described by Consultants as unfair. Government has therefore demonstrated the willingness to bring similarity or equity in these salary structures. Elementary biology teaches us that, the spine holds all parts of the body together. I believe hence the adoption of the accolade "Single Spine Salary Structure".(SSSS). This is to bring the different salary structures together in the public and civil services.

Prelude to SSSS

Four areas received attention by a team put together by Government, according to a team member Tony Oduro. This include the examination of the current : Pay Administration, Job Analysis, Job Evaluation and Pay Equity (Single Spine)

 Pay Administration

It was established that the major weakness of previous pay reform initiatives was the absence of a legally mandated institution with the definitive responsibility for everything related to pay, across the public sector. Fair Wages & Salaries Commission was therefore established to do the following:

  • Ensure fair, transparent and consistent implementation of Government's public sector pay policy;
  • Manage and coordinate all negotiations where compensation is financed from the Consolidated Fund.
  • To advise Government and ensure decisions are implemented on all matters related to salaries, wages, grading, classification, conditions of service, job analysis and job evaluation, performance management and indicators, allowance and benefits across the public sector among others.

 Service institutions were then classified for easy identification as follows:

  1. Public Policy, Planning, Service, Administration and Related Services (PPPSARS) (Incl. Local Government Services)
  2. Health Services
  3. Education (Non-Tertiary)
  4. Education (Tertiary), Science & Research
  5. Revenue and Accounting Services
  6. Security Services
  7. Legal and Judicial Services
  8. Sub-vented (Commercial & Non-Commercial)
  9. Regulators

Job Analysis

Thirty-five (35) Human Resource Managers were drawn from thirty-five (35) public sector institutions from February - August 2007. They reviewed the questionnaires used to gather data, the methodology and participated in other planning activities. Additional eighty-two (82) human resource management practitioners were drawn from forty (40) public sector institutions between March to July 2007 to do the following:

  • Select benchmark jobs across public sector
  • Administer Job analysis questionnaires to more than 5000 job holders
  • Analysed jobs, develop job descriptions and persons specifications.

 Job Evaluation

Job descriptions and specifications of the various institutions were evaluated.

Evaluation points for each job were summed up to determine the ‘ job worth'.

Consultants did quality control on all job evaluations. Job Evaluation Factors were grouped into four (4) items for analysis:

  • Knowledge & skill
  • Responsibility
  • Effort
  • Work Conditions

The above four (4) factors have thirteen (13) sub-factors to measure attributes of all jobs that are considered relevant to any job and for which some pay is given (compensable factors)

 Health sector representatives from organised labour and the teaching hospitals agreed on the following weighting which is not too different from international standard:

 Factor Weighting : Health Workers

Knowledge and Skills

43.5%

Responsibity

34%

Work Environment

9%

Effort

13.5%

Total

100%

 

Factor Weighting: Security Forces (Just for your study)

Knowledge and Skills

25%

Responsibity

35%

Work Environment

20%

Effort

20.%

Total

100%

However, it was established that supply and demand factors require that some jobs in short supply are paid higher.

 

 Single Spine Salary Structure

The proposed Single Spine Salary Structure therefore has the following objectives to:

—  Ensure all jobs within same job value range are paid within same pay range - equity

—  Place all public sector employees on one pay structure

—  Enable compliance and monitoring pay structures of semi-autonomous institutions

—  Enable Government to manage the wage bill more effectively

—  Minimise issues related to pay distortions and the number of labour negotiations

—  Transparency across the public sector as there will  only be one structure

—  The SSSS begins at the minimum wage

—  Increment would be negotiated between Government and organised labour, among others

 

Implementation

Fair Wages & Salaries Commission (FW&SC) has the legal mandate to implement the pay policies once approved by Government. The proposed salary structure, according to Government officials, is going through the necessary scrutiny to be implemented by next year. (2010). It is not known whether our current salary would be increased, maintained or decreased when the proposed SSSS is implemented.  Hopefully, all components of the Condition of Service for health workers may be attended to, with the implementation the of the new salary structure to promote work and happiness.

 

Published in Korle Bu Bulletin ( Official mouth piece of Korle Bu Teaching Hospital)

Appointment without Probation

The presidential election ended on the 2nd January, 2009. President Atta-Mills has been sworn-in to recruit people to deliver his advertised programme for the country.

The appointment of people to positions such as Ministerial, Heads of Public Institutions, Board of Organisations, ect for the first time may result in successful delivery or with challenges. People could have enough qualifications and experiences, but the ultimate issue is the intention they present themselves to pick up appointments in different political environment. This may be for the fame of it. Just like Maslow explains, people might have gone passed their basic and safety needs....... etc and now want to be famous (self actualization). Others may pick up appointments under different capacity because of money (nokofio) or to replenish their Bank Accounts after depleting them for political campaign. Achievers may also present themselves to help fulfill the vision of their boss (the president) etc.

Some the factors mentioned above could make experienced and well established people fail in their political positions.

It is therefore prudent that people are made to understand that, for any position that they are appointed to, they would be on trial (probation) for a stipulated period. Appraisal for the stipulated period is necessary as it motivates the appointees to stay focus during their contractual period. Government should however muster courage to terminate the appointment of those who are not performing and spur on those excelling.

Section 98 (d) of the labour law 2003 admonishes every employer and employee to agree on the period and conditions for probation.

I therefore suggest that Ministers and Government appointees should have probational period. Although I have not seen appointment letters of Ministers and other Government appointees before, I encourage appointment committees not to over-look this important clause in contract letter.

Performance appraisal at a specific period before confirmation is good. It is motivating for job holders to know that the employer is interested in what they are doing. This would also help to design training to correct their inefficiencies.
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