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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.