The Cabinet on Monday, October 12, approved a national duo clinical practice policy for health professionals and ministerial instructions that guides its implementation.

The policy on duo practice allows healthcare practitioners to practice in more than one place of work – public or private.

This is a major development considering that there has been lack of a proper framework to guide physicians, nurses and other healthcare professionals in case they chose to have more than one clinical job, health practitioners say.

Although duo clinical practice has not been illegal in Rwanda, those involved in it generally improvised their way through the situation.

"It was not prohibited but there were grey areas around it,” said a clinician in private practice. "The framework will clear this up.”

A doctor checks up an eye patient at Kibagabaga hospital. Photo: Dan Nsengiyumva.

Another source said that some health facilities were taking advantage of the absence of a framework to prohibit staff from having more than one job.

The New Times learnt that ministerial instructions were yet to be released by the time we were doing this story.

Experts say the policy and the attendant guidelines will allow public health facilities to employ part-time medical specialists in private practice seamlessly.

In many parts of the world, duo practice for healthcare practitioners is permitted to help attract specialists to public health establishments and promote the welfare health workers.

Dr Emmanuel Rudakemwa, a radiologist at King Faisal Hospital, Kigali, said the policy will help improve access to doctors since a specialist will be able to attend to patients in more than one hospital.

"This will result into timely and improved healthcare,” he said.

Rudakemwa noted that the policy will allow physicians to earn more, increasing chances of retaining them.

Preventing ‘unintended consequences’

"Overall, it will facilitate the country’s healthcare system to retain their best cadres,” he said. This, he added, "will dissuade physicians from leaving the health sector or even the country for greener pastures.”

He said: "It will also help retain public health workers, at least partially, because physicians will not feel compelled to fully move into private practice. Many will most likely find it more appealing to work in both private and public (facilities).”

But duo practice is not without its own challenges and experts called for holistic guidelines to avoid unintended consequences.

There is need for a thorough framework so that it doesn’t become a pervasive incentive in the end, Rudakemwa warned.

"If you fail to regulate dual practice, you may end up having doctors and other health professionals practicing in more than two or three places and that might affect the quality of services offered,” he said.

Dr Christian Umuhoza, a lecturer of at College of Medicine and Health Services at University of Rwanda and physician at the University Teaching Hospital in Kigali (CHUK), also underlined the importance of having the policy in place.

He said there was need to closely monitor the implementation of the policy to avoid scenarios where it may be abused by some healthcare practitioners who may end up spending disproportionately more time in private practice at the expense of their clinical duties (and patients) in public hospitals.

"For instance, some people may take time off without permission to go to work in their private clinics, or even lower the quality service they offer in a public hospital so as to drive more patients to their own private facility,” he said.

Some practitioners may even be tempted to take resources, such as drugs and equipment, from their public sector workplace to private practice, he warned.

"It is important that the policy and guidelines are thorough enough to regulate these things,” he added.

The New Times made repeated attempts to get a comment from the Ministry of Health and Rwanda Biomedical Centre but to no avail.