Denver Isaacs
12 September 2008
WITH the recent launch of Namibia's first cardiac health unit in Windhoek, and continued discussion around a future school of medicine at the University of Namibia, the public health sector has never sounded more progressive.
But while the Health Ministry continues to strive for better service provision, the shortage of local doctors that has plagued it since before Independence continues to act as a thorn in Government's side.
Last month, the Health Ministry confirmed that foreigners were in charge of 32 of Namibia's 34 State hospitals, the only exceptions being the Katutura State and Windhoek Central hospitals in the capital.
Figures from the Health Ministry show that, with the exception of Cuban doctors who enter as part of a political agreement between the two governments, there are currently 261 doctors working in the public sector out of approximately 1 500 doctors registered in the country.
Of this total number, 469 (about one third) are foreigners, further figures supplied by the Medical and Dental Council of Namibia show.
This shows a marked improvement over the situation back in 2006, when Health Minister Richard Kamwi said the total number of doctors in the country was 650 - half of whom were Namibian.
Just as then, however, the number of Namibian doctors practising has not benefited Government much, as most of them are in the private sector.
PRIVATE VS PUBLIC "The ministry still faces a huge challenge in that Namibian doctors do not want to work for the public [sector].
The majority of those working in the public sector are foreigners.
The main reason seems to be better salaries in private practice," the deputy Permanent Secretary in the ministry, Dr Norbert Forster, suggests.
A young doctor in the public sector, who asked to remain anonymous, said he earned about N$13 000 a month after deductions.
This figure, he said, could easily triple in private practice.
"The benefits to the public sector is that you have a steady income, you get a bonus in your birth month, and sick leave and normal leave days.
That's about it.
Going private might seem like a bit of a risk, but you make a lot more money there through consultations and dispensing [medicines]," he said.
Another factor keeping Namibians out of the public sector is the lack of incentive for going to work and live in rural areas.
"Most would rather work in Windhoek than somewhere in a village.
It's not just the salaries, but also things like schools and such that aren't to standard," says Dr Jack Vries, Senior Medical Superintendent in the Ministry's Regional Co-ordination Unit.
"Allocation is not need based, but reward based," commented another State doctor.
MEDICAL SCHOOL But while even countries such as the United Kingdom, Australia and Canada have been reported to have about a quarter each of their medical and nursing workforce made up of foreigners, Namibia, unlike the aforementioned countries, still lacks the means of producing its own doctors.
Currently, the bulk of Namibia's medical workforce are graduates from international institutions, mostly South African universities.
Minisre Kamwi said in March that there are currently close to 120 Namibians undergoing medical training in various countries.
"This translates to around 20 medical students per year of the six-year medical training course," Kamwi said during a meeting on the planned establishment of Namibia's own school of medicine at the University of Namibia (Unam).
The medical school has been on Government's mind since Independence, but its future remains in the hands of an advisory committee set up in 2001.
The Ministry hopes that when the school is finally in place, Namibia will have a constant supply of at least junior doctors on internship.
Doctors spoken to were knowledgeable about a "community service programme" that is apparently being looked at, which would see young doctors sent to various regions.
But scepticism exists, given the current lack of control over medical students who were awarded bursaries and were contracted to spend a year in public service for every year studied.
"Many manage to get out of these contracts.
They spend a year or two in public service and then manage to work out a deal where they pay off their debt in ridiculous ways.
I've seen cases where people were paying back N$100 a month," said one senior doctor.
"They should be made to work the entire period or pay back the lump sum owed," he suggested.
"That should be sorted out before the medical school becomes a reality," the same doctor said.
A 'hardship bonus' that was in place at the Ministry at one point, Vries said, has since been discontinued.
While the Ministry has not been able to provide reasons for this, sources have suggested that these incentives still fell short of what a doctor could make in the private sector.
TROUBLE WITH NO LOCAL EXPERTISE The necessity of the State gaining more local expertise is highlighted by the launch in June of the country's first cardiac unit.
In July, nine heart surgeries were successfully performed at the unit in the Windhoek Central Hospital, by a team led by a group of heart specialists from Cape Town's renowned Groote Schuur hospital.
The unit has remained dormant since then, however, and the next series of operations are scheduled for early 2009 when the South African team will return to Windhoek.
Meanwhile, Namibia remains on record as having more than 3 000 cardiac cases a year.
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