The turnover of medical doctors in Rwanda’s public hospitals is undermining the government's efforts to bridge existing gaps in the health sector, officials say. Apparently, medical doctors are moving to non-government organisations (NGOs) to do well paying jobs as consultants and project coordinators. In a bid to retain doctors in public hospitals, the Ministry of Health has renewed its restrictions on the NGOs recruitment process, The New Times has learnt. The ministry wants to approve any recruitment of doctors, both specialists and general practitioners, in local and international NGOs. However, some NGOs say the new attempt to retain doctors could be a ‘delicate move’ vis-à-vis labour rights. In a letter dated September 14, 2022, addressed to development partners in the health sector, the ministry says it is “much concerned that some [doctors] are leaving without fulfilling their commitment to serve the public sector after training.” Under what’s known as a ‘retention contract,’ general practitioners who studied on government scholarship commit to a two-year public service, while for specialists, the commitment is a period of five to seven years. For other medics, the letter signed by Dr Daniel Ngamije, the Minister of Health, says, “their departure causes a disruption considering the gap of medical doctors the sector is trying to bridge.” It adds that the phenomenon is having a “negative impact” on the quality of health services and the health system in general. And the NGOs have been reminded to follow instructions made in 2016 requesting them “to always seek approval of the Ministry of Health prior to initiating a recruitment process to hire any specialist and general practitioner.” Doctors’ Association and NGOs react According to Rwanda Medical Association, a syndicate of some 300 doctors, those who leave the public sector are offered better payment and working conditions or they just want to change their job for other reasons, adding however that the retention of doctors is necessary for the local health sector. “For us, the ministry's concern is a positive sign that they appreciate the need to retain our doctors,” said David Ntirushwa, the association’s president. “However, much as we look at the gap left by a doctor who joins an NGO, let’s also look at the welfare of those who work in the public hospitals, their salary, facilitation and motivation, which make them want to go elsewhere,” Dr Ntirushwa said. For instance, a doctor who works in a private hospital earns three to four times the salary of a doctor with the same training and experience who works in the public sector, The New Times has learnt. And for those joining NGOs, their salary could be five to six times more. “Though the salary would not necessarily have to be equal,” Dr Ntirushwa said, “the longest serving doctors need to be motivated through horizontal promotion for example, and that will prevent them from leaving public hospitals as well as inspire their junior colleagues.” The retention of doctors shouldn’t be forceful; instead there has to be improvements with regards to their working conditions, he added. Need for talks with NGOs The ministry should engage the organisations in talks to make sure that they understand what the letter entails, said Aflodis Kagaba, the executive director of Health Development Initiative (HDI), an NGO. “I don’t have any problem with the letter itself, but what I think will be very tricky is its implementation,” Kagaba said. “If a doctor has a contract with the ministry to work in the public sector for a certain period of time, then they should respect it. But if the ministry wants to say that any doctor seeking a new job will need official approval, that means they might be infringing on the doctor’s rights.” He added that the ministry’s concerns are “understandable,” but the new measure should be considerate of free movement of labour and workers’ rights. Official data suggests Rwanda has recorded a positive trend in its doctor to population ratio. The number of doctors per population has increased from 1/16,001 in 2010 to 1/8,294 in 2019. However, the target is 1/7,000 by 2024. The New Times sought a comment from the Ministry of Health, but by press time they had not responded to questions about what will be done in case a doctor leaves the public sector or an NGO initiates a recruitment process without the government's approval.