Before the end of this year, healthcare practitioners in Rwanda will start working under the duo clinical practice policy, an arrangement that will facilitate medics to offer services in more than one health facility (public or private). On Monday November 30, ministerial instructions for the policy were gazetted. The policy comes with a number of advantages even as medics still note that there are issues to be wary of in case it is not properly regulated. The Government banks on this arrangement to increase the ability to retain medics in public health facilities by allowing them to make some extra money in private clinics. In addition, the move is seen as gateway for patients to access more specialized services since specialized medics will be allowed to work in more than one hospital. However, medics note that there is need to closely monitor the implementation of the policy to avoid scenarios where it may be abused by some healthcare practitioners who may focus on making more money from additional jobs, and thus end up money compromising the quality of care and patient safety. How then will the Ministry of Health regulate this new policy? Here are five things you should know: Medics will be allowed to practice in one secondary hospital, and on contract basis Medical doctors and dental surgeons will do dual clinical practice in only one secondary health facility, and on a contract basis. “To ensure that the implementation of the dual clinical practice does not have a negative effect on the quality provided either in public hospitals or private health facilities, the number of hospitals where a health professional is allowed to do dual clinical practice is limited to one maximum,” reads the policy. However, under specific circumstances and assessment, the Minister of Health can authorize a medic to practice in an additional hospital. Procedures done in a secondary hospital should not exceed 50% of those done in a primary hospital Under the policy, a health professional working is allowed to do private clinical practice only after completing their working hours in his primary hospital (a hospital where he is primarily employed). That is to say, a medic can only attend to a secondary job during their times off his primary job, for example on weekends or other days-off. And to ensure that services provided under dual practice do not compromise the quality of care and patient safety, the number of patients managed and procedures performed in dual clinical practice “shall not exceed fifty per cent (50%) of those performed during the normal working hours,” according to a statement from the Ministry of health. Application is a prerequisite before a medic is allowed for dual clinical practice Each health professional who wishes to exercise dual clinical practice must submit their applications to the management of the primary hospital they work for. General practitioners, dental surgeons and medical specialists are allowed to apply for dual clinical practice, however, medical doctors doing postgraduate studies are not allowed to apply for the dual clinical practice. The application should include among other things: indication of the facility where the medic is going to do dual clinical practice takes; and an acceptance letter from the management of the hospital. Serious responsibilities for health facilities with medics on dual clinical practice For public hospitals that have private sections, they will have to establish a roster and timetable showing the time when a health professional is doing public or private duties to allow proper human resource tracking and management, according to the policy. Health facilities are also required to use an electronic system to manage dual clinical practice, providing detailed information on issues like procedures performed and generated incomes. The policy calls for respect of working hours, saying “non-respect of working hours shall constitute a disciplinary fault as stipulated in the law governing the public service.” A health facility shall also be required to share with health insurances companies working with it the list of health professionals who are allowed to engage in dual clinical practice on quarterly basis. Supervision by the Ministry of Health The Ministry of Health shall regulate, supervise and monitor the provision of health care services under the dual clinical practice framework in respect to the current regulatory frameworks. It shall also oversee the implementation of the policy to ensure provision of quality care services and safety to the Rwandan population and take administrative measures to those who are not complying with this policy and in accordance with existing laws and regulations. On a quarterly basis, public hospitals will have to report to the Ministry of Health, and Health insurances the number of health professionals who have been allowed or had lost their rights to exercise dual clinical practice.
