OPINION: Create a good administrative system for teaching hospitals

It was good news that management of the Mloganzila Academic Medical Centre (MAMC) has been put under the Muhimbili National Hospital. No doubt my opinion on this expressed in this column sometime back raised eyebrows.

I saw hostile glances when I visited the Muhimbili University of Health and Allied Sciences (Muhas) – something like how come I was betraying Muhas, but I was just putting the national interest first.

In any country, a good teaching hospital is mandatory, and has two primary functions: to provide state-of-the-art quality services to its patients – and, in the process, also serve as a quality teaching facility to the medical students. Without a good teaching hospital, doctors will be less than half-baked.

In this article, I will explain how there can be an efficient and effective administrative structure so that both functions of a teaching hospital are achieved optimally.

Universally, there is always some sort of tension and power struggle between a teaching hospital and a medical university.

When I joined Muhimbili in 1970, the story was totally different. There was a balanced relationship without any tensions.

In 1970, we had a Faculty of Medicine and a Dean (under UDSM), which is largely the precursor of Muhas. Muhimbili Hospital had a superintendent administratively under the MoH, and the faculty provided all clinical services, whereby teaching medical students was optimum. There was absolutely no tension.

In 1977, Muhimbili Medical Center (MMC) was created, merging the hospital and the Faculty of Medicine. The MMC head was a professor from the Faculty and, thus, services and teaching were under the same umbrella.

With time, the Faculty of Medicine became a UDSM constituent college, which then developed several faculties and institutes.

It was at this time that senior faculty started a power struggle, building their own empires of leadership at the expense of teaching because there was separation of university and teaching hospital.

In time, the college became a fully-fledged, independent medical university (Muhas) and the hospital became MNH.

No good reason was given for breaking up the earlier merger. Muhas medical students were seen as non-belonging and, at one time, MNH had an expatriate director-general and teaching was grossly affected.

This same structure still exists; but the leaders have changed and within MNH campus there are two other independent institutes namely MOI and JK Cardiac Institute – which is an anomaly.

One major lesson is that, when individual greed for power takes over, the national interest suffers. Thus, strong systems should be created to overcome individual biases and greed.

It is well-known that the best test-book in medicine is the patient. In any medical curriculum, patient-based teaching is the most effective. Fortunately, we have a very wide spectrum of patients who are very good teaching resources. What’s needed is how to maximize this opportunity.

First and foremost, all these institutions are public, and should have an administration like an orchestra that plays in harmony, to produce a melody. For that, we should not have too many totally-independent institutions that do not speak to each other.

We need medical care facilities like MNH, MAMC, MOI, Cardiac Institute, Temeke, Mwananyamala and Ilala Hospitals all reporting their teaching functions to the Muhas vice-chancellor.

De facto specialists in all these hospitals become honorary faculty members who should enjoy Muhas’ non-monetary privileges.

Each of these healthcare-providing facilities should have a substantive director responsible for the provision of clinical services, and who is funded via the national Treasury.

However, the directors reports to the VC, and their appraisal is done by a committee chaired by the VC. In so doing, each of the facilities will become a good teaching hospital.

The current practice is that some private medical schools have arranged a MoU with some of these facilities. This is not good practice. Private medical schools should thrive to build their own teaching hospitals especially for undergraduate studies.

There can be some sharing for postgraduate courses; but this should be beneficial and not exploitative of public medical university.

The Muhas VC should be responsible for all the public facilities and should be aided by the directors of the facilities. This is how Karolinska in Sweden functions.

If we want competent doctors from Muhas, then all these public hospitals should become teaching hospitals closely affiliated with Muhas.

In so doing, the extensive expertise in Muhas would be available, and the national interest would be maintained. Creating such an administrative structure is indeed a huge challenge because many players would wish to ‘protect’ their territorial boundaries – and, in so doing, would compromise the national interest.