THINKING ALOUD: Why limit medical specialists to regional, zonal hospitals?

Thursday January 11 2018

Professor Zulfiqarali Premji

Professor Zulfiqarali Premji 

By Prof Zulfiqarali Premji

It’s very comforting to learn that the Health ministry is seriously thinking of placing medical specialists at regional and zonal hospitals. (See The Citizen, December 16, 2017). This is indeed a very good idea. But then again: why only regional and zonal hospitals?

A little more than 56 years after political Independence from foreign rule, we are still unable to station medical specialists at district hospitals where many Tanzanians seek medical attention. This is, indeed, unacceptable – as we should have done better that that.

Admittedly, Tanzania has only a few medical specialists, mostly concentrated in major urban centres – and even some regional and zonal hospitals don’t have enough of the specialists. Thus the challenge is twofold: uneven distribution of the few specialists who are currently available; and the need to train more of them.

Financial gains

Usually, medical specialists opt to remain in brightly lit urban centres not only because of the related financial gains, but also because the conditions at regional and zonal hospitals aren’t particularly conducive or career-enabling.

Furthermore, diagnostic services are minimal at such hospitals – and, thus, a specialist virtually functions as a mere medical officer, with minimum intellectual challenges.

There is, therefore, a need to invest more in regional and zonal hospitals. This is in terms of fostering an enabling environment that would enable them to effectively attract and retain medical specialists.

Uneven distribution

But, this still doesn’t justify the uneven distribution of medical specialists. After all, it behoves the specialists to firstly go to these hospitals to initiate transformation and create a friendly-working environment.

Training medical specialists

Given Tanzania’s current annual population growth rate of about three per cent – and the number of specialists who’re trained per year – it is obvious that the number of specialists will never be enough.

Thus, one needs to think out of the box for a solution.

Currently, training in our institutions of higher learning is as follows: after internship, a medical officer is posted to work in a hospital. After two years of working experience, the medic applies for post-graduate training in a specific discipline like paediatrics, surgery, etc. If selected, the candidate pursues a three-or-four-year study programme, one year of which is mostly devoted to research and presentation of the research findings as a thesis.

This way, the candidate gets two years of clinical learning, and one year of research.

After completion, some candidates join university faculties, with the majority practising as medical specialists.

Tanzania’s needs are for specialists who can provide quality clinical services, and not researchers or faculty members.

In my opinion, Tanzania needs to train medical specialists in specific disciplines for 24 months instead of 3-4 years. After 24 months the “trainee” is awarded a postgraduate diploma instead of a Master’s degree.

Many European countries have adopted this system of postgraduate diploma in clinical sciences. Because the period is shorter, more specialists can be trained without compromising their clinical skills set.

I understand there are some senior faculty members who oppose the initiative of postgraduate diploma in clinical sciences – but don’t have a suitable alternative.

I think some of these “seniors” still believe that Medicine is for a well-defined esoteric group – and entry to the group must be restricted. This denies district hospitals the medical specialists they sorely need.

Still, the onus is on the Health ministry to initiate the training of more specialists, working in collaboration with higher learning institutions.

Stubbornly clinging to old systems is counterproductive. Besides, we have the responsibility of solving our problems by adopting innovative ways.

Postgraduate diploma

Ideally, the aim of the postgraduate diploma in clinical medicine should be to prepare medical practitioners who are creative, flexible and innovative in their activities, who adapt to ever-changing demands that are placed upon them in response to the changing dynamics of healthcare provision – as well as its integration with social care.

If such a system is adopted in earnest, it’s very likely that medical specialists will readily be available even for district hospitals.