The Zambia Medical Association has learnt with disbelief the circular from the Permanent Secretary-Administration of the Ministry of Health directing Provincial and district directors and Hospital Superintendents to stop medical personnel from being engaged in extra-economic activity such as private practice in private and public institutions.

It is very disappointing that only medical personnel have particularly been singled out.

This definitely amounts not only to intimidation but lack of appreciation of the Human Resource for Health despite what they put in to save the face limping health sector as far as Human Resource is concerned.

Our position on the issue still remains the same as that given in 2015 that, “there is no law that forbids citizens to have duo practice in public and private.

However, we take great exception to members who do not fulfil their man-hours in either public or private institutions and thus create the conflict and loss of trust in the accountability framework”.

Further, we wish to condemn the directive as ill-intended as it disregards what obtains in practice.

This statement, first of all, is ambiguous and misleading and we doubt that the technocrats advising the Permanent Secretary mean well.

It is ambiguous in that it does not specify whether this includes work or employment done outside government man hours.

The association is fully aware of the public service terms and conditions of service.

Section no. 86, cited in the directive, pertains to an officer who hold dual employment.

For example, while employed in the Civil Service, an officer accepts another employment on Full-time basis from either another government ministry/agency or draws two salaries while performing dual functionalities in the same or line Ministry.

As stated in the 2015 position above, the Association does not condone workers who abscond from work either in government or private institutions to work elsewhere.

In our view, section no.86 cited in the directive, implies as we have stated above and it shall continue to be until such a time as it shall be amended.

We wish to assure our members and the members of the public equally, that no law shall be broken by any member of the Zambia Medical Association, or the medical fraternity in general, who wishes to engage in meaningful economic activity if they so wish outside their government contractual hours.

If it was the intention of the Permanent Secretary to forbid doctors or other cadres from engaging in private practice at their own time, while serving in government, then we wish to state that the Permanent Secretary has misled himself.

The Permanent Secretary is on record to have defended the sector on parliament grounds while appearing before the Parliamentary committee on Parastatals two score months ago!

If this is not misleading the sector, then the office misled Honourable Members of Parliament on record.

The public may wish to know that Zambia has a high patient-doctor ratio and as such, the lack of critical human resource has resulted in the failure to attain health sector targets such as Maternal mortality, infant and child mortality, Tuberculosis cure rates, case fatality rates from malaria and other disease burdens like HIV/AIDS. Confining the few doctors to one employer, denies the majority of Zambians who seek care from private institutions.

As far as we are concerned, private institutions serve Zambian citizens and public service workers, in their time, work in these institutions for the same purpose of serving the public and improving health indicators.

This restriction, if followed, will impact the attainment of Universal Health Coverage (UHC) which implies that all citizens have access to health services of the highest quality.

It is no doubt that today, the public service boasts of highly qualified medical doctors.

Therefore, this directive, denies the members of the public access to quality health care of the highest standards as envisioned by the very government.

The Association wishes to clearly state that it is not a crime to opt for private health care by members of the public and that private sector contributes significantly to meeting the targets set by the same Ministry, reducing unemployment rates and contributing to GDP through various taxes.

The Ministry should remember that regulation no.86 has been in existence for a long time and equally dual appointment for senior doctors has been in existent for a long time.

The dual appointment in service areas as well as academic institutions has benefited the ministry greatly as at one time, only the University of Zambia had Specialist to teach, mentor and supervise doctors in the public sector.

Therefore, government should not turn its back on its universities that produces the very critical human resource it employs by denying senior doctors honorary appointment in public and private universities.

Failure to recognise the close relationship and need for dual employment in service areas and training, Zambia will not produce any quality locally trained doctors.

We shall have to rely on foreign countries like Cuba or India to donate doctors like in the neighbouring countries- an unacceptable situation!

The association has noted the growing trend of the ministry to push policies inimical to the development and progression of the profession in Zambia.

Such policies are passed unliterary without any prior consultation with ourselves.

We wish to remind government, Zambia doctors have sacrificed a lot, given up so many of their rights as workers for the sake of saving the public.

Some of the sacrifices we have endured are as follows;

  1. About 138 junior doctors employed last year have gone 7 months without pay!
    A sad situation which is equivalent to casualisation of the medical profession. We have not raised a finger against this injustice
  2. Doctors went for 5 straight years without a pay raise until this year when they received a nominal rise that is not even worth talking about.
  3. Resident doctors are currently being underpaid their fuel allowance for the past 5 years and have continued to live on the promissory note of the “issue being rectified”.
  4. Specialist doctors are being deployed to all provincial hospitals without a corresponding match in their pay. This too is tantamount to abuse of employees.
  5. Doctors in the public-sector work with limited resources and have gone without complaining.
  6. Licensure fees hiked to unthinkable amounts without any regard for what doctors get paid.

The public may wish to know that government has no jurisdiction to what an employee does outside their working hours.

While we appreciate that medical doctors are on duty all the time, in case of an emergency, government has got no right to abuse these overworked and underpaid workers!

The Permanent Secretary should also be reminded that the President of the Republic of Zambia, Mr Edgar Chagwa Lungu, instructed senior civil servants to engage in meaningful economic activity such as farming.

This gesture was followed by extension of cheap loans through the Public Microfinance Company.

The Ministry should tell us whether they have disregarded this policy direction from the head of state.

The Association recognises that farming, is not the only economic activity medical doctors can and should engage in. The Ministry should also realise that Senior Doctors play a critical role to raise critical revenue for the public institutions through high cost services, consultancy services and Research.

We need not remind government that should our members withdraw labour based on this directive, there will be massive disruption of service as most hospitals will lose out of the critical funds realised from High Cost, Consultancy and Research.

It is no hidden secret that government funded facilities do not receive their Monthly grants as it should be and the catastrophic effects of this directed will have far reaching consequences facility funding.

ZMA is aware that our members are actively paying tax on income realised through private practice and various consultancy services.

ZMA shall not stand aside when government passes policies meant to impoverish the profession.

However, we shall continue to support progressive and meaningful policies aimed at improving health outcomes and Health Finance such as National Health Insurance.

We remain open to discussions aimed at improving the profession and the health sector!

Issued by: Dr Francis Mupeta
Secretary General
16th May 2018

Ministry of Health circular

ministry of health circular
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