AFRO-NETS> RFI: MDs employed by the State and private health sector (5)

[Zakariaou Njoumemi <njoumemiz@hotmail.com>]

RFI: MDs employed by the State and private health sector (5)
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We should probably emphasise the economics of regulation within the 
health sector:

In many African countries, the regulatory mechanisms are largely in-
effective in the private health sector, due to inadequate Ministries 
of Health capacities for enforcement. From an economic perspective, 
one crucial dimension of regulation is concerned with the rules af-
fecting private use of public resources such as the multiple job-
holding by government employed in the health sector. Part-time pri-
vate or dual practice by government-employed medical personnel seems 
to be widespread in Sub-Saharan Africa.

Many government-employed physicians, senior nurses, nurses, nursing 
aids, midwives and laboratory technicians have today engulfed in the 
part-time private practice by consulting sick people, diagnosing ill-
nesses and writing out prescriptions, but also operate mini-clinics 
in total defiance of the regulations in place. In theory, this could 
have some negative effects on the actual quality of care received by 
patients. First, the location of such informal part-time private 
practice or clinics is done without any consideration of the working 
environment set down by the national medical regulation. Just a room 
and the business is started. Most often, such rooms are in the homes 
of the practitioners and at times serve other purposes (sleeping and 
cooking), when not occupied by a patient. Secondly, most of such 
clinics operate with no equipment, or just the basics. However, this 
widespread of dual practices confirms the failure of government legal 
restrictions or controls over the health care professionals.

This is because, there are several actors involved in the regulatory 
process: health care professionals, managers, the ministry of health, 
commercial interests, non-governmental organisations, community and 
consumer groups. The public health policy issue is to understand the 
nature of relationship between the regulator and the regulatee. 

Within the health sector, instead of an independent regulatory body, 
there are quite substantial self-interest motives in the regulation 
process. The government-employed medical professionals are regulated 
by a group of peers who have the authority under existing legislation 
to license and sanction them. In the regulatory environment, the gov-
ernment-employed medical personnel can therefore be seen as economic 
participants with skills to sell as well as being part of a special 
interest group with interest to defend. This point of view raises the 
questions of effectiveness and transparency caused by the regulatory 
capture, because a close relationship between the regulatory body and 
the regulatee may jeopardise the implementation of regulation, as the 
regulator may be easily manipulated by the regulatees.

The incentive regulation in both monetary and non-monetary forms 
could improve the positive change in behaviour and practices of the 
government-employed personnel in Africa. Assuming that the incentives 
are well implemented, the regulation could also include laws empower-
ing regulatory body to take legal action against public-providers for 
private-practice, or laws restricting such informal private medical 
practices during the public services normal working hours.


Njoumemi Zakariaou
Health Economics Unit 
Department of Public Health 
University of Cape Town 
Anzio Road, Observatory 7925 
South Africa
Tel: +27-21-406-6575 
Fax: +27-27-448-8152 
mailto:njoumemi@anat.uct.ac.za

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