…want protection against foreign counterparts
- Locals feel unprotected
- Calls to ban internship for foreigners
- High private healthcare cost blamed on foreign doctors
- Calls to establish workforce committee to control foreign influx
Healthcare space is emerging as a source of friction between local and foreign doctors, with expats standing accused of cashing in on public healthcare funding at the expense of delivering quality healthcare. The simmering tensions between local and foreign doctors culminated in the compilation of an emotionally charged letter addressed to the health minister Dr. Bernard Haufiku in September. In the letter written to Haufiku, and seen by The Patriot, NAMPath Laboratories managing director Esegiel !Gaeb, details his frustrations over the mushrooming of health facilities owned by foreigners. He alleges that practices owned by foreign doctors are solely focused on “cashing in on our health funding while also being aware of Namibia’s apparent lack of resolve to prosecute unethical and illegal practices”.
!Gaeb says the rising cost of private healthcare would result in the Government healthcare system being inundated with more patients. The letter was also forwarded to Attorney General Sacky Shanghala to probe all possible legal loopholes. Shanghala acknowledged receiving the letter but referred questions to Haufiku. Efforts to get hold of the health minister proved futile.The letter was co-signed by health professionals such as Dr E Shamena-Ronni (dentist), Dr ES Shongolo (dentist), E Afrikaner (medical technologist), Dr M Shamena (generl practitioner), F Nambahu (pharmacist) and Dr E Shooya (dentist.) Areas of concern listed by the private medical practitioners include private health service funding; regulation and private health services licensing; health service market industry protection for locals versus foreigners; protection of patients against poor treatment, over-servicing and unregulated tariffs; itinerant practice and working outside the scope of practice and registration of foreign nationals to practice health professions in Namibia. The correspondence reveals how !Gaeb warned Government of the imminent collapse of the private healthcare funding if it is not sufficiently protected. At present, the biggest chunk of funding for private health facilities is through the Public Servants Medical Aid Scheme. “We propose that a new mechanism to administer PSEMAS to control its use be put in place. We appreciate the establishment of the coordinating committee to oversee the work of the contracted administrator. However, claims for specific procedures and laboratory tests are very technical for each field and can only be verified by another professional with the same training as well as looking at international trends,” he says. He also calls for investigations into any irregular claims by health professionals, claiming: “We have names of foreign practitioners that are known to abuse the claims system.” “The Health Professional Council must also be proactive in dealing with unethical behaviour as they currently have laws in place, some, however, not watertight that they seem reluctant to apply due to lawsuits that could arise from such action.”There are also calls for the health ministry to limit the number of licences for all health facilities and practices in the country. “Licences to be limited to Namibian nationals only unless there is a specific need for a specific qualification that is not available in Namibia. Where Namibian nationals employ foreigners, the number of foreigners they may employ should be restricted and they should report annually as to their progressing in mentoring Namibians to fill these positions,” he said.
Expats in the private health sector also stand accused of overcharging patients for consultations, after hour fees for procedures, laboratory tests and medicine.“It is proposed that a national tariff setting mechanism should be put in place to replace the NAMAF recommended tariffs that are perceived to be anti-competitive. Trading hours of private health facilities must be regulated so that the working hours of health professionals in such facilities do such exceed the 12 hours prescribed by the Labour Act,” he says.Local doctors also accuse their foreign counterparts of deliberately misrepresenting themselves to the public for financial gain.“Some medical doctors, mainly foreigners, are reportedly using intern doctors or nurses to run their practices in their absence and prescribe medicine outside their scope or practice without being supervised,” !Gaeb alleges.He also shockingly claims that most foreign dental therapists mislead the public by not clearly indicating that they are not dentists.
Registering Foreign Nationals
!Gaeb is calling for proper rules and regulations for the registration of foreigners in order to control excessive in-flow of foreign practitioners in the country.“We suggest that it should be that all health professionals sit for exams by the industry and facilitated by the HPCNA.”!Gaeb also feels that the current free market system is not protecting Namibian health professionals. “A foreign workforce committee must be implemented. The function of this committee should be to ensure that foreigners coming to this country for studies or for work in health fields be controlled and monitored and once finished with their studies or Namibians are ready to takeover, their stay in the county is terminated,” he says.There also calls to ensure that foreigners are banned from doing their internship in Namibia, regardless of whether they studied in Namibia or elsewhere without the authorisation of the proposed workforce committee. He also wants foreign health professionals to be compelled to work for State institutions.“Restrictions should be applied to foreigners not to register in their practices, in health service provision, as sole traders. The very countries from which they originate, force those who would like to start businesses in their countries to be in joint partnerships with locals, why do they have this privilege in our country?” he questioned.
The local view
Local doctors, who chose to speak under condition of anonymity, said during an interview this week that: “As a foreigner you are not allowed to work in any other country just like that, but here everything is handed to you whether you are a Namibian or not. Why should foreigners be doing internships here and get paid same amount as Namibians?” questioned the health professional. One of the doctors claimed that at times foreign health professionals end up doing internship for more than three years, which is the minimum number of internship years offered by the health council. “This partly shows that some of them lack medical skills, yet they are allowed to treat patients.” “In the regions foreigners are making money by over-charging patients even for a simple appendix removal or C-section. They treat patients in private and deplete their medical aids and in the end dump them in state facilities. Without coming across as xenophobic, some of these foreigners are making a fortune from our people despite healthcare being considered as a basic need,” said another doctor. Another local doctor bluntly said: “Have you ever thought why only those who are well paid or those with medical aid seek medical treatment at private facilities, the rest of the nation must go to state facilities. This shows that the people who run the system do not trust it.”