By Herryman Moono
Last week, the Health Professionals Council of Zambia, HPCZ, in exercise of its powers as stipulated under the Health Professions Act No. 24 of 2009 of the Laws of Zambia ordered the Copperbelt University, CBU, to immediately discontinue offering two programmes at its School of Medicine for failure to meet set standards in accordance with the health profession Act.
Among others, the Health Professionals Act No. 24 of 2009 bestows on HPCZ the responsibility of:
- Registration of health practitioners and regulation of their professional conduct;
- Licensing and regulation of all health facilities;
- Accreditation of healthcare services provided by health facilities; and the
- Recognition and approval of training programmes for health practitioners.
- Conducting and managing professional licensure examinations
Under role (4), it is HPCZ’s role, and the only institution in Zambia, therefore, to approve ALL training programmes for health practitioners in the country, irrespective of the owner of the training institution, whether public or private.
HPCZ’s Chief Executive Office and Registrar Dr. Aaron Mujajati said HPCZ had withdrawn recognition and approval of Bachelor of Medicine and Bachelor of Surgery (MBChB) and the Bachelor of Dental Surgery after an HPCZ compliance monitoring inspection revealed, among others, gross over-enrollment of students, and an inadequate number of lecturers and the engagement unregistered and unlicensed lecturers.
This was a huge blow to the Copperbelt University, the second largest public university in Zambia.
Upon the order to CBU, however, the Higher Education Authority, HEA, in pursuant of its powers as stipulated under the Higher Education Act No. 4 of 2013 and SI No. 25 of 2016 as the sole custodian of all Higher Education Institutions in Zambia (both public and private) did direct CBU to continue offering the medical programmes suspended by HPCZ. Professor Stephen Simukanga, the Director General of HEA, states, in a media statement, that HEA has the authority to accredit learning programmes in all HEIs. Corollary, one draws the conclusion that since HEA is the sole custodian of HEIs and is responsible for accreditation of all learning programmes in these HEIs, then HEA was right to over-rule HPCZ’s order to CBU to discontinue the two programmes that fell short of HPCZ’s standards for medical training.
Debate has now ensued:
Who is right? HPCZ or HEA?
I would like to contribute to this debate as a health economist having had the privilege of studying and working with medical doctors.
With the humility of knowledge, from the economics perspective, health care provision and the demand for health care is a ‘special’ field that deserves special and meticulous treatment. Unlike all regular goods and services that we can buy off the market, the demand for health care has a special feature in that we demand health care not because we derive satisfaction or utility from its consumption, no, but because we derive satisfaction from the possession of good health, and we assume, in our decisions, that the consumption of health care will yield good health.
However, when we fall sick, we usually cannot identify what is wrong with us, and we defer the diagnosis of what our health problem is, how severe it is and what needs to be done to a medical practitioner. We thus appoint health providers – the medical doctors – as our ‘agents’ – and we want them to act on our behalf. Since the medical doctors are our appointed agents, we submit our health, safety and overall well-being into their knowledge, experience and ethical conduct, and are at their mercy. However, since the doctors will have more information about our health than we would, we find ourselves in a situation we economists call ‘information asymmetry’ – where one party to a transaction has more information than the other, and can thus exploit this. It is at this point that the training and practice of medicine attains a ‘special’ status, and requires regulation from training to practice by specialists, because the costs of having ill trained medical practitioners are high to individuals and society.
The training of a medical doctor or physician is a rigorous process that also embeds in it the principles of apprenticeship. A medical doctor, concerned with promoting, maintaining, or restoring health through the study, diagnosis, and treatment of disease, injury, and other physical and mental impairments requires, requires, as part of his or training, continuous apprenticeship from lecturers that are seasoned practitioners and are dedicated to both practice and pedagogy.
Given the special feature of health as stated above, it follows, therefore, that the training of health professionals be regulated ‘specially’ beyond the measures that would pass any college or university under the HEA. Supreme in such training regulation is the safety and competence of health care providers which would be expected to be embedded in the skills of the would be doctors who graduate from these training institutions. If this is the case, therefore, then HEA has NO competence in the assessment of the suitability and accreditation of higher education institutions to provide medical training. Such competence, however, lies with HPCZ as they are the custodians of health practice regulation, including health training.
The regulation, and thus accreditation of medical training cannot be left to the standards set by HEA, which, though meeting its requirements for a higher education institution, fail to meet the standards required of a graduate medical practitioner. As highlighted above, with regards medical training, one can see this as a two stage approach:
- An institution passes requirements for operation as a Higher Education Institution under HEA, and is thus issued with a certificate to operate as such.
- For those who wish to offer medical training, however, a second stage requires that they meet the standards and requirements for offering such programmes. Here, HPCZ enters to assess the institution’s capabilities based on the unique nature of the practice, and therefore the training of medical practitioners.
In this case, we can safely say that HEA’s instruction to CBU to continue offering medical programmes that do not meet the standards required for medical pedagogy is wrong, unfortunate and reveals a lack of appreciation of the unique nature of medical training.
Medical practice, and training, is, therefore, special. What HPCZ is doing is actually helping to uphold high education standards in the training of health workers, and this must be highly commended, especially at such a time when the quality of education in Zambia from HEA accredited institutions are losing international credibility.
As I conclude, to emphasize the special nature of medical training, let me cite part of the Hippocratic Oath which all medical doctors, as a passage of rite swear by as they graduate from their training:
“To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.
I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.
In purity and according to divine law will I carry out my life and my art.
I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.”
May the two institutions now harmonise their concerns and arrive at mutually beneficial, socially enhancing outcomes for health training in Zambia.