Herryman Moono
Herryman Moono

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:

  1. Registration of health practitioners and regulation of their professional conduct;
  2.  Licensing and regulation of all health facilities;
  3. Accreditation of healthcare services provided by health facilities; and the
  4. Recognition and approval of training programmes for health practitioners.
  5. 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 Aaron Mujajati said HPCZ had withdrawn recognition and approval of Bachelor of Medicine and Bachelor of Surgery (MBChB) and the Bachelor of Dental Surgery after an HPCZ compliance monitoring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:

  1. An institution passes requirements for operation as a Higher Education Institution under HEA, and is thus issued with a certificate to operate as such.
  2. 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:

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“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.”

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May the two institutions now harmonise their concerns and arrive at mutually beneficial, socially enhancing outcomes for health training in Zambia.

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22 COMMENTS

  1. Herryman,
    As you clearly state, the Health Professions Act No. 24 of 2009 of the Laws of Zambia gives the Health Professionals Council of Zambia HPCZ the responsibility to, among other things, recognize and approve of training programmes for health practitioners. My questions to you and Dr Mujajati are, where was HPCZ when the training programmes for medical practitioners at CBU were being proposed? Does recognition and approval of training programmes give HPCZ power to discontinue existing programmes or merely to withdraw recognition and approval of the same? These are serious questions that seek for clear answer on the mandate of HPCZ.

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    • @Zedoc(1); I believe HPCZ has the right to withdraw approval or discontinue programs. MR Moono has cited 3 reasons why HPCZ advised CBU to stop offering those programs;
      1. Over enrollment(which is a way institutions steal money) most of the times the extra students are ghost students. Over enrolling leads to sub-par education especially if one on one contact is required with professors.
      2. Unlicensed and under qualified proffessors. Enough said.
      3. Inadequate number of lecturers obviously due to over enrollment.
      If CBU can’t remedy these, then they need to shut down those programs instead of churning out half baked medical personal. We are talking about people’s lives here.

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    • 4.Recognition and approval of training programmes for HEALTH PRACTITIONERS.
      The courses being offered at CBU’s medical school are not for health practitioners, but for students. Those are not professional courses. Just like ZICA can not close down an accountancy programme offered at CBU because the Bachelor of accountancy is an academic qualification. Anything to do with academic qualifications it is the Higher Education Authority. Universities train students, not professionals who fall under Mujajati’s HPCZ

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    • CBU is providing unsafe training. They are NOT fit for purpose to produce medical professionals.

      Those of you that are not suitably qualified, or have fake and/or questionable qualifications will argue against common sense until you are blue in the face.

      Why do Zambians like taking short cuts? Always looking for the easy route.

      And you wonder why we are in this mess.

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    • IndigoTyrol, There is NO debate about the need for CBU to adhere to prescribed training standards. The issue is about the relevant AUTHORITY to close down the medical school. HPCZ does not simply have that authority. They are free to raise their concerns but encouraging them to do something which they have no authority over is promoting anarchy. Ati ‘Why do Zambians like taking short cuts?’. I thought you took the short cut when you opted to be an economic refugee!!

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    • mujajati was not given a cut which he normally receive from these bogas private universities around luska who are offering the same programme which he is saying CBU are unable to offer fo0lish Zimbabwean AARON,think befor you act or go back to your country ZIMBABWE

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    • 4.Recognition and approval of training programmes for health practitioners

      Indeed, this does not seem to mean discontinuation of programmes!
      HPCZ should concentrate on regulating already qualified professional Doctors!!

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  2. What was meant by the statement : “Recognition and approval of training programmes for health practitioners”? Training programs necessarily refers to practicals activities in the field, such as internships. The practical work for medicals must include treating patients under direct supervision of experienced trainers. Treatment of patients can not begin in the first year of theoretical studies because the first academic year is spent doing 4 pre-university subjects (A level equivalents). These generally correspond to: Biology, Chemistry, Physics and Mathematics. On that basis, the interdict from HPCZ was premature. The statement from HEA was timely and self-explanatory. It is promising for the country to take keen interest in tertiary and higher education.

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  3. HPCZ and HEA are engaged in Analysis Paralysis!
    Typical of Zambians!
    No spirit of teamwork and Collaboration!
    You can’t develop with this mindset of who was right and who was wrong! Why can’t HPCZ, HEA and CBU have a meeting to strike common ground and work towards normalizing things at CBU to alleviate the stress and uncertainty brought on the affected students? You can’t go on with endless debate about this. Stop washing filthy linen in public. HPCZ must also tone down. Much as you can be right about something, learn to approach matters in a dignified way. HPCZ must desist from addressing issues like this in the Press! Learn to reason with all stakeholders.

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  4. HPCZ is to hospitals, clinics and doctors while HEA is to universities, colleges and students.
    The key word in the HPCZ Act is “practitioners”. Medical students are not yet practitioners. Clause 4 on recognition and approval is clear: it speaks to the training of practitioners. So the mandate of university education i.e. training students; who are not yet doctors or “practitioners” in medicine, is for HEA. That’s the law.

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    • @3 and @5; the HEA need to do its job of ensuring that lecturers giving the courses before students do their practical works are licensed and competent. There is a reason fundamentals are taught first in school. Same as foundation for building a house.
      If you don’t know your anatomy and physiology, you have no reason whatsoever to practice on anyone!

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  5. What on earth is this about?

    “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”

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  6. WHERE IN THE ACT DOES IT SAY HPCZ SHOULD SUPERVISE UNIVERSITIES? DOCORS ALSO WHAT TO BEHAVE LIKE LAWYERS AT ZIALE BY LIMITING THE NUMBER OF DOCTORS. OVER ENROLLMENT MY FOOT

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  7. @ Dr. Makasa Kasonde (Private). Well put. My other problem with HPCZ is the seemingly ‘unreasonable’ way of acting: Close the program now! No warning. No nothing. Just like that? I find HEA more reasonable in their approach. Prof. Simukanga, having run a public University before, knows the reality.

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  8. I have read both the HEA and HPCZ statements. As a lecturer of 18 years in 3 different universities in Zed, RSA and Namibia, I find MR Moono and the HPCZ to both know nothing about university education. They know the product; they don’t know the process to produce it. The HEA approach was remedial. They identified shortcomings and engaged the institution to correct them in a reasonable time frame. Issues of overenrollment have been exaggerated and sensationalized by HPCZ. To the best of my knowledge CBU medical programs have not gone beyond foundation stage and most students are still going to be redirected to other schools. This has been the practice at UNZA for 50 years which has produced all the doctors in this country who are now separating cojoined twins and doing liver transplants…

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  9. Comment:
    Your analysis one sided. Kindly read the HEA act 2013 and HPCZ act of 2009, SPEIFICALLY ON THEIR FUNCTIONS, THEN U CAN MAKE AN INFORMED DECISION. FOR NOW U HAVE GOT IT WRONG BWANA ECONOMIST. READ BOTH ACTS….

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  10. Citizens, your country is being done a favour and you are busy complaining.

    CBU is not fit for purpose. Let them improve this institution so we have suitable qualified medical professionals.

    As a country, we need to reject mediocrity.

    I can not believe the nonsense that is going on under this government.

    That is what happens when you have unqualified people all over the shop.

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  11. Dr Mujajati, it seems you are over stepping your authority. When and where did you hear or read that LAZ has closed XYZ institution for this and that. All LAZ will do is to subject those half baked UNZA law students to a LAZ exam and the result will tell for itself who is properly baked and who is half baked. And now someone calling himself a health economist want to understand his thoughts only and not what is written. Is this not a shame to Mr Moono parading his total ignorance in the media. This is what is killing Zambia, even those who can read are failing to read to interpret the acts properly. It is a shame to the author of this article.

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  12. The question posed by the author is a legal one, but the author used a wrong framework (health practice) to answer it. The issue at hand is not whether the training of doctors is special or not. But who is right? HPCZ or HEA? Indeed all professions are special and as such all require special training.

    But it’s only legal bodies that can determine the validity of the conduct of either HPCZ or HEA. If there are any conflicting issues regarding authority in the empowering Acts of HPCZ or HEA, then these need to be legally resolved. The involvement of the Attorney General is just but a start as he has no authoritative power of interpreting the law.

    There is need to revisit the empowering Acts to correct and clarify which body, HPCZ or HEA, has ultimate authority in the regulation…

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