From Labour governments which downplayed the issue of private practice after normal working hours by medical specialists employed in the public sector (Ministry of Health) and often looked the other way to the MSM-MMM regimes, which claimed to be more socialist and were dead against such practice, the subject of private practice has suffered the whims of every Minister of Health.
In the middle of last century, the number of such specialists was very limited, and practically all of them worked in Government hospitals. However, as some private ‘clinics’ opened, they called upon this same pool of specialists to provide their services, with the blessings of the people in power and for good reasons: the latter, including the Governor and colonial officers would not attend the public hospitals for their medical treatment, and saw the specialists in private. In fact, then it was the Governor who officially granted the privilege of private practice, later to be delegated to the Ministry of Health.
In the 1980s, feeling that there was an adequate number of doctors (specialists and generalists) to man the private and public sectors separately, and because of abuse of the privilege by some specialists of the MOH (being found in private clinics during normal working hours), government decided to abolish that privilege for the specialists. Though the then Labour government had hinted that it wanted to apply this rule, as suggested by Health minister Dr Ghurburrun, it was left to Dr Nababsing of the MMM in 1992 to deal the death blow to private practice. He even said in Parliament that if 40 specialists were to leave the service, he would be able to replace them. Many experienced doctors left that year, and the replacement never came.
A collateral fallout of Dr Nababsing’s policy was that many consultant posts were suddenly vacant and were filled in by specialists with much less experience. They found themselves being promoted overnight to be in charge of specialised departments, whose functioning was affected adversely, in particular where discipline, management and clinical acumen were concerned. The losers were naturally were the public, those 75% of the population who resort to government institutions for treatment as they don’t have the means to go to private clinics.
This happened because the administrators at the MOH, as always, used a hammer to kill a fly: instead of disciplining the specialists who were the ‘brebis galeuses’ (whose services they themselves availed off as and when), they put the blame on all the specialists so as to have good conscience vis-a-vis the public. And when the hue and cry had died down, the ‘brebis galeuses’ simply carried on as usual, with blessings from higher up…
Things are no longer the same
Some 50 years ago specialists’ salaries placed them at the fifth level in the civil service hierarchy; nowadays it is more likely to be much lower down. Yet society still expects professionals who have been degraded and demoted to continue in their ‘noble’ pursuit while some two dozen posts in the civil service have claimed superiority over them. Can they go on playing the ostrich?
How should society reward its members who have spent some 10 to 12 years at university, in the prime of their lives, after spending millions and sweating through to obtain get a postgraduate seat? How could their Permanent Secretary or SCE, who may have been to university for 3 to 5 years at most, get a salary almost double theirs? A just, democratic society has to address such a discrepancy.
In the 90s, following Mr Nababsing’s decision, there was frustration in that there were two categories of SPs: one with the privilege of private practice and one without. How could the Ministry achieve efficiency when its employees were exposed to this two-tier unjust system? It was left to Navin Ramgoolam in 1998 to rectify this anomaly.
And gradually even the Pay Research Bureau recognized the pertinence of the demand of the specialists that they were underpaid. Thus came the tacit understanding that government specialists would continue to draw less than the heads of administration, but they would be allowed private practice to make up for their lower pay .
Meanwhile, the fear of private sector specialists for unfair competition from their public sector colleagues is natural but unfounded. Especially in the present context when more people with health insurance are going to private clinics. Besides, there is the irony that official policy has allowed more and more foreign specialists to come and practise in our Republic’s private institutions. As the ageing Mauritian private sector specialists retire, who will man the private sector if on top of that public sector specialists are not allowed in the private clinics. Is it the intention to import more foreigners?
If government persists in applying the sledge-hammer policy, we may well end up with the 1992 situation when the most experienced elements in the public service left. It is not the Minister but the poor patients in the government hospitals who will suffer the collateral damage.
Another aspect to this debate is whether stopping private practice for public sectors specialists will motivate the best to join the service? The state is encouraging every Mauritian to become a successful, happy capitalist – while expecting doctors to be devoted socialists!
Will Mr Gayan cross the line and go down in history like one of his predecessors: as someone who had demotivated and decimated the specialist cadre in the public sector, the negative effect of which is still being felt by hospital patients even after 25 years?