Health & Fitness

Tough doctors’ licensing a step in right direction

private doctor
Tough private doctor licensing rules will help to improve service delivery in public hospitals. PHOTO | SHUTTERSTOCK 

Last week’s move by the Kenya Medical and Dentists’ Practitioners Board to issue new regulations for the two categories of licences doctors hold was a bold move and a step in the right direction.

The Council of Governors, who are affected most by moonlighting doctors, need to further collaborate and toughen the fight to eliminate this unethical practice in the public health sector.

With salaries gobbling up more than 67 percent of county health budgets, dual practice licensure essentially means taxpayers pay for a full day but at most receive less than the fully agreed hours.

Taxpayers then end up paying for the same services at clinics owned by the same staff. This is arguably one of the biggest reason for poor health outcomes in county hospitals.

Despite multiple studies being conducted on the subject, health workers do not readily accept that moonlighting causes a problem, and those who accept its occurrence, insist its roots are beyond individuals.


The practice has soiled the high esteem society places on our profession and may be responsible for the shifting terms of engagement to now shorter annual contracts.

The distinction between public and private health sector employment and salaries are not very wide, yet outcomes vary quite considerably.

For those keen on health sector reforms, there is a wind of change in the medical regulatory arena.

The striking-off of doctors from the register was perhaps a warning bell of what is to come.

Stricter supervision of licensing and registration of facilities and doctors will help streamline and conform to regulatory best-practice standards in developed nations.

No doubt past licensure had loopholes, abetting potentially close to a quarter of private facilities being operated by government-employed doctors, a huge conflict of interest.

Despite the rigours that medicine has on practice time, reading as well as allocating time for physician’s recreation and rest, dual licensing means a component of the three is affected. Ultimately this impacts on one’s practice, their health, family life or patient care quality.

As far as patient care is concerned, evidence shows institutions, where senior cadres apply themselves to daily care, tend to have better outcomes. The reverse also holds.

County government representatives must align with the ongoing wave of reforms on how public funds are spent.

They must also be better at supervision of their staff. Despite their doctors drawing full-time salaries and State benefits like pensions, the practice is to be in their private facilities and twice or thrice a week pop-in to the primary public hospital employer.

On the positive side, this rule will now also allow for better staffing ratios as shortages can be easily spotted.

The era of moonlighting doctors should end in 2020. It is a disgrace to our profession.