Doctors employed in public service should not be involved in private practice.

This is one of the recommendations made at a recent  consultation held by members of Civil Society in Grenada to look at the island's health care needs.

The meeting attracted representatives from Non-governmental Organisations in the country, as well as the Grenada Union of Teachers (GUT), Grenada Chamber of Industry and Commerce (GCIC), Grenada Medical Association (GMA), Grenada Nurses Association (GNA), and Grenada Pharmacists Association (GPA) among others.

The officials looked at a draft policy document that was prepared by the Ministry of Health that focused on Private Practice in Public Facilities.

There have been growing concerns in recent years that several doctors hired by the State to perform duties at the island's medical facilities do not show up for work on many days and that the public is short-changed.

It is alleged that several of the doctors have also obtained more lucrative contracts at the american-owned St. George's University (SGU) and spent most of their time at that facility.

The consultation noted the following:

* Doctors who are in public service through appointment by the Public Service Commission are granted private practice privilege via their Letter of Appointment.

* Private practice privilege is granted to doctors in consideration of the low salaries of the public service.

Private practice privilege is given only to specialists. For specialists who do not engage in private practice, an allowance is given in lieu of private practice.

* Other categories of health care providers do not enjoy private practice privileges. e.g. Nurses, Pharmacists, Therapists. However, they are permitted to engage in private work.

* The Ministry of Health does not offer adequate assistance/incentive to healthcare providers to facilitate their continuous professional development.

* Some category of consultants were overworked. For example, anaesthetists could work from 8:00 a.m. to 4:00 p.m. If on-call, duty could extend to 11:00 a.m. The next day when they would again begin the regular work day.

General Conclusion and recommendations:

The general conclusions and recommendations of the stakeholder consultation were as follows:

* There is a crisis in the health care delivery system in the country. However, most of the problems in health could be solved if Government demonstrated political will.

* Private practice is just one of the issues to be addressed in respect of health care delivery. The real issues are compensation, staffing and incentives for all health care professionals.

* There is a need for a critical and comprehensive review of the health care delivery system in the country. This should precede policy development. It must be participatory and inclusive. The entire society should be involved.

* Primary/preventative health care must be prioritised. Grenada, which once led the way in primary health care in the Caricom region, needs to re introduce a strong, vibrant all inclusive primary health care system.

* The nation needed to become more assertive in articulating its needs in respect of health care delivery.

* Specific attention must be given to psychiatric health care services with consideration for grief counseling, managing death and dying pre and post operative counselling, hospice care etc

* Policy development must not become politicised. A bad policy is worse than no policy.

With specific reference to the draft policy, the consultation noted that the purpose and the principles presently enunciated by the draft policy appeared to be divorced from people and from service.
The consultation recommended that the policy should focus on the end user, i.e the people using the service.

The following specific recommendations were proposed:

* The policy must have a key principle which acknowledges health care as a basic human right of all Grenadians.

* The policy should also adopt the slogan, "Health of the Nation is the wealth of the Nation!"

* Key principles of the policy should also address:

(i) Access to health care by the general population including the most vulnerable in community - disparities re access to health care should be narrowed.

(ii) The well-being of the patient and his/her family - persons served by public facilities should not be disadvantaged or placed at risk as a result of private practice.
The policy should ensure that there are systems and resources in place to have private practice without risk to patients served by public facility.

* Doctors employed in public service should not be involved in private practice.