A worrying turnover of specialised medical doctors in public health institutions has forced legislators to call for the revision of the retention policy to curb ongoing brain drain to private hospitals.

Rwanda maintains a four-year retention policy on doctors trained through government sponsorship before they are allowed to be employed elsewhere.

However, according to Members of Parliament, a number of the medics migrate to neighbouring countries looking for better contracts before the completion of the period, on top of failing to pay the cost of training them.

According to Theobald Mporanyi, a member of the Budget standing committee of parliament, time is ripe for revision of that policy or increment of salaries for specialised medical personnel.

“There is a need to make an exception; otherwise we are jeopardising the nature of the medical service delivery,” said Mr Mporanyi. “After all, why should someone leave after he has gained experience?

“We also need to adopt a model of ranking our medical personnel to know where the gap is and how to fill it, if not the incoming sustainable development goals in health sector.”

He said that the real issue revolves around low salary of doctors.

Although the exact number of specialised doctors who have already moved from public hospitals is unknown, a number of the institutions are reported to have lost one or two medics to better paying hospitals, mostly private.

In an interview with a medical officer working at Kanombe Military Hospital who preferred anonymity, Rwanda Today learnt that a recent poaching of a gynaecologist by a private hospital from the military facility left a huge gap in maternity wards.

“I understand that the management is looking for another doctor but negotiations have been dogged by failure to agree on a salary ceiling,” said the source.

According to the public salary scale, a specialist medical doctor is entitled to Rwf900,000 gross with a take-home of Rwf514,000 on top of fringe benefits.

This is however said to be slightly lower than what is offered at private hospitals and neighbouring countries such as Kenya and Tanzania.

In an exchange with Health minister Dr Agnes Binagwaho on the social media microblogging website Twitter, she tweeted: “The doctors we educate have a contract of retention of four years, after which they can work wherever they want.”

She did not however comment on whether the policy is efficient or if it is likely to be revised.

The 2011 World Health Organisation report on the doctor-population ratio in Rwanda puts the figure at one doctor to 17,240 people but, according to the country’s health reports, that has since gone down to 1:15,428.

One nurse is responsible for 1,200 inhabitants with 68 per cent residing in rural areas. This means an additional 930 doctors are needed to meet the accepted global standards.

It is for this reason that the programme, Continuing Professional Development (CPD), was commissioned to financially help doctors pursuing specialised courses, said Prof Emile Rwamasirabo, head of the Rwanda Medical and Dental Council (RMDC).

While Rwanda has made huge strides in health, especially ensuring access to basic medical services countrywide, cases requiring specialised treatment remain expensive and almost inaccessible.

For instance, a kidney patient requiring dialysis requires a lot of money to foot the bill at a referral hospital, else they will need to go through a lengthy transfer process from local health facilities, which might worsen his case.

This applies to expectant mothers with pregnancy complications, who are in serious need of most specialised gynaecologists. They will need to seek medical services in expensive private hospitals or leave themselves to fate.

According to officials, mainly members of RMDC, at least 80 per cent of complaints on bad medical services or damage claims received by the council are maternal health-related. But only 46 midwives work in the public sector and 75 per cent of doctors are based in Kigali, where only 20 per cent of Rwandans live.

In a country that targets close 3,500 nurses and midwives before 2017 from the current serving 800, still five per cent of all the deliveries are traditionally conducted or with no assistance by a specialised health practitioner.

Only 487 deaths per 100,000 deliveries are recorded, another reason for health experts to demand at least two permanent gynaecologist and paediatrician at every health centre and district hospital.