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Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis / Bartholomew S. Eze

DOI (Published version): 10.23889/Suthesis.51641

Abstract

Dual practice (DP) occurs when doctors employed in the public sector work concurrently in private practice. This study examines the perceived effects of DP on the public healthcare system in Enugu Urban area, Nigeria and the burden on patient finances. The study comprises a survey of 407 service use...

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Published: 2019
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
URI: https://cronfa.swan.ac.uk/Record/cronfa51641
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Abstract: Dual practice (DP) occurs when doctors employed in the public sector work concurrently in private practice. This study examines the perceived effects of DP on the public healthcare system in Enugu Urban area, Nigeria and the burden on patient finances. The study comprises a survey of 407 service users who had visited both public and private health facilities in the last year, focus groups exploring service users’ perceptions of benefits and disbenefits, interviews with DP and non-DP doctors exploring why they engaged in DP or refrained from doing so, and interviews with policy makers and senior administrators on their views of DP. Additionally, sensitivity analysis was used to calculate doctors’ hourly pay in the public sector and to create hypothetical estimates of the value of hours lost due to absences associated with DP. The estimated annual value of hours lost from DP to a single public tertiary care hospital was US$16,013 (best case scenario) and US$63,399 (worst case scenario). Benefits of DP were identified as speedier attention, reduced bureaucracy in private practice and reduction of pressure in public hospitals among others. Reported disbenefits included low commitment to public patients, late reporting and absence of doctors from work, and sharp practices. The public system was ranked higher in respect of the structure element of healthcare quality, whereas private practice performed better in the process and outcome elements of quality. The main motives for DP were seen as income enhancement followed by prestige and fringe benefits enjoyed in the public system. Reasons given by non-DPs for working exclusively in the public sector included the stress of private practice, family issues and career development. Among the different mechanisms and options proposed for managing the issue of DP in Nigeria, intramural practice appeared to command most support from policy makers and other senior stakeholders.
Keywords: Public healthcare, dual practice, Nigeria
College: Faculty of Medicine, Health and Life Sciences

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