Dual Clinical Practice (DCP) policy to improve retention of Human Resource for Health in Rwanda: A cross sectional study design

Abstract

Abstract Background Despite the high demand for public services globally, the quality of services provided by public health facilities remains questionable. Poor remuneration of public sector health care providers (HCPs) prompts their migration to private health facilities. The Dual Clinical Practice (DCP) Policy in Rwanda is a promising strategy to improve retention of human resource for health in public health facilities, allowing HCPs to supplement their income by engaging in private practice alongside their public sector roles. This study aimed to explore the implementation challenges and opportunities regarding the potential reformulation of DCP schemes.Methods A cross-sectional and retrospective study was conducted across five Rwandan public hospitals focusing on evaluating the implementation of the DCP policy. Quantitative and qualitative data was collected via Key Informant Interviews (KIIs) and Joint Interviews (JIs), as well as analysis of health facility records. Data was analyzed using Atlas.ti software.Results The study involved participants from six Rwandan hospitals, with 20 healthcare providers and 32 patients participating. Qualitatively, it was found that the DCP policy was well-received, with high satisfaction among patients using DCP services (81%). However, challenges were noted in policy awareness and operational tracking of DCP engagements. Quantitatively, an increase in patient enrollment was observed in most facilities, and the DCP outpatient visits accounted for a significant percentage of total outpatient visits in some hospitals. Revenue analysis showed that while the DCP contributed to hospital income, there were concerns about the sustainability of the scheme and the adequacy of remuneration for healthcare providers.Conclusion This paper underscores the need for a multi-faceted approach involving tax authorities, hospital administration, and health insurance companies in addressing these issues. Ultimately, there is great need for collaborative efforts involving various stakeholders to revise policies and improve physical infrastructure, balancing healthcare quality with healthcare provider retention, and providing insights for similar global healthcare challenges.