CORE COMPETENCIES IN HUMAN RIGHTS FOR HEALTH PROFESSIONALS

1. CORE COMPETENCIES IN HUMAN RIGHTS FOR HEALTH PROFESSIONALS • PERSPECTIVES AND EXPERIENCES WITH REGARDS TO HUMAN RIGHTS IN HEALTH PROFESSIONAL EDUCATION IN ZIMBABWE • Presented by: Dr P S Makurira MBChB (UR) LRCS/P (Glas);LRCS,LRCP (Edin); FCPCZ, MBA (NUST) Chairman • Medical and Dental Practitioners Council of Zimbabwe • UNIVERSITY OF CAPE TOWN 5 – 7 JULY 2006

2. MEDICAL AND DENTAL PRACTITIONERS COUNCIL OF ZIMBABWE – PERSPECTIVES

3. TO BE THE REFERENCED REGULATORY AUTHOURITY IN PROMOTING EXELLENCE IN STANDARDS OF HEALTH CARE, EDUCATION AND ETHICS. MISSION STATEMENTTO PROMOTE THE HEALTH OF THE PUBLIC THROUGH LICENCISING, EDUCATION AND REGULATION OF THE MEDICAL AND DENTAL PROFESSIONS.OUR CORE VALUESETHICS PROFESSIONALISM JUSTICE CONTINUOUS QUALITY IMPROVEMENT

4. WHAT IS HUMAN RIGHTS • Human Rights in general refers to all those aspects that we are entitled to by virture of being human beings. Components of Human Rights Human rights is a diverse subject. The following are some to the components of Human Rights, which include: • Right to food • Right of access to treatment • Right to respect and dignity which is inherent in humans. • Right to equal access to the public service of one’s country • Right to enjoy the best attainable state of physical and mental health etc.

5. HIPPOCRATIC OATH Every doctor when they qualify is required to sign the Hippocratic Oath issued as the “Medical Code of Ethics” (Geneva Declaration 1948) “ ….. I solemnly pledge myself to consecrate my life to the service of humanity ……………. I will practise my profession with conscience and dignity; The health and life of my patient will be my first consideration; I will respect the secrets which are confined in me;……My colleagues will be my brothers: I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient; I will maintain the utmost respect for human life,……even under threat, I will not use my medical knowledge contrary to the laws of humanity…..” The supremacy of the right to life is the basis of all we as health care professionals.

6. PROFESSIONALISM According to the International Medical Professionalism Project (IMPP) professionalism is defined as the basis of medicine and contract with society. It demands the interests of patients above those of the physicians, setting and maintaining standards of competence and integrity and providing expert advice to society on matters of health. It is of paramount importance that the principles and responsibilities of professionalism, which in essence are the precepts of Human Rights, must be clearly understood by the health profession as well as the society whom we serve. ATTRIBUTES OF PROFESSIONALISM • Competence • Practitioners should be competent in their area of practice. Thus they should be equipped with skills and must have the ability to detect any forms of abuse when presented with such cases.

7. Honesty Practitioners should realize their limitations. They should not misrepresent in given situations. Confidentiality Practitioners should only release information about their patients when it is absolutely necessary. Where doctors have a dual responsibility, they should be as professional as possible. The problems of dual loyalty are universal to all countries. Appropriate relationship Have the appropriate scientific knowledge. • Maintain trust by managing conflict of interest. • Be knowledgeable of one’s professional responsibilities i.e a) Clinical knowledge b) Communication skills c) Ethical and legal understanding

8. LAWS ON HUMAN RIGHTS IN ZIMBABWE • Chapter 3 of the Constitution of Zimbabwe provides for the declaration of rights and Section 15 of the said Chapter articulates protection from inhuman treatment.. In addition, Zimbabwe is a signatory to the following Human Rights Conventions. • Universal Declaration of Human Rights, Article 5 • International Covenant on Civil and Political Rights, Article 7 ( I C C P R ) • African Charter on Human and People’s Rights, Article 5 • Convention against Torture and other Cruel Inhuman or Degrading Treatment or Punishment. This is augmented by a variety of Acts and Charters which include the:- • Patients Charter • Child Protection Act • Sexual Offences Act • Domestic Violence Bill • Zimbabwe is in the process of forming a Human Rights Commission.

9. Council Regulations • Rights of Patients • The Medical Professional Conduct Regulations published in Statutory Instrument 41 of 2004 Section 21 provides for patients to consult other practitioners. This recognizes the rights of patients to freedom of choice. • Section 5 of the said regulations also requires every practitioner to provide 24 hours of medical coverage to members of the public or his patients, this recognizes the rights of patients to access to treatment at all times. • Section 5 (2) provides that a practitioner shall advise his patients or members of the public where to obtain medical services when consulting rooms are closed. In addition, section 136 of the Health Professions act (Chapter 27:19), provides for the observance of the rule of Natural Justice. Clearly these regulations strengthen the mainstreaming of human rights in the medical and dental professions.

10. Experiences • As a regulatory body, first and foremost we have to ensure that every practitioner wishing to practice medicine in Zimbabwe must have gone through the requisite medical training. In our case the basic MBChB and BDS, which is offered meets minimum standards as evidenced by the Curriculum. • With regards to the foreign qualified practitioners, we assess the applications and use information exchange including Certificate of Good Standing to ensure that the practitioner meets the minimum requirements to practice. Unfortunately, Zimbabwe has had the experience of unpleasant characters like Michael Swango –”A Convicted Felon” Some doctors who come to the country without proper registration and proceed to do surgical procedures with adverse outcomes (examples are there) The challenge has been the non-cooperation of some regulatory bodies in assisting to trace some of these doctors. The usual disciplinary process takes place in cases of violations that registered members may commit.

11. HIV / AIDS is a challenge and of concern is that it raises a lot of human rights issues. Many people could be saved if the prices of the life prolonging drugs were reduced.The national effort has seen the reduction of the prevalence rate from 24,6% in 2004 to 20,1 % in 2005. Continuos Professional Development , CPD is a requirement for annual licensing. This is done to improve competencies for all registered members and the MDPCZ has been granted permission by the General Medical Council (GMC) to adapt and adopt its ethical guidelines. These will be distributed to all registered members in an effort to conscientise and educate all registered members and students (medical and dental).

12. WHAT KEY COMPETENCIES ARE REQUIRED? • The key competencies needed by health professionals are many and varied. The major ones are:- • Awareness of the ethical guidelines and laws and regulations that apply. • The ability to detect cases of abuse in different settings e.g. domestic violence, child abuse, etc • The need for continuous professional development • Counseling skills . We believe that the issues of human rights have been mainstreamed into the core business of the medical and dental professions and indeed other health professions in Zimbabwe. The core values we espouse of ethics, professionalism, justice, and continuous quality improvement encapsulate this. In conclusion, these core values can only be achieved with a holistic approach to the following challenges which humanity faces especially in the third world.

13. The need to address the brain drain. • Do the developed countries have Rights to professionals trained in poor third world countries whilst their populations suffer from a lack of services by qualified personnel? • Is it time to create subsidies for health care professionals who work in the most disadvantaged areas? I believe that these are key considerations as we draw up a paradigm shift in the realm of human rights. I THANK YOU