Impact of Physician Dual Practices on a Pediatric-Oncology Outreach-Program

Document Type : Research Articles


1 Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya.

2 Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta, Indonesia.

3 Emma’s Children Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, Pediatric Oncology, The Netherlands.

4 Department of Pediatric Oncology, Dr Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.

5 Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.


Objective: Physician dual practices (PDP) can be defined as ‘doctors combining clinical work in public and private health-sector.’ This study explores the impact of PDP on a long-term pediatric-oncology outreach-program between large referral hospitals in the Netherlands, Indonesia and Kenya. Methods: This cross-sectional descriptive study used a self-administered semi-structured survey.  The most senior doctor from each partner site was interviewed in June 2022. The survey contained 70 closed-ended and 7 open-ended questions and took 30-45 minutes to complete. Closed-ended questions were evaluated on 2-5 point rating scales. Informed consent was acquired and respondents endorsed the final report. Results: In the Netherlands an estimated 0-20% of senior doctors combine work in public and private-sector, while 60-80% do so in Indonesia and Kenya according to the respondents. In Indonesia and Kenya, most of doctors are involved in PDP to augment low government salaries. Impact of PDP on pediatric-oncology care is minimal in the Netherlands, but detrimental in Indonesia and Kenya: shortage of experienced doctors, limited supervision of junior staff, slow diagnostics and delays in chemotherapy administration ultimately lead to undermining of the quality of care and adverse patient outcomes. Conclusions: PDP adversely impact patient care at the Indonesian and Kenyan partner sites of a pediatric-oncology outreach-program. Strategies addressing PDP in resource-poor settings are required to improve treatment outcomes and survival of children with cancer.


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