19/09/2026
OPEN LETTER TO PROF. ROMA CHILENGI, MINISTER OF HEALTH
THE IRONY OF A SYSTEM THAT HAS BECOME A BOTTLENECK IN MEDICINE
Dear Prof. Roma Chilengi,
Firstly, congratulations on your appointment as Minister of Health.
As you take up this important responsibility, I believe Zambia needs an honest conversation about medical training, internship, licensing and employment.
The discussion around unemployed doctors is often reduced to one question: When will Government employ them?
But perhaps we are asking the wrong question. Government does not have to employ every doctor Zambia produces. The bigger question is whether our system allows competent doctors to become fully registered and compete in the wider health economy.
After approximately six years of medical training, our graduates proceed into internship as Junior Resident Medical Officers (JRMOs). During this period, they are not merely students observing healthcare. They participate in actual healthcare delivery while completing supervised clinical training. I am not proposing that internship be abolished.
Internship is important. Supervision is important. Competence is important. Above all, patient safety must remain non-negotiable.
My concern is where internship sits within our training pathway.
When universities continue producing doctors but internship capacity does not grow at the same rate, we risk creating a bottleneck between graduating from medical school and obtaining full professional registration.
Interestingly, the HPCZ 2022–2026 Strategic Plan itself identifies the “increase in the number of health professionals, training institutions, students and health facilities” as an opportunity.
CAN ZAMBIA LEARN FROM INDIA?
India provides an interesting model.
Under India's National Medical Commission regulations, the Compulsory Rotating Medical Internship is expressly defined as an integral part of undergraduate medical education.
After passing the final MBBS examination, a candidate undertakes at least 12 months of supervised rotating internship, completing prescribed practical competencies under qualified supervision. Satisfactory completion is required for the award of the MBBS degree and permanent registration.
That raises an important question for Zambia: Why can't we examine a similar model adapted to our own healthcare system?
Instead of universities producing medical graduates who must subsequently compete for limited internship opportunities, perhaps internship-level competencies should become an integral and properly planned component of the medical training pathway.
If six years are insufficient, then let us consider restructuring medical training itself. Perhaps the programme becomes seven or seven-and-a-half years, with the final 12 to 18 months dedicated to intensive supervised clinical practice equivalent to the current JRMO period. These doctors would still work in hospitals.
They would still participate in ward rounds, emergency care, calls and patient management under supervision.
They would still rotate through the required clinical disciplines.
They would still maintain logbooks and demonstrate prescribed competencies.
Therefore, integrating internship into medical education does not mean losing the healthcare services currently provided by JRMOs. It changes where that supervised period sits within the professional training pathway. At the end of this training, there should still be a rigorous national competency or licensure assessment before eligibility for full professional registration.
This is not about lowering standards. We should not lower the bar. We should redesign the pathway to the bar.
SEPARATE LICENSING FROM GOVERNMENT EMPLOYMENT
Government employment and professional licensing should not be treated as the same problem.
Government should employ according to public-sector needs and available resources. But once a doctor has completed accredited training, satisfied all supervised clinical competencies and met HPCZ requirements, that doctor should have a clear pathway to full registration. They can then compete for opportunities in Government, private healthcare, NGOs, research, academia, occupational health, corporate health, healthcare entrepreneurship and other areas of the health economy. Those who meet the requirements of other jurisdictions can also pursue international opportunities.
After this stage, doctors can subsequently pursue postgraduate specialist training according to the applicable requirements.
Honourable Minister, I therefore propose a national technical review of our medical training-to-licensing pathway, bringing together the Ministry of Health, HPCZ, HEA, medical schools, teaching hospitals, Zambia Medical Association, private healthcare providers and medical students. Let us study the Indian model and determine what Zambia can learn from it. Let internship remain. Let supervised practice remain. Let rigorous competency assessment remain. Let HPCZ regulation remain. Let patient safety remain paramount. But let us remove unnecessary structural bottlenecks.
We should be training doctors not merely for the Government payroll, but for the entire health economy. The answer may not be for Government to employ every doctor Zambia produces.The answer may be to build a system in which Government does not have to.
Congratulations once again on your appointment, Prof. Chilengi.
Elijah Njabuka Musonda
Ministry of Health Zambia
Zambia Medical Association
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