We need more public sector doctors, yet many newly qualified doctors can’t get work
South Africa faces a shortage of doctors, yet we aren’t even employing all the doctors we already have. (Photo: Shutterstock)South Africa has a healthcare worker crisis. Those in power need to face it and think bigger about how to address it.
Many would have seen headlines a few months ago about doctors protesting for jobs in KwaZulu-Natal. It may have been easy to write it off as ‘just another protest’, but journalist Sue Segar decided to take a closer look at exactly what is going on.
After lots of painstaking research, this week we finally published Sue’s article. The picture she paints is a heart-breaking one. Many of the doctors who protested are lovely, inspiring young people with a passion for public service. They also saw medicine as a relatively safe job, a ticket out of poverty, yet now they are scrambling for work and struggling to keep their heads above water.
Beyond the moving details of what individual doctors are going through, the article also gets at what is arguably the biggest healthcare story in South Africa today – the pervasive shortages of public sector healthcare workers across the country. Whether it is a recent ombud’s report, annual reports from provincial health departments, or reports from community healthcare monitoring group Ritshidze, the picture of understaffed clinics and hospitals have been a consistent one for years. And of course, it is people needing healthcare services who ultimately pay the price.
The nuances of what is happening are important. It is true that we don’t have enough medical doctors in South Africa. But it is clearly also the case that we aren’t even employing all the ones we do have. In the context of the tremendous need out there, this does, and should boggle the mind.
The general explanation, and it appears to be the position of the KwaZulu-Natal health department (even though they didn’t answer the questions we sent them), is that there simply isn’t enough money to employ all the healthcare workers we need. To be fair, austerity is certainly a big part of what is going on. All nine provinces are having a tough time employing enough healthcare workers.
But the idea that austerity is just a fact of life and that people will simply have to make do with fewer healthcare workers is no solution. That those in power seem to have meekly accepted this state of affairs suggests a startling lack of vision and leadership.
It is not that the problem hasn’t been described. South Africa does have an impressive strategy document that sets out the issues and makes it clear that we need to act urgently. The problem is that, apart from some extra money here and there, not much of consequence has been done to turn that strategy into concrete and systemic change.
We won’t pretend to have easy solutions. These are complex systems with many role players with sometimes conflicting interests. But the fact that these are difficult problems is no excuse for letting them drift. Letting things drift is what gets us into the absurd mess Sue describes in KwaZulu-Natal.
In short, those in power need to face up to the seriousness of our human resource crisis and start thinking bigger about how to address it.
- Maybe government and labour should negotiate a grand new deal that sees many more healthcare workers employed in exchange for lower salary increases for higher paid healthcare workers. This is obviously easier said than done, which is why it would need all of the President, Minister of Health, and union leadership’s sustained commitment to pull off.
- Maybe the national and provincial health departments need to newly map the actual need for healthcare services and then ask Treasury for money based on that demonstrated need. Too much health funding in South Africa is still driven by historical funding patterns rather than today’s needs. Even our vacancy rates often mean little since the total posts (vacant plus filled) is disconnected from the actual need in many areas.
- Maybe we also need to face the reality that corruption and mismanagement makes the funding of our health departments a hard sell. Just this month an Auditor General presentation to parliament again painted a bleak picture of governance in our health departments. Ultimately, if treasuries are to be convinced to write bigger cheques, health departments won’t only have to make the case for more healthcare workers, they’ll also have to show that the money won’t be stolen or wasted.
- And yes, maybe NHI should be placed on hold for a few years so that the health minister and health department can focus on addressing the healthcare worker crisis. Alternatively, if NHI is really an essential part of addressing healthcare worker shortages, maybe the relevant elements of NHI (such as its rearrangement of district health management and contracting of GPs and specialists) should be fast-tracked.
Ultimately, what is needed most though is leadership that stops dodging the issue. South Africa has a healthcare worker crisis. Between treasuries, health departments, premiers, and the presidency, it is time we stop ignoring the elephant in the room.