Sunday, June 28, 2009

90 000 doctors needed in next decade

Nine thousand. That's the number of doctors which the government this week apparently admitted it must recruit every year for the next decade to contain what is already a serious national crisis in our public health.

Yet its own policy on foreign doctors appears to have left the government in something of a quandary.

The accepted position appears to be this: the Department of Health elected to restrict the number of foreign doctors to five percent of the total number of medical practitioners in this country. But while this is in its HR policy, stakeholders say there have not yet been any moves towards enforcing it. However, it could mean reducing an already dwindling number of doctors from other countries, who want to work here, to a total of just over 1 500.

A report commissioned by the Department of Labour from the HSRC last year says that, given the fact most of these doctors work in the public service and most of these in the rural areas, the effect will be devastating.

Studies show there are more doctors who qualified in South Africa working abroad than the total number of doctors working in the public sector in this country, indicating there are serious inequities in healthcare delivery.

Africa Health Placements (AHP) has recruited 1 000 doctors - half of whom have been South African and the other half foreign-qualified, almost entirely from developed nations - for posts in under-resourced, mostly rural hospitals.

A report from the organisation shows that doctors employed by the State must treat about 34.6 million people or 82 percent of the population.

It seems so obvious. The more doctors government recruits, the better it will be for patients. Yet the limit remains.

AHP's CEO Saul Kornik says that even anecdotal evidence is revealing. "When we go and visit rural hospitals, there are often lots of patients sitting on the grass outside because there are too many to see.

"They have often travelled half a day or a full day to get there, and rural patients tend to present themselves very late.

"The more doctors there are, the easier for the patient to make the journey through the healthcare system… Where there is a good contingent of doctors, the existing health care staff no longer feel burnt out. Community service doctors then see that a particular hospital is functioning better and are now happier to go and work there too. It improves things for everyone."

Among the reasons for not expanding the recruitment policy are existing high-level G77 agreements between countries of the South which have pooled their economic interests and precluded some hiring between nations. There are also existing government-to-government contracts - particularly with Cuba, Tunisia and Germany - which allow the poaching of doctors under controlled conditions.

But a year ago, the chairperson of the advisory board of AHP, Dr Clarence Mini, again effectively warned that the government's questionable human resources plan for the health sector, based on continental agreements or not, was denying the nation a better service.

AHP, like many other interested parties, believes that much more could be achieved if the government would reconsider its policy concerning especially other African countries.

"We've said to ourselves as AHP, let's try and work with government on these agreements, specifically on the SADC countries," explains Mini.

"For an example, when the biggest hospital in Harare closed down, we wanted to know what was supposed to happen to those doctors. Do we just let them get into the next plane to London when we need them here? But then that issue of the original agreements came up again.

"Look, we understand these agreements were signed in good faith at a time when we did not need as many doctors. But the situation is different now. And now is also the time when you have doctors from the DRC coming in and becoming car guards here, which is totally unacceptable.

"We say, let's try, even if it means we work out a short-term agreement where they work not more than three or five years. But the answer still seems to be 'no'."

So while well-qualified, hard-working doctors may be ushering you in and out of your parking spot at the mall, they could be treating disease, delivering babies and saving lives. But doctors also need to feel wanted.

The HSRC's report shows that many African doctors who are denied entry into South Africa will simply go abroad - and never return. Our own doctors do that, too.

Despite overstaffing in British hospitals, there are at least 3 500 South African doctors working in Britain, a further 2 000 in the US, more than 1 000 in Canada and close to 500 in New Zealand.

Yet our annual medical school intake is less than 1 500.

In fact, the annual intake of the country's eight medical schools has remained static over more than a decade, despite the fact that the population is now 47.9 million.

In Australia, there are 2.8 physicians per 1 000 of the population. In Sweden there are 3.5 and in Hungary 2.8. In South Africa, there is an average of 0.57, with 0.36 in the public sector and 1.69 in the private sector.

Still, the key question remains. If, as Health Minister Dr Aaron Motsoaledi himself said this week, we are in a dire situation, why can't the policy on recruitment be re-examined, especially since there is no scarcity of doctors from other countries who want to work in hospitals here?

Eight years ago, Britain's National Health Service (NHS) was battling to keep up with too few doctors, so it gave itself time to work on replenishment and retention, changing working conditions for doctors and even shifting the retirement age from 60 to 65 with a special dispensation.

It went on an international recruitment drive. Now it has such an excess of junior doctors that its recruitment is mostly closed.

The long-held view of critics of the government's policy is: let's go for it, and attack our problem in the same way.

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2 Opinion(s):

Anonymous said...

A polemic. Ah, but to admit that something is wrong with the state of SA's health system would be unpatriotic, probably even racist. Besides, the doctors that left were probably racists anyway.

To get the government to admit to shortcomings that lead to emmigration in the first place, would be a good start. But that isn't about to happen, so the exodus will continue, because it is Apartheid, Colonialism or Whiteys fauly, of course. Perhaps government should seek compensation from the colonial countries that accepted the doctors, then those funds could be used to attract more Cuban doctors.

Anonymous said...

Well why don't we just recruit Sangomas into the health system. I think it would work much better. Look there is a morgue so if you need muti from humans it is on hand. Lower cost of drugs as everyone can eat leaves and bring their empty Coke Cola bottles to refill the doctors brew. I think it would work out much better.