Docs to be told where to work
President Jacob Zuma has quietly signed into law sections of the National Health Act that can prevent doctors and other health professionals opening private practices where they choose to.
All health professionals - such as dentists, dieticians and physiotherapists - who wish to open a private practice or clinic will have to apply to the Department of Health for "a certificate of need" to give them permission to work in their chosen suburb.
The certificate will be compulsory from April 2016.
For example, if a women becomes a doctor and wants to join her doctor mother in the family practice, her mother will need approval from the government, according to Casper Venter, director of the Healthman consultancy.
Sections 36 to 40 of the National Health Act have existed for 10 years but were not signed into law until late last year. They came into effect in April, but health professionals have two years in which to acquire the certificate of need.
According to the act, the aim is to ensure an "equitable spread" of doctors and other health professionals across the country.
Healthcare workers could face up to five years in prison or a fine if they run a private practice without a certificate after April 2016.
Venter said the law could affect a doctor who retired and wanted to sell his practice built up over many years. A doctor who did not acquire a certificate of need for that area would not be able to buy the practice from the retired doctor, meaning the government would need to approve to whom he could sell it.
The spokesman for the SA Private Practitioners' Forum, Chris Archer, said: "It's an experiment in social engineering. It is destined to fail. Doctors should be able to work and live where they choose."
He said he could understand the rationale of trying to ensure healthcare services and staff were provided in under-serviced areas, but the current effort would "end up on the dustbin of failure".
"The process will encourage bribes and corruption," he added.
Venter said the certificates would be an "administrative nightmare".
"There are about 70000 dieticians, specialists, GPs, physiotherapists and occupational therapists who would all need certificates to open a new practice in private. The department is not geared for this kind of [action]."
If a doctor is prevented from opening a practice in Sandton, it is not clear if he or she will then work in nearby Alexandra.
Archer said medical staff would "vote on the new law with their feet".
A doctor who asked not to be named said: "No problem. We will just leave [South Africa]."
The law states that before the director-general of health can issue a certificate, he must take into account how the health establishment "fits into national, provincial and municipal health planning".
He needs to look at whether doctors' and dentists' rooms are distributed equally across affluent and poor areas.
Elsabe Klinck, a health law consultant, said healthcare professionals need not panic.
"One of the criteria in the act is the financial viability of a practice, which would mean no one could force a practitioner to start a practice in an area where it would not be financially viable."
She said the health minister would need to write regulations to explain how the process would work and stakeholders would be able to comment on the regulations.
Department of Health spokesman Joe Maila said a certificate of need would be linked to the building in which the professional worked.
He could not explain what would happen if a certificate was denied or explain how the process would work for specialists who work at three different private hospitals, as is common.
2015 UPDATE - PROCLAMATION DOES NOT PASS CONSTITUTIONAL SCRUTINY
The law was struck down at the beginning of 2015 in the Constitutional Court on a technicality. It was found to be invalid as it had be signed into law without the regulations explaining how and who would implement it.