NHI stillborn without doctors
A critical shortage of medical doctors could hamper the successful implementation of the government's ambitious National Health Insurance.
Yesterday, the South African Medical Association singled out doctor shortages as "one of the major issues" standing in the way of the multibillion-rand scheme.
With a limited number of doctors trained each year and thousands emigrating - for more lucrative salaries and because of fears about safety at public health facilities - Sama said the government would find it difficult to implement the NHI countrywide by 2014.
The non-statutory association, which has a membership of 17 770 doctors, said the number of graduates produced each year by eight medical schools would need to be doubled for the next 10 years for the country to have enough doctors.
In addition, the government would have to introduce incentives to retain highly skilled medical practitioners and speed up the registration of foreign doctors seeking employment in South Africa.
Sama chairman Dr Mark Sonderup said the country needed to produce at least 2400 doctors a year instead of the current 1200.
Speaking at the association's offices in Pretoria yesterday, Sonderup said about 30000 doctors were registered with the Health Professions' Council of South Africa, but only 24000 were actively involved in clinical work.
"Roughly 6000 of these registered doctors are either not active or are practising outside the country while maintaining their registration with the HPCSA."
Sonderup said a recent study had shown that 23400 South African-trained doctors were registered and practising abroad.
Sama lamented the poaching of South African doctors and said South Africa was unable to poach other countries' doctors because of the working conditions here and the bureaucratic nightmare of registration.
"One has to be employed to be able to get a work permit and before you are employed, you need to be registered with the HPCSA. This takes years to do, which discourages doctors intending to work in the country," he said.
Although Sonderup commended the training of South African doctors by Cuba as helpful, he questioned its appropriateness. He said perhaps the time had come for the government to redirect these resources to increase capacity within the country.
"The other issue we are concerned about with the Cuban training programme is that we are training South African doctors in a country with a totally different healthcare system and disease burden . these Cuban-trained doctors will have to be retrained to be able to deal with the healthcare challenges of their own country," he said.
Doctors in private practice were willing to heed Health Minister Aaron Motsoaledi's call for them to work four hours a week in public healthcare facilities for the successful implementation of the NHI, but Sonderup said doctors were concerned about compensation.
"They do not want to leave their practices to be paid peanuts [by government]."
The dean of the faculty of health sciences at the University of Pretoria, Professor Eric Buch, said its current intake of medical students was 230 a year, but its training facilities were designed to accommodate only 200.
He said the university was working closely with the Health Department to garner support to build more facilities and appoint more lecturers, which would enable the university to increase its intake to 350.
"Medical education is very expensive. It costs the university about R1-million to train one doctor so we are happy with the good relationship we have with the Department of Health . With the necessary support in place, we are looking at increasing our intake to up to 400."
To achieve this, Buch said, his faculty had partnered with the Gauteng health department and the National Health Laboratories.
He said medical education relied heavily on subsidies, adding that the university was committed to working, in the national interest, to increase the number of doctors in the country.
But Motsaoledi said his department had given Wits University R8-million last year to enrol a further 40 medical students, and the other seven medical schools would be given R48-million to take 160 more students for this financial year.
"This is a worldwide problem but worse in sub-Sahara. There is a shortage of 4million health workers, including doctors, worldwide. This is not a problem unique to South Africa.
"Besides assisting medical schools financially to take more medical students, we are building another medical school in Limpopo; the only thing left now is for the building to start," he said.
Sama's public service doctors chairman, Dr Phophi Ramathuba, said the lack of management skills in hospitals contributed to the emigration of doctors.
"What we are saying has been confirmed with the recent advertisement of hospital CEO posts to recruit people with healthcare management background," said Ramathuba. He said 100 doctors would receive management training at Sama's expense.
Ramathuba said the government needed to introduce incentive programmes to attract doctors to work in rural areas.
The association's head of the public sector department, Dr Lebo Maroo, said the safety of doctors at public health facilities was the other issue driving doctors out of the country.