In a complete turnaround, and in contrast to previous statements and declarations by the National Department of Health that it has no money, on Tuesday, Health Minister Joe Phaahla said the government would now give jobs to hundreds of unemployed doctors who have completed their community service training.
This followed protests by more than 200 jobless doctors in Pietermaritzburg on Monday when a memorandum and list of grievances was handed to Deputy Health Minister Sibongiseni Dhlomo.
In his announcement, Phaahla said more details would be revealed by Minister of Finance Enoch Godongwana when he tables the Budget in Parliament next week Wednesday.
Initially, the government said it did not have the budget to employ almost 800 newly qualified doctors – who have been protesting for the past two months over the state’s inability to provide them with posts in the public sector, which the Minister said last week was due to budget constraints.
The state would hire them if it could, but it just didn’t have the money, he said at the time.
The march to the provincial Health Department in Pietermaritzburg on Monday to protest the decision echoed similar protests in Pretoria in January.
BusinessLIVE report that provincial Health Departments are under financial pressure because they have to honour last year’s higher-than-anticipated wage deal, which left the Treasury with a R37bn shortfall.
After implementing unprecedented in-year cuts in the Medium-Term Budget Policy Statement in November, it signalled worse was to come over the medium term, prompting provincial Health Departments to freeze posts and put the brakes on new hires.
Last week, senior clinicians wrote an open letter to the Finance Minister urging him to reverse the budget cuts, saying the hiring freeze imposed in provinces such as Western Cape was not only harming patients but jeopardising training.
Change of mind
On Tuesday, reports IOL, during the debate on the State of the Nation Address, Phaahla told Parliament that all doctors who wanted to join the department would be employed by 1 April (the start of the new financial year), and that details were being ironed out with National Treasury regarding the funding.
“We are doing everything we can to retain as many doctors, nurses, physiotherapists and others … in the public health system … The details will be announced next Wednesday … and we are working with provincial Health Departments to speed up the process so that by 1 April 2024, those who will already be in posts will be able to start.”
He said the department was not focusing solely on doctors, and would do everything it could to retain as many other healthcare professionals as it could in the public sector.
“I am confident provinces will be able to start giving appointment letters even before that date. I am sorry to disappoint political parties who were hoping to cash in on the disappointment of the doctors. The measures … will give us breathing space while we work on long term solutions.”
He confirmed that at least 100 Cuban doctors were employed countrywide in the public health system, The Citizen reports.
“They are recruited on a particular skill … All of them will be in rural areas…unable to attract people with a particular special training.”
When challenged on whether these positions could be better filled by unemployed South African doctors, Phaahla said they were in rural areas providing specialist services, and that locals were not keen to work in such environments.
“These facilities have been advertising those particular specialities for a while and have not been able to attract local doctors.”
He said while some doctors might prefer to leave the country for greener pastures, others who decide to go into private practice can work with the government and “help to provide services beyond only those who have sufficient income”.
“I am not saying people should necessarily go into private practice, I am saying it’s an option.”
However, he failed to provide the cost of setting up a private medical practice or where the young doctors would find the money to do so.
Unacceptable
At Monday’s KZN march, the frustrated young doctors said it was up to the government to find solutions, and that the state’s failure to plan for their placement – after at least six years of training – was unacceptable.
Dr Siyaneliswa Shozi, who had convened the demonstration, said their plight was a reflection of government’s failure to plan for healthcare professionals and patients in South Africa, reports News24.
“We are told there is no money but … we believe this is an issue of gross mismanagement,” he said, urging President Cyril Ramaphosa to personally hold accountable “all officials who have allowed the situation to degenerate to this level”.
Deputy Health Minister Sibongiseni Dhlomo, who accepted the signed petition from the group, said that 10 years ago, the country was producing 1 200 graduates, but the number had now doubled.
“We should realise that doctor numbers did not just increase . . . there was an increase in university intakes coupled with the doctors who had studied in Cuba,” he added, assuring the doctors that the ministry had plans to address their unemployment woes.
He said he was mindful the newly trained doctors had incurred thousands of rands in debt and needed to be employed to pay this back, but budget cuts had also “strained the department’s planning efforts”.
“Should we stop buying food for the patients? Should we not buy a new ambulance? We therefore err on the side of decreasing on human resources, including doctors,” said the minister.
Dr Siyabonga Shozi, part of the newly formed committee to deal with unemployment, told TimesLIVE the situation was not acceptable.
“Doctors should find space in government hospitals because that is where there is critical need.”
He said more than 825 doctors were without work, and the number was likely to increase, and also rejected the suggestion that they shunned rural placements.
“That is false, and we reject that perception with all the contempt it deserves. The fact of the matter is there are currently no positions.”
Public Servants Association of South Africa (PSA) provincial manager Mlungisi Ndlovu criticised government for its failure to foresee the crisis, saying unfilled vacant posts cut across a number of different job titles at health institutions.
“There are people in power to ensure the budget is available, but instead, they only wait for the National Treasury. What are they doing to mobilise funds?”
He questioned how more than R200bn could be released during Covid-19, but the same could not be done to alleviate this crisis.
“We are running the risk of losing these doctors to foreign countries. These youngsters want to serve the country… it took them six years to study,” he said.
Confusing ethics
In a separate issue, the private sector is taking on the Health Professions Council of SA about its “confusing” ethical rules on employment. The new set of rules was published in the Government Gazette on 17 November, reports Die Burger.
Mediclinic said the previous rules prohibited private hospitals from employing doctors directly. Hospitals like Mediclinic could only appoint doctors in management positions while doctors treating patients had to work independently. It is “unclear” whether the new rules changed this position, the hospital group said.
The SA Medical Association (SAMA) and Solidarity also criticised the lack of clarity in the new rules, but but HPCSA spokesperson Christopher Tsatsawane said the rules were quite clear.
Even under the old rules, private entities that are not registered by the HPCSA could employ doctors, but those entities have to be “approved” by the HPCSA.
IOL article – Phaahla announces hundreds of unemployed doctors will be hired by April (Open access)
The Citizen article – Unemployed doctors crisis: About 100 Cuban doctors working in SA (Open access)
Die Burger article – Onsekerheid oor nuwe etiese reëls vir dokters – wie mag hulle aanstel? (Restricted access)
News24 article – 'On behalf of Tintswalos, we are not happy': KZN doctors protest unemployment due to budget cuts (Restricted access)
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