Recognising refugees’ and asylum seekers’ skills could help tackle the critical skills shortage of healthcare professionals in South Africa with its alarming doctor-patient ratio of one to 3 198, writes Prashana Rampersad in the Daily Maverick.
It’s no secret that the country has a healthcare skills crisis, with Health Minister Joe Phaahla recently admitting that it’s worsening: in 2019, the doctor-patient ratio was one to 1 266.
With healthcare practitioners emigrating in record numbers in search of greener pastures, South Africans are facing falling healthcare standards and rising costs. About 35 000 nurses alone are estimated to have left the country, drawn by better salaries, among other motivations.
The situation has prompted the government to update the critical skills list to include an unprecedented 41 professional codes in the healthcare sector – qualifications that migration authorities commit to prioritising when allowing working expatriates to have a regulated legal stay in South Africa.
But rather than hoping and waiting for skilled professionals from other countries to choose to move to SA, there is a ready solution at hand: tapping into the skills and knowledge of refugees and asylum seekers who are already here.
An untapped resource
South Africa is seen as a desirable destination for refugees, given its comparative stability and level of industrialisation, and we host the largest number of immigrants on the continent. Official estimates say SA is home to about 2.9m immigrants. This is roughly 5% of the population.
Many are skilled professionals, including in the medical professions, but because of the non-voluntary nature of their immigration, their skills are often not used effectively.
The employment of refugees and asylum seekers tends to be lower than for other economic migrant groups and citizens. While the right to work is a fundamental human right – regarded as essential for life and dignity, and is explicitly granted to refugees in international and regional law as well as in numerous national constitutions – in practice, refugees and asylum seekers have to overcome many obstacles to work in South Africa.
For example, they usually face an uphill battle having their qualifications recognised. South Africa’s pre-immigration qualifications recognition processes, which seek to ensure the qualifications and skills of immigrants are of sufficient quality and match those deemed essential by professional bodies, are onerous, even for voluntary migrants.
One requirement, for example, is that immigrants must produce the necessary paperwork before entering the country, probably the last thing you think of packing when leaving your country in a hurry – assuming, of course, you have a functioning bureaucracy in place to access that paperwork in the first place.
And even when their qualifications are successfully recognised and pre-immigration work is done correctly, numerous barriers can still deter African refugees and asylum seekers in possession of healthcare qualifications from entering the sector.
They are also denied many protections. According to one study, the South African Government is increasingly using national security as a motivation for limiting asylum seekers’ access to the labour market and socioeconomic programmes. And, as the UN Refugee Agency (UNHCR) has also recorded, the spectre of xenophobia is never far away.
Finding the sweet spot
In my own work, I have found that refugees and asylum seekers are falling between the cracks of the respective regulations of the Refugees Act and the Immigration Act. While the Immigration Act, 2002 (Act No. 13 of 2002) and its critical skill list should, in principle, allow refugees and asylum seekers to enter high-skilled labour markets, the Refugee Act restricts critical skills visas to economic migrants.
Work needs to be done to identify a “sweet spot” between the regulations as a way to ease the path of refugees and asylum seekers finding themselves in South Africa, and allow them to do the work for which they are qualified, easing the country’s own skills deficits.
The cost to our country of not doing so is illustrated by the story of “Dr Futu”, a medical doctor who left the Democratic Republic of Congo due to its political instability. In Critical Skills, a short documentary released in 2021 by the Scalabrini Centre of Cape Town, Futu speaks of the challenges of entering South Africa and trying to get his qualifications as a medical doctor recognised here. Unable to do so for now, he finds small jobs such as welding and trench digging.
“Being a doctor was a dream,” he said in the film. Sadly, in South Africa, that dream is on hold. Meanwhile, the scarcity of healthcare workers in public hospitals has reached crisis levels.
The “problem” of emigration could easily be solved by reframing the “problem” of immigration. With more efficient systems that recognise the skills and knowledge possessed by asylum seekers and refugees, they could be a boon for South African healthcare, allowing us to replace, faster and more effectively, the physicians, dentists, nurses and other medical professionals leaving our shores.
This would also free refugees and asylum seekers from the cycle of structural poverty and socioeconomic dependency on the state. It really is a win-win situation.
The question is: what will it take to ensure the country steps up to take it?
• Prashana Rampersad is a Bertha Centre scholar currently completing her MPhil in Inclusive Innovation with the University of Cape Town Graduate School of Business (UCT GSB).
See more from MedicalBrief archives:
SA healthcare on collision course with staffing crisis and growing disease burden
Bureaucracy strangles specialist nurse supply in SA
SA nursing under threat as UK, Canada lure staff to address crippling shortages
More investment in health workforce critical for future of SA – World Bank