Hospital Association of SA Chief Executive Officer, Dr Dumisani Bomela, says HASA is “perplexed” by the omission of medical skills, in particular nurses and doctors, from the Department of Home Affairs’ recently released Critical Skills List, reports MedicalBrief. HASA, which represents the private hospital sector, urged a government rethink.
As reported in MedicalBrief last week, the latest Home Affairs Critical Skills List, which determines eligibility for a work visa or permanent residence, lists no medical or allied professions as being in short supply.
The previous, Critical Skills draft, list included General Practitioners as a desired skills category, but no longer. from the 101 occupations listed in the final list, registered mental and child and family health nurses, have also been removed. It records a need for nurse educators
In previous iterations of the list, hospital superintendents, general doctors and specialist doctors, hospital and retail pharmacists and nursing professionals had been included on the critical skills listings.
Bomela said that HASA’s presentation last month on the proposed National Health Insurance to the Parliamentary Committee for Health, “made clear how far behind we are in terms of medical skills available and how stalled our production of these skills has become over the years.”
HASA pointed to OECD statistics that show South Africa lags far behind a basket of comparative countries for nurse and doctor numbers per 1,000 inhabitants with ratios of 1.3 (Turkey 2.1; Russia 8.1; Norway 17.8) and 0.8 (Turkey 1.9; New Zealand 3.3; Austria 5.2) respectively. “In the category active medical schools per million inhabitants, South Africa’s ratio of 0.16 similarly lags behind countries like Libya (1.88), Brazil (1.50), and Colombia (1.15), Bomela said.
“Leaving out skills previously included on the critical skills list sends the message that we have overcome the problem we had – but that is simply not the case. It cannot be, as the nursing profession has already long struggled to attract new recruits, a situation that is exacerbated by the amendments to the nurse training curriculum and the accreditation of training facilities that has stalled the numbers of new nurses being trained – in a moment when a significant number of nurses in the profession are already over 50 years of age and will be retiring soon.”
“It is furthermore difficult to reconcile the 2030 Human Resources for Health Strategy which, for instance projects a shortage of 34 000 nurses by 2025 if nothing is done to attract and retain falling numbers of nursing aspirants, with this critical skills list,” said Bomela.
The shortage of nurses and doctors and the slow development of medical skills pose serious questions for healthcare delivery now, and in the future under the proposed universal healthcare service system, said Bomela.
“If anything, in the first two waves of COVID when medical staff were laid low through infections, we came to see very clearly how threadbare our human resources for health are and how vulnerable these shortages make the healthcare system. Nor, frankly, was the vaccine drive left unaffected by the shortage of medical staff – as we know, the vaccine rollout slowed to a trickle at times due to staff shortages.”
“Our national situation is clear,” says Bomela, “we are not training enough medical skills to overcome existing dire shortages in doctors and nurses in general, and particularly among specialists and nurses with specialist skills. Already, medical facilities are struggling to fill posts.
“Already, faced with a shortage in this country, the association has had to lobby government to enable members to recruit nurses with specialist skills from overseas. Already, in various parts of the country, specialist skills are in such short supply that waiting lists are lengthening beyond months and into years.
“We must continue to use the critical skills list as an immediate solution to an existing acute problem,” says Bomela, “while we work to overcome our longer term human resources for health crisis.”
HASA called on the government to amend the critical skills list to include medical skills required not only to facilitate critical care, but also to pave the way for the efficient operation of the public health system which is the bedrock for the proposed universal healthcare system.
Attorney and Democratic Alliance Shadow Minister of Labour Michael Bagraim said: “In last week’s SONA, President Cyril Ramaphosa touched on the subject, and at least acknowledged that the critical skills list had not been updated since 2014. However, he said the list followed on from ‘detailed technical work and extensive consultations with business and labour’. The real problem is that the updated list does not contain any medical personnel. The question is answered in the following statement: ‘The updated list reflects the skills that are in shortage today, to ensure that our immigration policy matches the demands of our economy’.
“In essence, the president does not believe that the health of the country has anything to do with the economy. There appears to be a strong inference from the presidential statement at SONA that medical skills need not be taken into account and are secondary to the individuals who will be brought in to try to get the engine room of the economy up and started again. This myopic take of critical skills needed is typical of a government that cannot exercise lateral thought at all.”
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