Two dozen young doctors are sitting at home unemployed after completing their training – funded by the Free State government through the Nelson Mandela-Fidel Castro (NMFC) Bursary programme – and their community service, despite being contractually obliged to work for the province for the number of years for which they were funded.
They said their appeals to the provincial government had been unsuccessful – yet while authorities acknowledge the dire situation, “employing these young professionals after internship and community service is not a statutory obligation”, they said.
According to *Thabo, one of the programme’s beneficiaries who asked to remain anonymous, all efforts to obtain jobs had been fruitless.
“We’ve been to the MEC’s office, the Premier’s office, we’ve spoken to the Health Department HoD, but no one seems to be taking accountability. They just bounce you to the next person… there’s no real sense of urgency about what’s happening …in the hospitals, with the [staff] shortages, the patients or even us, as their investments,” he told Daily Maverick.
Waiving obligations
The cohort sent a memorandum of demands to the Premier and Health MEC in January, pushing for appointments in local facilities.
In a response, Free State Health HoD Masechaba Sesing confirmed that the bursary policy places “a contractual obligation … to either offer employment to bursary holders upon completion of their studies, provided there are vacant funded posts…and on the bursary holder to work back the bursary for the period of the bursary granted, should the department offer a post within three months from date of completion of the studies”.
However, “should the department not be in a position to offer employment within three months from date of completion, the bursary holder is released from the bursary obligation”.
Thabo claimed the three-month limit on the State’s obligation to employ the bursary holders was a new development, not featured in their original contracts.
In a second letter from the NMFC Bursary cohort, addressed to Sesing and dated 7 March 2025, the graduates again pleaded with the department to find a way to retain them in the public sector.
“For [the] Free State, each graduate costing R1 137 500 to R1 750 000 is an asset to address our … dire healthcare gaps. Yet, without a robust retention strategy, we risk losing these doctors to urban centres or other provinces, undermining… the province’s investment,” stated the letter.
Thabo claimed Free State Health had not advertised any positions for post-community service doctors since January.
Taking its toll
He said it was not only NMFC Bursary holders struggling for public sector posts, but also those from other State-funded bursary programmes that support medical training in Russia, China and South Africa.
He added that the crisis had taken its toll on the mental well-being of graduates, with many experiencing depression and anxiety.
“You hear from your colleagues [in the public sector] … how overwhelmed they are, and you have the ability to help, but you can’t because you’re not in the system.”
Since completing his community service last year, Thabo has found work in another province, in the private sector, but he said the large number of young doctors migrating to private facilities increased the likelihood of exploitation.
“The issue with private… they know we’re unemployed, we’re desperate. Instead of giving us the hourly rate they normally give, they reduce it because they know we’ll take whatever we can get. So, it’s tough financially,” he said.
“I’d love to come back home [to the Free State]. There’s so much potential. We’re running behind on so many things — the infrastructure, the development. I’d like to be …able to contribute to the primary healthcare system in general… But if I’m not allowed the opportunity, then obviously self-preservation is going to come into play.”
Processes to follow
Mondli Mvambi, Free State Department of Health spokesperson, acknowledged there were graduates of the NMFC Bursary programme whom the department hadn’t been able to employ, but said the necessary HR processes “must be followed in appointing them”.
“Posts must be advertised and they must apply. The department does not get enough funding … to meet all of its human resources and other pressing service delivery needs.”
If the department is unable to employ them within three months of them completing their studies, they are allowed to “ply their trade” in other provinces, the private sector, the National Department of Health or overseas, Mvambi said.
The Free State is not the only province struggling to provide posts for these young doctors.
Dr Percy Mahlathi, Deputy Director-General for Hospital Services and Human Resources in the National Department of Health, said the department was “fully aware” of the issue.
“It is not limited to students who were studying overseas or in Cuba. Even those who are studying in our own medical schools, funded by the various provinces, face the same challenge,” he told Daily Maverick, but noted that employing these young professionals after internship and community service was not a statutory obligation.
“The moral obligation is there, but a contractual obligation is no longer there. I’m saying moral obligation because when you’ve got such a huge… patient load in the public health system, you would like to have as many health professionals as possible. But when you don’t have enough financial resources, what do you do?”
Processes around the budget that was tabled on 21 May have yet to be finalised in Parliament, and Mahlathi hoped allocation would be made to employ “most, if not all” of the doctors who recently completed their community service.
“Once the provinces get funding allocations, they will prioritise those they have funded to study – there’s been an investment in those who were given bursaries, and they should be prioritised.”
He was unable to confirm when this would happen, but estimated there were around 1 300 such doctors awaiting employment.
“With these ups and downs with the budget… it has become a serious problem for the provinces. Very few people were able to be employed.”
Mahlathi was against any changes to the medicine bursary programmes, like a reduction in the number of beneficiaries.
“I don’t think it would be a good idea for governments to say, ‘Look, we don’t have money now, we’re going to stop educating South Africans’, because we will feel a terrible impact in about eight to 10 years, when we’ve actually got fewer [graduates],” he said.
Dr Aslam Dasoo, convenor of the Progressive Health Forum, said unemployed graduates of the NMFC Bursary programme were “organising themselves”, and that the forum had contacted them.
“The bursary is underwritten by the State and the forum will support their stance on the bursary being written off, provided they take up positions in the public service for a specified period when posts become available,” he said.
See more from MedicalBrief archives:
Trainee doctors in Eastern Cape petition for jobs
DoH’s ‘reckless’ failure to place junior doctors aggravates medical emigration
New SA medical schools, but employment prospects remain uncertain