South African medical professionals are highly sought after and valued globally, and many are now leaving the country because of a lack of trust in the National Health Insurance (NHI), among other issues, write Raeesa Khan and Mehnaaz Olla in The Sunday Tribune.
After 1994, SA had emerged as an economic powerhouse with a healthcare system that was once the envy of the continent. However, it is facing a massive haemorrhaging of skills at a time when there is clear evidence some of our medical professionals, among the best in the world, could play an important role in economic growth in the NHI implementation.
As these professionals leave, the country will have to grapple with challenging issues, including severe understaffing, overcrowded hospitals and a disparity in access to quality medical care.
Added to this is the vulnerability of rural communities as medical resources become increasingly concentrated in urban centres as the brain drain intensifies.
According to the Department of Health, South Africa has a vacancy rate of 18.6% for specialist medical personnel and 13.7% for nurses.
Interestingly, the Democratic Nursing Organisation of South Africa (Denosa) recently raised concerns about the shortage of nurses in public health facilities, even though 20 000 nurses are unemployed.
With the country’s slow economic growth and political uncertainty, the likelihood of more skilled healthcare professionals considering emigration increases, potentially harming our economic development.
Globalisation has led to increased global demand for healthcare workers. However, without substantial investment in all sectors, developing countries will continue to experience the adverse effects of migration.
In South Africa, it is evident that retaining these professionals will require government and civil society intervention. If not, the system risks collapse.
While globalisation facilitates the movement of labour in South Africa, most of the reasons pushing healthcare workers to emigrate are rooted in structural and socio-economic factors.
Further, most of these challenges are internal. The government has not adequately or urgently addressed the issues undermining the sector.
Public facilities are overcrowded, have critical staff shortages, and offer low pay, while constant budget restraints affect the procurement of resources and equipment.
Statistics show that in 2020, emigration of professionals decreased because of the pandemic. However, rates began spiralling again after lockdown restrictions eased.
The NHI has been a topic of significant discussion and debate, and its potential impact on the medical brain drain is concerning.
While the NHI aims to provide universal healthcare coverage and improve equitable access to services, its implementation has raised specific challenges and questions regarding the effect on the migration of medical professionals.
The South African Medical Association (SAMA) represents about 17 000 doctors, and according to a SAMA survey, as many as 38% of its members intend to leave the country in response to the anticipated implementation of NHI.
SAMA spokesperson Dr Mvuyisi Mzukwa said the trust between government and the profession had decreased.
In a survey by mutual financial services giant PPS, of the 2 905 medical professionals who participated (respondents included doctors, dentists, attorneys and medical engineers), 58% were pessimistic about the NHI.
They were especially concerned about capacity and infrastructure limitations, the potential financial burden on taxpayers, and government’s ability to roll out the system effectively.
Perceptions regarding NHI have been mixed; some view it as an opportunity to provide quality healthcare for all, and inspiration to help make a difference. Others are concerned about the uncertainty and changes in remuneration, job security, and the current state of the profession in this country.
Additionally, private-sector medical professionals fear the unknown. SAMA chairperson Dr Mzukisi Grootboom said doctors and nurses heading for Canada and the UK are emigrating to countries that have their iteration of universal health coverage.
Therefore, it may not be fear of the concept of universal healthcare but fears regarding the make-up and implementation of the NHI that drive this crisis.
The brain drain is a complex challenge requiring a multi-faceted approach involving government, medical institutions and civil society.
Our healthcare system should consider:
The improvement of working conditions: workload reduction, provision of better equipment and facilities, and ensuring a safe and supportive work environment.
The implementation of fair and competitive compensation and remuneration for professionals.
Funding should be prioritised for domestic medical education and training programmes that allow medical professionals to enhance their qualifications.
Retention incentives like loan forgiveness programmes or scholarships that would contribute to services in underserved and rural areas.
Developing policies to foster the positive well-being of staff. These can be designed to prevent burnout, harassment, and violence in the workplace.
Healthcare policies should also be transparent, consistent, and supportive of the needs of staff.
There is no one-size-fits-all solution to the brain drain crisis. Strategies need to be tailor-made to fit South Africa’s unique circumstances and challenges.
Comprehensive healthcare management is pivotal for achieving equitable access to quality care, improving health outcomes, and addressing the brain drain crisis.
• Khan is a Mancosa healthcare management academic and Olla is the manager of Mancosa’s School of Healthcare
Sunday Tribune PressReader article – Medical brain drain puts SA in dire position (Open access)
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