It’s official, writes Peta Lee for MedicalBrief. There is no shortage of medical skills in South Africa. 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.
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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
Minister of Home Affairs, Dr Aaron Motsoaledi, included on the list call centre managers, investment managers, multimedia specialists, zoologists, and contact centre specialists “who can speak Mandarin, Flemish and Swedish”. There’s space for forensic accountants, but not forensic pathologists, naval architects but not surgeons.
Labour lawyer Michael Bagraim, who is also the Democratic Alliance shadow minister of labour, described the list as “lacking, to say the least”.
“They have included certain skills that are definitely not critical and other skills which could be very easily obtained in South Africa," he said. “I have noticed the glaring omission of medical professionals. It is common knowledge and accepted by government that we are short of medical professionals almost across the board, including nurses and doctors and a plethora of associated skills.
“Unfortunately, our training institutions and tertiary education institutions cannot keep up with the needs of the medical profession and certainly cannot keep up with the needs of the various institutions. Foreign qualified medical practitioners have struggled to get work permits and are often so despondent that they return to their home countries.
“This situation is destined to get worse. The government approach is rather strange in that it argues that it needs extra medical practitioners and therefore brings in people from Cuba. On the other hand, it is so reluctant to place new graduates in proper posting.
“The initial list was drawn up by the Department of Employment and Labour and has been approved by Home Affairs. This issue has been taken up with the Department of Employment and Labour who have not answered any questions.”
The South African Medical Association (SAMA) was asked for comment but had not responded by the time of publication.
Among the media criticisms of the draft list, released last year, was that it was produced under the ministerial oversight of Motsoaledi, himself a medical doctor and the previous minister of Health. That earlier list recommended the immigration of general practitioners but not medical specialists, of which there is a crippling shortage in South Africa..
This government’s earlier White Paper on Migration estimated that for every professional allowed to enter South Africa, eight left. Demand for healthcare has risen in step with population growth, particularly in urban areas, and pressure on the public healthcare system is only going to increase with the implementation of the National Health Insurance (NHI).
South Africa also has a major, critical shortage of doctors. As far back as 2017, before current emigration patterns aggravated the situation there were only 25 state doctors for every 100 000 citizens. India boasts 70 doctors per 100,000 people and Brazil has 189 per 100,000.
South African graduate doctors continue to lack confidence in state healthcare facilities, while foreign doctors were more willing to work there. A recent study by Econex showed that up to 80% of newly-qualified doctors chose not to work in public health facilities.
A survey in 2019 by researchers at the University of Cape Town into mental health care in the country found that only three provinces had child psychiatrists in the public sector.
The situation regarding specialists like nephrologists is equally dire. A study by the University of Stellenbosch (reported in MedicalBrief last October) analysed the country's nephrologist workforce between 2002 and 2017 and current training capacity, then used this to forecast the nephrology workforce for 2030.
“At the current rate of production of just eight nephrologists per year and with 71 nephrologists expected to leave the profession in the next 12 years, the nephrologist density in 2030 is forecasted to be 2.6 per million population (174 nephrologists),” wrote Professor Razeen Davids, the lead researcher and head of Stellenbosch University's division of nephrology.
There were no nephrologists practising in the North West and Mpumalanga provinces, and only one each in Limpopo and the Northern Cape.
Last year, the SA Medical Association (SAMA) told parliamentarians that thousands of local doctors might emigrate if the NHI were adopted in its current form. SAMA criticised the Bill for lacking essential detail and warned about the “uncertainty and anxiety” it was causing in the medical profession.
SAMA warned that in its current form, its 12,000 members did not support the NHI, a poll of its members had found. Around 78% of respondents did not believe the NHI proposals would improve healthcare services in the country.
SAMA had included a question about emigration when it polled its members about the NHI proposals. A total of 38% said they wanted to emigrate, 39% said they would not and 17% were unsure.
The nursing shortage is also dire. According to South Africa’s 2030 Human Resources for Health Strategy, if nothing substantial is done it is projected that by 2025, there is likely to be a shortage of about 34,000 registered nurses in primary health care.
Almost half of South Africa’s nurses due to retire in the next 15 years and with only universities accredited to offer the professional nurse programme there will be an almost 80% drop in new nurses in three years’ time. According to 2020 statistics from the SA Nursing Council (SANC), the current age demographics of registered nurses and midwives are heavily skewed towards older practitioners, with fewer than a third under 40. The statistics show 27% of registered nurses are in their 50s, 26% in their 40s, and only 21% in their 30s.
As reported in March last year in MedicalBrief, budget cuts and the shortage of specialist nurses have left some of the country’s hospitals with hundreds of unfilled critical posts. Former Health Minister Dr Zweli Mkhize had blamed these two factors for the high number of vacant posts at the Dr George Mukhari Academic Hospital in Pretoria.
There were 544 vacancies at the George Mukhari and 357 of these were for nursing professionals and clinical professionals. A further 79 posts were for health professionals such as dieticians, medical technologists, radiographers and respiratory therapists.
This is a free-to-use MedicalBrief article produced under Creative Commons Licence. We ask republishers only that they acknowledge MedicalBrief as the source and if possible link to the original article.
New Critical Skills list