R440m fraternal Cuban Brigade 'won't take SA jobs'

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Health Minister Zweli Mkhize says the deployment of Cuban doctors — apparently costing the South African government R440m — would not take jobs away from SA doctors and that the National Treasury has approved the filling of all doctors' posts previously frozen, writes MedicalBrief. The SA Medical Association says the government’s lack of consultation before bringing in 171 Cuban doctors was “flawed and wrong”.

The Cuban group consists of more than 200 people in total and consists of experts in epidemiology, biostatistics, and public health, family physicians, health care technology engineers and experts to provide technical assistance. The South African government has not mentioned costs involved but a document, purporting to be an initial Health Department budget for “187 Cuban Brigades” totalling R440m, was posted to Twitter by former Johannesburg mayor Herman Mashaba, who said its authenticity had not been established.

Business Day said it had approached the National Treasury for comment on the document, which referred them to the Department of Health. No comment had yet been received.

The documents show that the average cost of the Cuban medical brigade was projected at R2.35m a person, considerably more than hiring local talent. The document contains a proposal for spending R7.5m to accommodate 11 advisers for 345 days in Pretoria, at a rate of about R2,000 a day. Accommodation for the rest of the personnel is pegged at R121m for a year, and the total salary bill is projected at R275m.

A public sector registrar or mid-level medical officer, comparable to a Cuban family physician, now commands a salary of about R1.2m a year, according to SAMA, writes Business Day.

It quotes Western Cape Health spokesperson Mark van der Heever saying that the national health department would pay the Cuban doctors’ salaries, but the province was responsible for sourcing accommodation. According to Limpopo Health MEC Phophi Ramathuba the province needed "serious assistance", but its biggest headache was its shortage of specialists, not generalists.

Mkhize said the country was lucky to have the doctors as Cuba had already committed big numbers of doctors to other countries, including Italy. South Africa owed a huge debt to that country for continuous health care support, including training of the latest crop of 700 South African students.

The Cuban doctors would be deployed to provinces once they emerged from a precautionary quarantine period in a Pretoria hotel. This deployment would be soon, said Mkhize, given that theirs was “not necessarily the 14-day quarantine” usually prescribed.

Mkhize said finance Minister Tito Mboweni had personally given a commitment that the funding would be found for additional staff to enter the health system, Mkhize told a media briefing. The national health ministry had done an inventory of posts and found that in some provinces all had already been filled. Posts in provinces with vacancies would be filled and the minister called on all doctors who wished to apply to come forward.

SAMA chair Dr Angelique Coetzee said in an IoL report: “While we are not averse to the so-called Cuban Brigade assisting us, we feel strongly that the principle of not engaging with SAMA – as the biggest representative body of doctors in the country – is flawed and wrong.

“There are many unemployed doctors in South Africa and many community service medical officers have still not been placed. In addition, many private practitioners have indicated their willingness to assist.”

Coetzee said South Africa has many public and private health specialists, family physicians and epidemiologists who would have heeded the president’s call for assistance. “Retired doctors can be brought back into the service delivery system – even for a short time. They can also mentor younger doctors who lack the necessary experience and skills.

“Only when we have exhausted all our internal human resources should a consultative process between SAMA, the Department of Health and the Presidency been initiated to bring the Cuban specialists to South Africa,” Coetzee said. SAMA would be requesting a meeting with Health Minister Dr Zweli Mkhize “to express its unhappiness on the processes and principles involved”.

The Cuban doctors will be deployed as follows: 29 to Gauteng, 28 to KZN, 26 to Western Cape, 20 to Eastern Cape, 17 to Free State, 14 to Mpumalanga, 13 to Limpopo, 13 to North West, and 11 to Northern Cape. The doctors total 171 out of a contingent of 216.

Herman Mashaba tweet with purported DOH budget:

Full Business Day report

Full Reuters Health report

Full IoL report

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