The country needs shared stewardship between the government and the growing cohort of retired clinical managers and doctors and their accumulated wisdom and experience, suggests Zolile Mlisana in Daily Maverick.
Mlisana writes:
South Africa faces the reality of serious skills shortages in healthcare – for many reasons, which need no repetition here. What needs more attention is the parallel reality unfolding quietly alongside it.
This is the rich reservoir of senior clinical expertise which is being relegated to lie dormant at the very moment when the system’s demand for judgment, continuity and mentorship is intensifying.
This article proposes strategic recourse to this pool. It attempts to raise a national stewardship issue between productive citizens and the government; what I call “shared stewardship”.
Across the country there is a growing cohort of senior clinicians whose professional lives span decades of patient care, crisis navigation, institutional leadership and the development of younger clinicians of all disciplines.
Their experience is more than just the volume of service historically rendered: it includes judgment under pressure, ethical tensions and travails, and tacit knowledge that cannot be replicated through protocols or accelerated training.
A proposal for shared stewardship
Some existing service delivery frameworks already demonstrate that flexible, wisdom-centred deployment of senior clinical expertise is feasible. Credit is due. The District Clinical Specialist Team model illustrates one possible pathway for structured recourse to senior judgment, without prescribing it as a single or rigid design.
Senior clinicians, many of whom have secured stable pensions, should reasonably consider, in patriotic conscience, service at reduced remuneration, even at 50% of legislated rates.
The Occupational Specific Dispensation was crafted without adequate regard for long-term fiscal projections. It need not remain the country’s albatross.
Stewardship is an expression of personal maturity. It is obedience to the burden of privilege. The question is no longer whether the country can afford to rethink its relationship with senior clinical wisdom. The question is whether the country can afford not to. It is not impossible.
Caution must be raised, that the responsibility does not lie with the state alone. It calls for a mutual covenant. It rises above any abdication by government or romantic voluntarism by citizens.
It calls for shared stewardship, as it must be, if the country is to be saved from implosion, and even as humanity itself globally needs it to stem its looming moral and ethical vortex.
States cannot carry continuity alone. Citizens cannot outsource moral responsibility to institutions without consequence. Civilisations endure only when responsibility is distributed relationally across generations, professions and social strata.
When stewardship collapses into entitlement or a monetised value proposition, systems hollow out. What will follow will never be a sudden catastrophe, but a slow implosion, as we are currently witnessing.
Dr Zolile Mlisana is a paediatrician whose work spans clinical practice, institutional leadership and public-interest thought leadership. He recently retired from public service at the prescribed age of 65 and has since returned to private practice. He is a former founding chairperson of the South African Medical Association and former principal of Medunsa.
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