South Africa has a critical shortage of doctors, with less than one doctor to treat 1,000 patients, Minister of Health Dr Joe Phaahla revealed in answer to a parliamentary question from the Democratic Alliance. Since 2019, the ratios, among the worst in the world, have worsened substantially.
Phaahla indicated that the country currently has a doctor-to-patient ratio of 1 to 3,198 (0.32 to 1,000). In 2019, the country had 0.79 doctors per 1,000 patients (1 to 1,266) – already dismal when compared with the United Kingdom (3.03), India (0.93), Brazil (2.32), and Mexico (2.44), the DA said in the Department of Health’s Budget Vote in Parliament on Tuesday (10 May).
Introducing his budget vote to the National Assembly, the health minister said the COVID-19 pandemic had facilitated closer co-operation between public and private health sectors, from sharing hospital beds to a common platform for reporting on COVID-19 tests. He added that the government was committed to universal health coverage for all South Africans and urged MPs to support the National Health Insurance Bill, which is before Parliament’s Health Committee.
However, the DA disputed this, highlighting the shortages in the sector. “This shocking state of affairs persists despite the more than 21,000 specialist medical personnel posts that are vacant across all nine provinces, and which the national Department of Health has yet to fill,” said the DA’s shadow health minister, Michele Clarke.
“It is clear that South Africa has a dangerously low number of medical health practitioners and with the implementation of the National Health Insurance as well as the mass emigration we are experiencing it will only get much worse,” Clarke said.
“The critical shortage was created by the incompetence and corruption of the ANC government who seems unwilling to address these serious concerns. In fact, just last week the Gauteng Health Department failed to pay April salaries to 91 doctors and nurses at the Helen Joseph Hospital. And the interns at the Chris Hani Baragwanath Hospital were also the victims of late payment.
NHI concerns
Clarke said these figures are particularly concerning in view of the planned introduction of a National Health Insurance (NHI) scheme.
“How does the government envision managing the NHI project when it is unable to make the current universal healthcare system work?
“Before the government can even begin to think about the NHI, it must increase the numbers of qualified medical personnel working in the public healthcare sector.” Clarke added that R8.8bn has already been allocated towards the NHI.
“Why is this money not used to alleviate the critical shortage of medical personnel? The DA calls for these funds to be redirected towards the training and employment of doctors and nurses, and the development of nursing colleges
“South Africa’s current health care problem cannot be alleviated by pipe dreams. These serious concerns must be addressed head-on with practical and pragmatic solutions.”
Health Budget Vote
At the Health Budget vote on Tuesday (10 May), the DA said that the DoH was “a clear demonstration” of how fraud, corruption and maladministration has destroyed public services for the poor and that the R8.8bn allotted for the NHI was under threat from criminals.
“The health needs of the South African people exceed the capacity of the health department and after 28 years, it is clear that this government doesn’t have the ability to fix it, despite massive spending. What they have delivered is one of the highest inequality rates in the world – this too has a massive strain on the health system.
“The lack of adherence to procurement processes has been the biggest contributing factor to Covid- corruption … The Special Investigations Unit investigated 5,467 contracts awarded to 3,066 service providers with a total value of R14.3 billion. Investigations into 4 549 contracts that had been finalised of which 2 803 were found to be irregular. This means that 61.2% of all procurement was irregular,
Within programme 2, an amount of R8.8bn has been allocated to the NHI. Considering the massive irregularities in procurement and high risk of mismanagement of funds, the R8.8 billion rand of taxpayers’ money being allocated to this programme will be at the risk to fraud and corruption, as this programme has historically underspent and is prime for looting.
“The NHI should be scrapped in its entirety. The funding should be used towards solving the chronic problems in the sector such as infrastructure and skills development, as well as ensuring that hospitals are capacitated to supply quality universal health care to all citizens within South Africa that depend on State health care.
“Considering the shortage of funds, we are already experiencing severe impacts on health infrastructure, filling of vacancies, offering of high-end care, waiting times at clinics and surgeries, availability of medication and the affordability of the NHI.
“Since the initial costing of the NHI Bill, we have experienced a pandemic, economic decline and millions of job losses. South Africa’s tax base has shrunk. A shrinking tax base highlights the increasing concern regarding the NHI’s unaffordability now more than ever.
Government needs to strengthen its health workforce. This has become critical. The budget for nursing services program has only increased by 1.3% in real terms.
Considering that the vacancy rate for nurses is 21 453 and the vacancy rate for specialist medical personnel is sitting at 602, it is clear that the budget for the development of required nursing and specialised skills is not enough. Despite these shortages, nurses have been left out of the critical skills list.
NHI will ultimately fail to provide equal access to quality health services under these conditions. It will become another failed SOE, Clarke told Parliament.
Exodus of skills
Business Tech writes that health stakeholders have previously raised concerns that South Africa could see an exodus of doctors and other key medical personnel ahead of the planned introduction of the NHI scheme. There is also a growing concern that the country could lose valuable training skills as professionals consider leaving.
Briefing parliament in March, the Department of Health noted these concerns, adding that the NHI would need skilled personnel to function, not just healthcare professionals, but also general skilled human resources, which would be central to the system.
“This is a big ship that will need to be turned, but the framework is in place,” said acting Director-General of Health Nicholas Crisp. He said that a framework was in place to ensure the country has the necessary skills, with his department developing a ‘Human Resources for Health strategy’ before the start of the COVID pandemic.
See more from MedicalBrief archives:
HASA chief: Medical omissions from Critical Skills List ‘incomprehensible’
SA’s public hospital staffing disaster: 12,000 vacancies for nurses and doctors
SAMA’s warnings on NHI Bill met with hostility