Foreigners’ hopes of health careers in SA dashed

Hundreds of foreign nationals who graduate with healthcare degrees cannot work in SA despite the country’s desperate shortage of personnel, according to health minister Joe Phaala.

Doctors and pharmacists are required by law to complete internships after they graduate, and all healthcare professionals must complete a year of community service before they can register with their statutory councils to start working in SA.

However, hardly any community service posts have been allocated to foreign nationals who graduated with health science degrees since 2019, according to figures provided by Phaala in a written response to DA MP Madeleine Hicklin.

“Due to limited funded posts, most foreign nationals could not be placed,” health department spokesperson Foster Mohale said.

Deep budget cuts imposed in the medium-term budget policy statement last November saw provincial health departments impose a hiring freeze, leaving hundreds of SA doctors unable to secure community service posts at the beginning of this year. The February budget included an extra R3.7bn for 2024/25 to address the immediate crisis, but provinces are expected to remain under pressure over the medium-term expenditure framework, with limited scope to hire personnel.

Altogether 158 foreign nationals applied for internship or community service positions for 2024, but none was granted a post. Almost a third (43) of the applicants were pharmacy graduates seeking community service posts and 48 applications were for internships in medicine or pharmacy. Applicants included graduates in audiology, physiotherapy and diagnostic radiography.

Last year, the health department received 343 applications for community service and internship placements from foreign nationals, down from 362 in 2022. There were 520 applications in 2021, 409 in 2020, and 435 the year before. Many individuals reapplied in the hope of securing an internship or community service position, but in the six years to 2024 only two succeeded.

PRIORITISED

The government had prioritised South Africans over foreign nationals as it had not budgeted for the growth in medical graduates from SA universities or the students sent to Cuba for medical training, Shabir Madhi, dean of the faculty of health sciences at Wits, said.

“The tragedy is many of these graduates are keen to establish themselves and practise in SA, but are unable to do so without fulfilling [statutory council] registration requirements. It is somewhat paradoxical considering the recognised shortage of doctors in SA, as well as doctors being a scarce skill set eligible to apply for work permits,” he said.

SA has a critical shortage of healthcare personnel, with 0.8 doctors per 1,000 population in 2021, according to the World Bank. The UK has 3.2 per 1,000, and Brazil 2.1 per 1,000.

Mohale said the foreign national allocated a post in 2019 had been funded by their country of origin, and a second was allocated a post in 2023 because they applied and started work in September when there was a post available.

“It should be understood that when foreign nationals apply to study in SA they are well aware that it is not an automatic entry into the workforce, hence their status is that of study permit holders. Foreign nationals who graduate with health professional degrees become a resource for their countries of origin and may return to practise there,” he said.