WHAT ARE WE DOING ABOUT IT?
Joe Maila, spokesman for the Ministry of Health, says the Human Resources Strategy for Health for the periods 2012/2013 to 2016/2017 has set a number of objectives to address the shortage of doctors. “This has already begun with a programme to increase the intake of medical students.”
In 2012, universities took in 145 more medical students than ever before, maxing out the universities’ teaching facilities in the process. From 2013, the universities plan to take in an additional 360 students a year and from 2014 the goal is 400 additional students in total a year. The majorit y of the new students will go to the University of Pretoria (Tuks), which will be teaching up to 110 students more a year. Tuks has already received R310m in additional funding to upgrade its infrastructure to be able to deal with the influx.
Increasing the intake places a huge strain on universities in terms of capacity and it’s safe to say there won’t be any additional increases in intake, prompting Government to commit to a new medical training school to be built in Polokwane.
In addition to increasing the number of trainees, Motsoaledi says foreign doctors are being recruited to fill the gap. “These doctors are recruited from all over the world, and applications are received from many countries, including Cuba.” The HPCSA s ay s t here a r e c u r r ent l y 5 875 foreign doctors registered to practise medicine in SA.
Government is also sending students to Cuba to train as doctors. Motsoaledi says the Ministry of Health has a Health Cooperation Agreement with the Republic of Cuba to train SA medical students. This agreement was signed in 1996. “The Agreement was revised in October 2001 to allow the medical students to return to South Africa after completing their fifth year of training in Cuba to do final clinical training in local Medical Schools,” he says.
There is a growing concern about the number of students that have gone to Cuba for training and the number who have in fact qualified as doctors. Between 1997 and 2009 a total number of 624 medical students were sent to Cuba for training.
In October 2011 Precious Matsoso, DG in the Department of Health, told parliament that... “to date 257 students had graduated from Cuban medical training”, which means less than half of them actually qualified as doctors.
Even so, the number of students sent to Cuba this year has increased significantly. “To address the acute shortage of doctors, we sent 1 000 students for training to Cuba in October. This is a temporary measure for one year to boost numbers, which will come on stream in eight years’ time,” Motsoaledi says.
In 2011 there were 3 004 foreign doctors registered with the HPCSA in SA, of whom 194 were Cuban.
Democratic Alliance MP, Patricia Kopane, says Government can do more.
“We send students to Cuba, but it’s only a small number of people we send, so that it doesn’t really help much in the end. It’s also never been made clear why we can’t send students to be trained in countries other than Cuba. As far as I’m aware, no attempt has ever been made to investigate sending students to Europe, the US or anywhere else,” Kopane says.
She says training deficiencies are a grave concern in SA. “Currently our medical institutions are not capable of producing enough doctors. We need to at least triple the number of doctors currently practising medicine, and we need to do it as soon as possible. The departments of health and higher education should sit down and work together to develop a strategy to develop more doctors.”
The main reasons doctors leave SA include f inancial considerations, local working conditions, inadequate safety and security at hospitals and clinics, and various administrative challenges. Locally trained doctors are highly regarded beyond our borders and are offered lucrative contracts when they do venture abroad.
According to statistics f rom t he HPCSA, close on 4 800 doctors in the UK and 3 500 in Australia were trained in SA. There are about 1 200 South African trained doctors in New Zealand and around 900 in Canada.
Another major reason why doctors leave SA after having qualified is due to a lack of funded registrar posts at training hospitals. There have been about 1 400 unfilled, unfunded registrar posts countrywide for close on a decade. These are posts that allow doctors to train as specialists. Maila admits that the unfilled registrar posts are a concern and is considered a priority. “The key issue is to ensure dedicated financing to fill these posts, and the department is looking at how to secure this.”
He admits that SA has a shortage of specialists in many areas, in particular in anaesthesiology, general surgery and paediatrics.
Government is doing what it can, but if its interventions and strategies do not deliver, it’s highly likely that in the best- case scenario, healthcare in SA will decline substantially in years to come and at worst, the much vaunted National Health Insurance (NHI) Plan will be unworkable.
James-Brent Styan Dr. Aaron Motsoaledi