Finweek English Edition - - INSIGHT: LOCAL -

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

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