Hardest by austerity measures
ees. Employee compensation now accounts for about 65% of provincial health expenditure, according to a 2016 working paper released by the project.
This results in less available posts for health practitioners as provinces enforce staffing moratoria both officially and unofficially, he says. Unofficial hiring freezes may be hidden in changes to hiring processes, he explains.
“In the past, the CEO of the district hospital would confirm appointments. What’s happening in some provinces is that the responsibility to approve appointments has been shifted to the political head. This delays the process. It now takes up to five months to make an appointment,” says Rensburg.
National department of health spokesperson Popo Maja denies that the hiring of health workers has stalled because of a lack of permanent posts in the public sector. But he says, because the number of new pharmacists exceeds the number of available community service positions nationwide, some pharmacists will complete community service in the private sector.
The national department of health has repeatedly denied moratoria in media reports. Instead, health minister spokesperson Joe Maila said that doctors are not applying to rural health facilities, where the need is greatest. Maila did not respond to Bhekisisa’s request for comment.
Junior Doctors’ Association of South Africa chair Zahid Badroodien says the bulk of the 130 doctors waiting to start jobs at public health facilities are from KwaZulu-Natal and the Western Cape, but that the issue remains a national concern.
Badroodien says: “Doctors in all major provinces [are] still waiting in anticipation for a call from a hospital to say they can continue work within the public health sector.
“The government may deny that posts are frozen, but this does not alleviate the concern that doctors cannot find facilities to be employed in and when interviewed are told that there is only a limited number of posts as funding for posts is limited.”
Badroodien questions why the department has not made public a list of available positions for doctors nationwide.
The health departments of the Eastern Cape, Northern Cape, KwaZulu-Natal, Gauteng, Free State, North West and Mpumalanga did not respond to requests for comment. Western Cape department of health spokesperson Zimkhitha Mquteni acknowledges austerity measures are a challenge. But Mquteni says the department is trying to protect service delivery and clinical posts.
Meanwhile, Rensburg says that cost-containment measures are likely to hit already understaffed rural areas the hardest.
Rensburg explains: “The reality is there is a shortage of doctors in the system as doctors generally favour urban areas. Budget cuts are harsher on the rural areas.
“Mistakes we make in health don’t show immediately. We’ll only feel the effects in a year or two from now. A small saving on budgets now can ultimately cost us a lot more than we’ve saved.”