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| Foreign doctors may save SA |
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Janet Smith June 27 2009 at 03:34PM |
Get IOL on your mobile at m.iol.co.za |
Nine thousand. That's the number of doctors which the government this week apparently admitted it must recruit every year for the next decade to contain what is already a serious national crisis in our public health. A report commissioned by the Department of Labour from the HSRC last year says that, given the fact most of these doctors work in the public service and most of these in the rural areas, the effect will be devastating. Studies show there are more doctors who qualified in South Africa working abroad than the total number of doctors working in the public sector in this country, indicating there are serious inequities in healthcare delivery. Africa Health Placements (AHP) has recruited 1 000 doctors - half of whom have been South African and the other half foreign-qualified, almost entirely from developed nations - for posts in under-resourced, mostly rural hospitals. A report from the organisation shows that doctors employed by the State must treat about 34.6 million people or 82 percent of the population. It seems so obvious. The more doctors government recruits, the better it will be for patients. Yet the limit remains. AHP's CEO Saul Kornik says that even anecdotal evidence is revealing. "When we go and visit rural hospitals, there are often lots of patients sitting on the grass outside because there are too many to see. "They have often travelled half a day or a full day to get there, and rural patients tend to present themselves very late. "The more doctors there are, the easier for the patient to make the journey through the healthcare system… Where there is a good contingent of doctors, the existing health care staff no longer feel burnt out. Community service doctors then see that a particular hospital is functioning better and are now happier to go and work there too. It improves things for everyone." Among the reasons for not expanding the recruitment policy are existing high-level G77 agreements between countries of the South which have pooled their economic interests and precluded some hiring between nations. There are also existing government-to-government contracts - particularly with Cuba, Tunisia and Germany - which allow the poaching of doctors under controlled conditions. But a year ago, the chairperson of the advisory board of AHP, Dr Clarence Mini, again effectively warned that the government's questionable human resources plan for the health sector, based on continental agreements or not, was denying the nation a better service. AHP, like many other interested parties, believes that much more could be achieved if the government would reconsider its policy concerning especially other African countries. "We've said to ourselves as AHP, let's try and work with government on these agreements, specifically on the SADC countries," explains Mini. "For an example, when the biggest hospital in Harare closed down, we wanted to know what was supposed to happen to those doctors. Do we just let them get into the next plane to London when we need them here? But then that issue of the original agreements came up again. "Look, we understand these agreements were signed in good faith at a time when we did not need as many doctors. But the situation is different now. And now is also the time when you have doctors from the DRC coming in and becoming car guards here, which is totally unacceptable. "We say, let's try, even if it means we work out a short-term agreement where they work not more than three or five years. But the answer still seems to be 'no'." So while well-qualified, hard-working doctors may be ushering you in and out of your parking spot at the mall, they could be treating disease, delivering babies and saving lives. But doctors also need to feel wanted. The HSRC's report shows that many African doctors who are denied entry into South Africa will simply go abroad - and never return. Our own doctors do that, too. Despite overstaffing in British hospitals, there are at least 3 500 South African doctors working in Britain, a further 2 000 in the US, more than 1 000 in Canada and close to 500 in New Zealand. Yet our annual medical school intake is less than 1 500. In fact, the annual intake of the country's eight medical schools has remained static over more than a decade, despite the fact that the population is now 47.9 million. In Australia, there are 2.8 physicians per 1 000 of the population. In Sweden there are 3.5 and in Hungary 2.8. In South Africa, there is an average of 0.57, with 0.36 in the public sector and 1.69 in the private sector. Still, the key question remains. If, as Health Minister Dr Aaron Motsoaledi himself said this week, we are in a dire situation, why can't the policy on recruitment be re-examined, especially since there is no scarcity of doctors from other countries who want to work in hospitals here? Eight years ago, Britain's National Health Service (NHS) was battling to keep up with too few doctors, so it gave itself time to work on replenishment and retention, changing working conditions for doctors and even shifting the retirement age from 60 to 65 with a special dispensation. It went on an international recruitment drive. Now it has such an excess of junior doctors that its recruitment is mostly closed. The long-held view of critics of the government's policy is: let's go for it, and attack our problem in the same way. We need to up the intake at medical schools, perhaps build more training institutions, enhance retention strategies and not leave Treasury out of the debate. Recruiting doctors, as the government knows from its controversial battles with them over the Occupation Specific Dispensation (OSD) that resulted in an offer this week, is impossible without a cash injection. In fact, even against the backdrop of Health Minister Motsoaledi's announcement of a R1 billion pay increase for State doctors this week, observers were querying where the government intended getting the money to sort out its hopeless mishandling of the OSD crisis. It promised State-employed doctors and nurses their pay rises a year ago. Nothing happened and the result was this week's strike. So the government finally came back with an offer which it says is to be implemented next month, but the South African Registrars' Association and the South African Medical Association, as well as the Finance Ministry, have expressed concern. Is it really possible? Meanwhile, the country still needs doctors. The relative cost of training doctors here versus recruiting doctors from other countries seems obvious. Estimates are that it costs nearly R2 million to train a South African doctor, while recruiting a foreign doctor costs less than R150 000. South African medical schools provide fewer than 50 qualified doctors to rural hospitals in a year, yet three years ago, the health department introduced a policy limiting the employment of foreign health professionals to three-year, non-renewable contracts. The US, whose President Barack Obama is going through a painful process to address his country's own healthcare crisis, is reported to be planning to recruit up to half a million health professionals over the next 10 years, some of whom may well be South Africans. In September last year, then-minister of health Dr Manto Tshabalala-Msimang was asked about our foreign doctor numbers. She said a total of 507 had been placed since 2006. Meanwhile, it has not been an easy ride for foreign doctors who have come to work here, either. There have been many documented cases of foreign doctors who want to stay on, taking their issue to the courts. Notably, the KZN health department spent hundreds of thousands of rands in cases against Cuban doctors fighting to keep their jobs, to the extent that one judge said an inquiry ought to be launched within the department to hold an individual responsible for the huge waste of public funds. The legacy of apartheid is serious. Health care and health itself are influenced by race, and HIV has severely cut available resources. Retention is difficult enough, with doctors citing stress, the need for a quality of life, security, more and better nursing, and funds for specialities and research as reasons for wanting to move abroad or into the private sector. These issues are in addition to their inability to cope financially. Although Motsoaledi announced on Wednesday that specialists' salary packages would be increased from R369 271 to R962 174, the picture for specialists who treat those without medical aid and must thus access State hospitals, is unsettling. While it is disturbing that there are a mere 208 specialists in Gauteng to serve a million people and 339 in the Western Cape per million, the situation is far more dire in KZN, where there are only 60 specialists. The situation gets progressively worse in the predominantly rural provinces such as Mpumalanga, where there are seven specialists. Motsoaledi admitted this week that principal specialists were difficult to retain in the profession because of their high skills level and the demand for their services in the private sector, abroad and in research. Yet there are many specialists from African countries who understand the broad range of disease seen in our hospitals and who have the emotional and moral background to cope with the difficulties. As the HSRC report says: "By contributing to South Africa's health system, they will also contribute, albeit indirectly, to South Africa's ability to support the rest of the continent in other respects. These are the issues for which there seems to be no ideal solution." We believe it is possible that new Health Minister Dr Aaron Motsoaledi is unaware of the lack of communication from his department, and that he may yet demand improvements, yet the fact remains, we are unable to provide readers with comment from the government on the health issues as set out above.
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