New global health crisis looms
Even with the hope of vaccines ahead and registration for over sixties opening yesterday, the world could face another health-care crisis if the shortage of skilled health professionals is not addressed.
The World Health Organization has projected a potentially devastating global figure of an 18 million shortfall of health-care workers by 2030. It predicted it would have deadly consequences for patients, economies and communities.
International health-care organisation Project Hope has put the shortfall figure at 15 million.
South Africa’s Health and Welfare Sector Education and Training Authority (HWSETA) also issued a stark warning this week after the release of critical skills shortage data.
According to the Xpatweb Critical Skills Survey 2020/21, Health Professions and Related Clinical Sciences rank in the top 10 most in-demand skills, while the Department of Home Affairs draft critical skills list includes general medical practitioners, registered nurses and pharmacists.
Project Hope has projected that by the end of the decade the world would need 80 million health workers, "but without intervention we'll only have 65 million workers worldwide, leaving a gap of around 15 million and causing serious consequences for the health of billions of people around the world“.
HWSETA chief executive Elaine Brass said the Covid-19 pandemic had compounded these issues, making the skill shortages "glaringly apparent".
"Health workers are among those who have been heralded as our national heroes during the pandemic. They have had to care for patients suffering from the virus while fearing that they could fall ill too. We owe our support to those on the front line at this time. By addressing these skills shortages, we will be able to better support our health-care workers in the long run," said Brass.
South African Medical Association (Sama) spokesperson Dr Angelique Coetzee said: “We are aware of the workforce shortage. The problem in South Africa is that even though we have a shortage, we don’t have the money to pay for doctors and nurses or other workers in the public sector. And doctors in the private sector work for themselves.
“Sama is very concerned about the shortage of health-are workers in this country. We are extremely concerned. But it doesn’t help to have a lot of health-care workers and allied health-care workers included that can’t get posts because there is not enough money on a provincial level to pay these people,” she said.
“So we try very hard to lobby and to get people employed. The problem is, we get the same answer over and over, that there is not enough budget, not enough money. So it’s not just specialists that are leaving the country, it’s nurses, it’s doctors, and GPs too.
“I think we should be concerned about any health-care worker leaving this country.
“In the private sector, it’s much more difficult to start on your own and to run a practice. So we presume that most of the younger doctors going forward will not be able to do that.
“To go into the medical field, it's extremely important to understand that you need to have the correct matric subjects to allow you to be able to study medicine, and so going forward, the choices of your matric subjects is very important.
“The health-care sector is a service industry, it is not an industry where you are going to make lots of money unless you are a doctor or a specialist. I want to make it clear that you are actually going to work for every cent, and that is maybe one of the reasons why there is not that big an appetite in this sector.”
“It’s really hard work. Long hours, it’s not always easy and you are not assured of what income you’ll be getting. Again, I want to stress, that in the public sector there are not enough posts in the public hospitals for doctors after their community service due to lack of money and lots of other internal problems.
“You also need to have the correct personality to work in the industry. It's a service industry, so you need to have a lot of emotional IQ to be able to work with people. It doesn’t matter how bright you are, if you don’t have the emotional IQ and understand people, it will frustrate you.
“I think this is something one needs to look at going forward to make sure that we get the right people into the health-care industry," said Coetzee.
Kevin Halama, spokesperson for public health-care union, Hospersa, confirmed that staff shortages in the public health sector were among the key issues brought up in a Public Sector Collective Bargaining Council meeting this week. He said there were nurses sitting at home, but that there was no budget for vacant posts, adding that many nurses who are working feel overworked and burnt out.
He also highlighted that the majority of the population do not have medical aid and require health services from the public health system, saying highly qualified medical professionals, including nurses, prefer to work in the private sector which offers better working conditions.
"There is a staff shortage and it’s been raised at the bargaining council. There is still a moratorium on filling posts in the health sector and this was an issue before the Covid pandemic started, but which has been exacerbated by the pandemic.
"There just isn't the budget to fill these vacant posts. It’s quite a huge number and when we visit facilities, we see one nurse looking after so many patients. The department complained about overtime claimed by health workers, but they need to fill the vacant posts or staff have to work overtime to care for patients. The shortage is clearly visible," said Halama, adding that there was a particularly critical shortage of specialised nurses, such as midwives and those in specialised fields of medicine.
Meanwhile, universities across the country said they experienced a healthy stream of applications for their health sciences faculties, and that enrolment figures indicate that South Africa will have enough health-care workers in the near future.
Associate Professor and Dean of the Faculty of Health Sciences at UCT, Lionel Green-Thompson, said: “We have not seen a drop in applications for the spaces we have. A few of our programmes, namely medicine and physiotherapy, are in fact oversubscribed. We processed in excess of 9 000 applications for the 440 places in our first-year programmes.
UJ spokesperson Herman Esterhuizen said they had not noticed a decline or an increase in their health sciences enrolments.
“All I can say is that our health sciences enrolments are at maximum capacity,” he said.
Wits spokesperson Buhle Zuma said the institution had seen an increase in the number of students applying in health sciences.
“In 2021 the Faculty of Health Sciences received 14 000 for 220 spaces (Bachelor of Medicine and Bachelor of Surgery degree).”
Department of Home Affairs spokesperson Siyabulela Qoza could not comment on a possible brain drain of health professionals, saying there was no box to tick about why people were leaving South Africa.
“The department doesn't register the categories of South Africans leaving the country. We only ensure that such people meet the international travel regulations and that they have the correct travel documents,” he said.
The Independent on Saturday