Wanted: Foreign doctors, nurses

ORGANISATIONS representing medical professionals are fuming over the government’s move to import specialist doctors and nurses to work in the public health sector.

Some detractors have warned that the sector was already on “life support” and the shortage of specialist doctors and nurses was due to the government’s negligence, lack of foresight and ignoring warnings.

It comes as the Department of Home Affairs published a “critical skills” notice which was gazetted this week.

It means foreign doctors can be recruited to fill the skills deficit.

Specialist doctors in more than 30 medical disciplines were listed as wanted, including surgery, dentistry, anaesthesiology, pathology, obstetrics and gynaecology.

The country also lacks specialist personnel skilled in five nursing disciplines such as paediatrics, intensive and trauma care.

In May in an answer to a parliamentary question from the DA, Health Minister Dr Joe Phaahla revealed that the country’s doctor-to-patient ratio is 1:3 198 i.e. 0.31 doctors per 1 000 patients. And the number of doctors was on the decrease.

The organisations warned that the shocking state of affairs persisted despite the more than 21 000 specialist medical personnel posts which are vacant across all nine provinces, which the national department has yet to fill.

Home Affairs initially published its critical skills list in February.

However, after engagements with the health ministry, SA Nursing Council, Health Professions Council of South Africa (HPCSA), and other bodies and experts, Home Affairs revised the previous list and gazetted the latest version.

Home Affairs Minister Dr Aaron Motsoaledi, who is the former health minister, said the latest listings would contribute positively to the country’s skills deficit.

HPCSA’s spokesperson Christopher Tsatsawane singled out the “production rate” of specialists as the key reason for the shortages.

“Training institutions have not increased their capacity to produce specialists in line with the population growth. We also lack the right infrastructure for training advanced specialists.”

Department of Health’s spokesperson Foster Mohale said the biggest challenge was retaining skilled medical professionals as many were lured into emigration or private practice.

“This is a concern. Attractive salary package offers makes it difficult to retain some of them.”

Mohale said they had a strategy to retain scarce skills but conceded that it wouldn’t completely stop the brain drain.

He said they hoped that the rollout of the “National Health Insurance Model” and the recently signed “Human Resources for Health 2030 Strategy” would alleviate such challenges.

The department’s equitable share and human resources training grants provided opportunities for general practitioners (medical and nursing) to enlist for their registrarship and qualify as specialists in scarce fields of study, Mohale said.

He said his department strived toward building health-care capacity to match the demand, and that the existing medical universities produced enough skills.

Democratic Nursing Organisation of SA’s Sibongiseni Delihlazo said they were “extremely angry that we have to import specialist nurses because of the government’s actions”.

Delihlazo accused the government of neglecting nursing for a long time.

“The number of nurses the country produces each year continually decreases instead of increasing, and numerous nursing colleges have been shut.”

He said the World Health Organisation conducted studies on the state of nursing around the world, in April 2020, and concluded there would be a 10 million worldwide shortage of nurses by 2030.

For countries to avoid catastrophic consequences they needed to produce 8% new nurses every year.

“Our country has not adhered to the warning, but has done the opposite.”

Delihlazo said most nursing students were funded by the government, which has been reduced, yet the population continues to grow and more people relied on the public health-care system.

He noticed health departments were reluctant to release nurses in their employ for specialist training, “as their respective systems will crumble due to nursing shortages. Nurses are being held to ransom”.

Delihlazo said the country’s nurses were targeted by first-world nations, and some recruitment agencies were permanently positioned in the country, scouting for local nurses.

“We could have produced our own nurses in a country with serious unemployment issues. The government

doesn’t have a strategy to keep our nurses,” he said.

Dr Anil Bramdev, spokesperson for the KZN Specialist Network, also took aim at the lack of registrar training posts. “Specialists can only be trained in state institutions. Unfortunately, there are no private training facilities.

“There have been efforts to open private institutions, but they were not given the required licences.

“We are totally dependent on public institutions attached to universities to train specialists. Registrar posts have been restricted in numbers and in terms of racial quotas.”

Bramdev said in some provinces specialist posts were frozen if candidates were not of a particular race group.

UCT’s head of medicine Dr Lionel Green-Thompson believes we need more engagement on this critical skills shortage.

The Medical Research Council’s Professor Glenda Gray said the country’s skills deficit needed to be addressed. “The issue always is the more rural provinces where no one wants to go. The health system needs an overhaul to address the long-standing issues of trying to optimise patient management.”

Dr Angelique Coetzee, head of Solidarity Doctors Network Advisory Board, said: “Before you can import new doctors from overseas into the country you need to employ your own doctors. Yes, we do have a critical shortage of doctors, the Western Cape is no exception.

“The public sector is also in dire need of more specialists and even general practitioners, but there is no money to pay them. It’s good that doctors are back on the scarce skills list, it makes it easier for them to come into the country, but there will be no huge influx due to a lack of funds.”

Progressive Health Forum’s co-convener, Aslam Dasoo, said health professionals were leaving public health-care services due to a decline in the sector.

“With accompanying freezing of posts because of misspending, creating evermore shortages to add to an existing burden,” said Dasoo.

“Steady defunding of these services, from budgetary shrinkage, mismanagement, medical negligence liability, wastage and corruption, accounting for up to half of the health-care budget being compromised, means that staffing at every level of health-care delivery is compromised.

“The fact that thousands of nurses and doctors remain unemployed in SA, means that the critical skills list is not a clear strategy to fill posts, except where particular specialist skills are not available in the country or for staffing in perennially underserved rural areas.

“This is not the case for staffing at administrative level, which is often bloated and a direct cause of budget depletion.”

But Western Cape health MEC Nomafrench Mbombo believed that the province was not affected as it had “a high ratio of specialists to the population”.

Michele Clarke, the DA’s spokesperson on health, said the skills shortage was “unbelievable”.

“We should make available more training facilities, especially for nurses, and the government should look at partnering with the private sector regarding training. Public health care in our country is on life support.”