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The public health sector needs as many health professionals as possible, but budgets are tight
There is no doubt that more health professionals should be employed. However, what will not be done is to employ a health professional against an unfunded post. This has happened previously and will not, under any circumstances, be repeated.
On Monday 22 January 2024, Daily Maverick published an article by Dr Sunhera Sukdeo, a graduate of my alma mater, the University of KwaZulu-Natal. Her article “I’m an unemployed doctor, like many medical peers, despite SA’s health skills shortage”, highlights the difficulty of provincial Departments of Health to employ all medical doctors.
This follows a claim by the South African Medical Association Trade Union (Samatu) that there are 800 unemployed doctors. This unverified figure has since been quoted by many in the public media.
The National Department of Health has requested concrete data on this. This was based on the January 2023 experience where this organisation claimed to possess a database of more than 1,000 unemployed doctors. What we found then was that the figure was grossly exaggerated. At present, the SA Medical Association (Sama) reports a list of less than 400 doctors who say they are unemployed.
It should be noted that indeed the National Department of Health would wish every health facility to be appropriately staffed. The struggle to get adequate budgets allocated for the employment of professionals affects every health professional group, not just doctors. The rehabilitation professionals are hardest hit.
When government employs a doctor, it seeks a doctor irrespective of racial descent. We are alarmed by Dr Sukdeo’s statement that when she applied for a post, she learnt that it was reserved for “African males”. One would appreciate receiving proof of this so that it can be investigated and formally addressed.
What we wish to avoid is to reduce a genuine problem of youth unemployment in the health sector to a statistical contestation. However, it is necessary that we share with the public facts from the government’s recent employment records. Appointments of medical doctors normally take place during January, March, and July. This is aligned to completion periods as not all doctors complete community service or internship in the same month.
During the years 2021, 2022 and 2023, a total of 3,976, 4,698, and 5,006 respectively were employed. This number includes medical interns, community service officers and medical officers. The table below shows the new employment as of December 2023.
Provinces have since advertised and are in the process of advertising and/or interviewing applicants. Several of the vacant posts are in rural areas, places that some prefer to sit out for a year rather than venture into unfamiliar territory. This is another yearly problem where some young doctors reject rural placements using a variety of reasons.
There is no doubt that more health professionals should be employed. However, what will not be done is to employ a health professional against an unfunded post. This has happened previously and will not, under any circumstances, be repeated.
It is important that we address certain principles that underlie the employment of medical doctors. They are obliged to undergo a two-year internship training programme upon successfully completing their undergraduate studies. This is a prerequisite for registration for independent practice. This is followed by a year of community service. Upon completion of compulsory community service, the doctor is free to seek employment anywhere.
Budgeting constraints
The problem that primary employers, the provincial Departments of Health, face is the struggle to receive adequate budgets. The current financial squeeze felt by every government sector and the country impacts on the resourcing of health services.
Upon receipt of accurate information regarding who is unemployed, my office will, as we did in 2023, approach all provincial departments with a request to absorb as many as they can. It is incorrect to portray the department as heartless and non-caring, as some colleagues have expressed in some social media platforms. While the country has a well-crafted Human Resources for Health Strategy 2030, resourcing it is an uphill struggle.
The department has interacted with Sama and Samatu, requesting both organisations to supply us with accurate data. It is not possible for the department to keep a database of unemployed doctors. Not all doctors wish to work for the state. Some work privately and only do sessional work. There are various permutations that individual doctors choose.
However, the fact remains that the public health sector needs as many health professionals as possible. This is why representations to the National Treasury continue at the highest level of administrative and political authority with the hope that the next budget will be kind to the health services. DM
Dr Percy Mahlathi is Deputy Director General: Human Resources for Health, Hospital and Tertiary Health Services, National Department of Health.
I thought there may be two sides to this story.
There is a 3rd side.”budgets are tight” …because of our useless, corrupt government.
There are many many good people in our country trying their best in their respective vocations despite the arrogant, corrupt incompetence of the ANC.
Dr Mahlathi, in this article and in a previous virtual interaction, has spoken many untruths that I wish to dispel.
1. Doctors want employment. It is untrue that majority refuse to work for rural communities. He and the NDoH would have to produce poll results to that effect.
2. Many of the unemployed doctors are government bursary holders with contracts that oblige the state to employ them (doctors) for the number of years that their training was funded by the states. Some of them trained in Cuba while others trained locally.
3. Improvement of the public healthcare system is solely the responsibility of the state; and such a strategy cannot be without resourcing adequate essential workers.
Not all workers in the DoH are essential. However doctors, nurses and some allied health professionals are.
That is why the above do not take leave during festive season and were not at home during the Covid-19 pandemic.
4. For the DoH to dispute the numbers they would have to produce their own as facts otherwise what is there remains unchallenged.
5. As medical internship and community service solely rest on the responsibility of the state, the state knew exactly how many doctors would qualify for post-community service from 01 January 2024; and the surely they also have a list of all their bursary holders on those numbers.
Only an irresponsible state would let its investments and taxpayers monies go to waste as the state is currently doing
The DDG, in this article and in a previous virtual interaction, has spoken many untruths that I wish to dispel.
1. Doctors want employment. It is untrue that majority refuse to work for rural communities. He and the NDoH would have to produce poll results to that effect.
2. Many of the unemployed doctors are government bursary holders with contracts that oblige the state to employ them (doctors) for the number of years that their training was funded by the states. Some of them trained in Cuba while others trained locally.
3. Improvement of the public healthcare system is solely the responsibility of the state; and such a strategy cannot be without resourcing adequate essential workers.
Not all workers in the DoH are essential. However doctors, nurses and some allied health professionals are.
That is why the above do not take leave during festive season and were not at home during the Covid-19 pandemic.
4. For the DoH to dispute the numbers they would have to produce their own as facts otherwise what is there remains unchallenged.
5. As medical internship and community service solely rest on the responsibility of the state, the state knew exactly how many doctors would qualify for post-community service from 01 January 2024; and the surely they also have a list of all their bursary holders on those numbers.
Only an irresponsible state would let its investments and taxpayers monies go to waste as the state is currently doing
“… she learnt that it was reserved for “African males. One would appreciate receiving proof of this so that it can be investigated and formally addressed.”
One would do well to review the advertisements on the KZN DOH website. A current example: a post for an Obs and Gynae Specialist at Grey’s Hospital lists its Employment Equity Target for the post as being African Male, African Female. What this translates to practically is that even if an African Male is not the best candidate interviewed, if he is the only African Male amongst the interviewed candidates, he will be offered the post.