The Solidarity Doctors’ Network says there is a distinct and bitter irony to the government doggedly pursuing its costly National Health Insurance (NHI) goals while already struggling to find the necessary funds to employ medical graduates.
In January, the South African Medical Association Trade Union (Samatu) raised concerns about hundreds of newly qualified medical doctors being unable to find placement in the public service.
Health minister Joe Phaahla later confirmed that around 690 medical graduates were awaiting placement in public practices but said that provincial and local departments did not have the funds to hire them.
According to Solidarity’s Medical Sector lead, Peirru Marx, this placement crisis exacerbates the pressures on South Africa’s overburdened health system and is contributing to the ongoing loss and flight of critical skills in the country.
“The fact that many young doctors have to study and look for work abroad is a clear indication of the lack of job opportunities and financial constraints within the South African medical sector,” Marx said.
Marx said the placement of doctors has “almost reached breaking point”, and this is all taking place as the government puts most of its focus on enacting the National Health Insurance (NHI) Bill.
“The irony of the situation is clearly seen in the government’s inability to even address the immediate needs of recent medical graduates, (all) while they are trying to implement a large-scale health insurance system,” he said.
“There are currently 33.3 doctors per 100,000 of the population available in the public sector. This means the doctor-to-patient ratio is 0.3 doctors per 1,000 people of the population,” Marx said.
This is more than ten times fewer than other countries that depend on state health systems, he added.
“The implementation and execution of plans remain poor, and year-on-year, we find ourselves in the same dilemma regarding placements and budget constraints. Doctors are reporting feeling hopeless and frustrated with no assurance of employment for 2024.”
According to Samatu, the department cites budget constraints as a barrier to hiring qualified medical doctors every year, “but no substantial measures are evident to solve the funding dilemma”.
Meanwhile, Professor Alex van den Heever, who works at the Wits School of Governance, said the Department of Health received enough funding at the start of the year – but due to inadequate planning, it has now run out of money to hire new doctors.
The funding and placement dilemma is made worse by the views that the NHI will not even be a reality for the foreseeable future.
While president Cyril Ramaphosa may sign the NHI Bill into law in the coming weeks or months, the implementation plan is decades-long, even without the legal challenges it is guaranteed to face.
Efficient Group chief economist Dawie Roodt recently noted that the government’s plan to implement the NHI in South Africa faces two major challenges – both of which mean the scheme will likely never be implemented.
The first challenge is funding. A report by the Solidarity Research Institute found that an additional R295.93 billion is needed to fund the government’s NHI plan. This is a conservative estimate.
Raising these funds is unaffordable due to the government’s deteriorating fiscal health in recent years, and the state is unlikely to be able to draw the funding from taxpayers without immense fallout.
The second challenge, Roodt said, is that even if the President signs the Bill into law, it will face several lawsuits and be tied up in court for years to come.
Solidarity confirmed this, stating that it is currently involved in a series of legal battles against the NHI Bill in an attempt to protect the interests of the medical profession and those of the general public.