Bad to worse for South African doctors, nurses, and other healthcare experts

South Africa’s healthcare system is facing an escalating crisis, with doctors, nurses, and other healthcare professionals bearing the brunt of a funding squeeze that has only worsened in recent months.

The situation, already dire due to budget constraints, has been exacerbated by a freeze on foreign aid from the Trump administration, putting more than 15,300 healthcare workers’ jobs at risk, according to Health Minister Aaron Motsoaledi.

The affected personnel include doctors, nurses, pharmacists, data capturers, and technical experts, many of whom work in health districts that are hardest hit by HIV/AIDS.

The crisis stems from an executive order signed by former US President Donald Trump on his first day in office, pausing all foreign aid for 90 days pending a review to ensure it aligned with his “America First” agenda.

Although a partial waiver was later granted by then-US Secretary of State Marco Rubio, South African NGOs relying on PEPFAR funding had yet to receive clearance to resume operations.

The ripple effects of this decision have placed additional strain on an already embattled healthcare sector struggling to function amid severe budget constraints.

Even before the US funding freeze, budgetary limitations meant that approximately 1,800 newly qualified doctors in South Africa found themselves unemployed despite having completed their community service.

Motsoaledi cited a lack of financial resources as the reason for being unable to absorb them into the healthcare system, despite the country’s critical need for medical professionals.

South Africa has only 0.3 doctors per 1,000 people—far below the World Health Organisation’s recommended minimum of 2.5.

The South African Medical Association (SAMA) has raised alarm over the growing crisis.

Dr. Mvuyisi Mzukwa, chairperson of SAMA, warned that the shortage of doctors is a longstanding issue that continues to worsen due to inadequate government planning and financial mismanagement.

The Health Minister acknowledged the severity of the problem but pointed to broader economic constraints, stating that the issue of unemployed graduates extends beyond the medical field.

He insisted that while the demand for doctors is high, the government lacks the financial means to hire them.

“We are facing very serious austerity measures and crippling budget cuts, which affect our ability to hire doctors and perform many other functions,” Motsoaledi said.

“We understand the grievances of doctors, but in the final analysis, you cannot hire someone if you don’t have the means to pay them, and that’s the situation we are in.”

In an attempt to mitigate the crisis, some of South Africa’s top HIV scientists and key healthcare facilitators are exploring alternative solutions, including the creation of a solidarity fund with support from the business sector.

Their goal is to fill the gap left by the US funding freeze and prevent further disruptions to HIV/AIDS and tuberculosis (TB) treatment programmes. However, not everyone supports this initiative.

Dr. Aslam Dasoo, spokesperson for the Universal Healthcare Access Coalition (UHAC), representing 80% of South Africa’s healthcare stakeholders, has strongly opposed the idea.

He argues that the South African government should be held accountable for its failure to adequately fund healthcare rather than relying on alternative financial solutions to compensate for its shortcomings.

According to Dasoo, the R12 billion in PEPFAR funding that has been put on hold is a fraction of what South Africa loses each year due to mismanagement, wasteful expenditure, and corruption in provincial health budgets.

He noted that, with the exception of the Western Cape, provincial governments routinely mismanage billions in allocated healthcare funds, with some provinces losing up to R8 billion annually due to fraud and inefficiency.

“It’s elementary; we need to change the system of financial accountability and appoint competent leadership and reporting lines.

“That way, we could save R60 billion between the eight provinces that have had qualified audits for ten or more years.

Our PEPFAR financial support is chump change compared to what our government is allowing to be wasted or pilfered. We could support the whole of Africa with that saving,” said Dasoo.