South Africa faces massive healthcare worker shortage

 ·2 Sep 2020

A leaked document from the Department of Health shows that South Africa is facing a major shortage in healthcare professionals in the next 10 years.

The document, which was first reported on by healthcare monitor Spotlight and Maverick Citizen, shows that the country is facing serious personnel shortages at both a national and provincial level.

It projects that an additional 97,000 health workers will be needed by 2025 to address inequities across provinces, with community healthcare workers making up about one third of that figure.

Modelling shows that an additional 88,000 additional primary healthcare workers will also be needed by 2025, and that the number of medical specialists also needs to increase significantly to keep up with demographic and epidemiological changes.

Funding this shortfall of workers would cost upwards of R34 billion to cover salaries.

“The current economic and fiscal outlook in South Africa is bleak. However, various analyses indicate a current and projected shortage of skilled health professionals in South Africa,” the department said.

“Due to population growth alone, the shortfall in essential health workers will worsen by 2025 if health workforce expenditure only increases in line with inflation.”

The department’s data shows the overall national density of medical specialists was calculated as 16.5 per 100,000 in 2019. However, there are an estimated 7 specialists per 100,000 population employed in the public sector, and 69 per 100,000 in the private health sector.

There are also inequities across provinces, the data shows. For example, the Western Cape has 25.8 medical specialists per 100,000 public sector population, compared to only 1.4 per 100,000 in Limpopo.

Although the location of public sector tertiary and central hospitals influenced this maldistribution, in practice this means that accessing specialist services in Limpopo is extremely difficult in comparison to other provinces.

The NHI 

The inequities highlighted in the document have been used as a central argument in the need for National Health Insurance (NHI) in South Africa, with government pushing for more balance between public and private healthcare – in terms of spending and accessibility.

While critics of the NHI have called it unworkable and too costly, proponents have called it a moral imperative too address the need for quality healthcare for all.

Dr Nicholas Crisp, NHI fund developer and consultant at the Department of Health, said that the ultimate goal of the NHI was to achieve ‘equity’ and ‘good quality healthcare’.

“What we are trying to do in universal health coverage is have a greater number of people, with a greater number of services, with less financial vulnerability at point of care.”

In terms of funding, Crisp said that while part of the NHI’s budget was ‘given up’ to help fund the ongoing coronavirus response, the budget was ultimately used to improve infrastructure, facilities and equipment.

In effect, the crisis has helped accelerated the move to NHI.

He said that the coronavirus has also helped the government learn new lessons around staffing, health and safety, and health products – all of which will help boost the implementation of the NHI.

“On top of that, our data was a big shambles before Covid and that was one of our big projects in the NHI office. We had to convert our entire NHI’s digital capabilities to look after Covid.

“Now what we are left with is an unbelievably competent digital system that has data in which we would never have dreamt of having before.” He said that this includes data from the private sector which will help boost the NHI’s capabilities.

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