Warning over major ‘NHI brain drain’ in South Africa

 ·11 Jan 2024

South Africa’s healthcare industry faces the serious risk of mass emigration of medical professionals in the wake of the National Health Insurance (NHI) scheme being implemented in the country.

According to higher education provider MANCOSA, the consequences of the ‘NHI brain drain’ are incredibly serious, noting that any hole left by the loss of skills will leave the country with severe understaffing, overcrowded hospitals, and a vast disparity in access to quality medical care.

The Department of Health has said that South Africa has a vacancy rate of 18.6% for specialised medical personnel and 13.7% for nurses.

However, amidst the nation’s slow economic growth and political uncertainty, there is now a high likelihood of more healthcare professionals emigrating because of the NHI, impacting South Africa’s economic development.

Why are doctors going

Exacerbating push factors like the NHI, medical professionals are also being beckoned by an intensely competitive global landscape.

There is incredibly high demand for healthcare workers across the globe, and without major investment in the healthcare sector, developing countries will continue to see the mass migration of healthcare workers to regions with better opportunities.

However, despite the demand for skilled medical practitioners overseas, it’s the problems in South Africa are pushing doctors out.

“While globalisation facilitates the movement of labour in South Africa, most of the reasons pushing healthcare workers to emigrate are rooted in structural and socio-economic factors.

“Further, most of these challenges are internal. The South African government has not adequately or urgently addressed the issues undermining the country’s healthcare sector,” MANCOSA said.

“Public healthcare facilities are faced with overcrowding, an overt shortage of staff, low pay, and constant reduction in health budgets, which impact the procurement of medical resources and equipment. This will be a key issue in a year where South Africa faces one of its most important General Elections since 1994.”

The National Health Insurance (NHI), which seeks to introduce universal healthcare, has also been raised as a massive over its implementation.

The South African Medical Association (SAMA), which represents 17,000 doctors, said that as many as 38% of its members intend to leave South Africa if the NHI is introduced due to significant distrust with the government.

58% of the 2,905 respondents in a survey of medical professionals from PPS said that they expressed pessimism over the NHI, with concerns about infrastructure limitations, the financial burden on taxpayers and the government’s ability to roll out the NHI efficiently.

The exit of these highly skilled professionals would undoubtedly have a noticeable effect on service delivery within the healthcare sector and would be a hindrance to the NHI.

“The introduction of the NHI has raised some concerns regarding the future of medical care in South Africa. Perceptions have been mixed; some view it as an opportunity to provide quality healthcare for all South Africans, which motivates some professionals to stay because they are inspired by the ability to make a difference in the country,” MANCOSA said.

“Other professionals have expressed concerns about the uncertainty and changes in remuneration, job security, and the current state of the medical profession in South Africa, which they believe encourages emigration. For the NHI to succeed, it requires core competencies in resource allocation, funding, and human resources.”

However, according to MANCOSA, the fear of the NHI from private-sector medical professionals has more to do with the unknown than the idea of universal healthcare.

SAMA’s Chairperson, Dr Mzukisi Grootboom, said that many doctors are moving to Canada and the United Kingdom, which have their own iterations of universal healthcare. Thus, it’s not fear of the concept of universal healthcare but rather the South African government’s implementation of the system.

MANCOSA said there were a number of considerations that the healthcare system should take to prevent the brain drain of medical personnel out of South Africa:

  • Improving working conditions such as workload reduction, provision of better equipment and facilities, and ensuring a safe and supportive work environment;

  • The implementation of fair and competitive compensation and remuneration for healthcare professionals;

  • Funding should be prioritised for domestic medical education and training programs that will allow medical professionals to enhance their qualifications;

  • The implementation of retention incentives such as loan forgiveness programs or scholarships that would contribute to services in underserved and rural areas; and

  • Developing policies that will foster the positive well-being of healthcare professionals. These can be designed to prevent burnout, harassment, and violence in the workplace. Healthcare policies should also be transparent, consistent, and supportive of the needs of healthcare professionals.

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