South Africa’s chronic shortage of health care professionals

South Africans, like the citizens of many other African countries, suffer from a number of serious health problems. As a result, average life expectancy at birth has declined from 62 years in 1990 to a mere 43 years in 2006. The decline in life expectancy can be attributed almost entirely to the substantial rise in HIV/AIDS. Indeed, SA’s adult population has one of the highest prevalence rates in the world, with an estimated 21.5 per cent of the population infected. Less than a handful of other African countries have higher rates.

It is not unreasonable to assume that as the HIV positive patients begin to develop AIDS-related diseases, there will be a greater demand for skilled health workers. The Health Systems Trust estimates that SA will require an additional 3,200 doctors and 2,400 nurses by 2009 to care for the large number of infected patients. It is therefore unfortunate and inappropriate for the Department of Health to respond to our current chronic medical staff shortage by limiting the number of foreign health professionals entering SA.

The South African Minister of Health, Manto Tshabalala-Msimang recently released the final draft of a discussion document entitled, ‘A National Human Resources Plan for Health’. The ambitious mandate of the report is, ‘to provide skilled human resources for healthcare adequate to take care of all South Africans’. The discussion document comes largely as a response to the substantial staff shortages in the public health care sector.

A report released by the Organisation for Economic Co-operation and Development (OECD) in 2003 indicated that 23,407 SA-born health professionals were working in five OECD countries. The majority of these expatriates were practising in the United Kingdom. The remainder were working in the United States, Australia, Canada and New Zealand. In order to partially make up for this outflow of health professionals, South Africa was fortunate enough to attract enough foreign doctors to make up 20 per cent of the total number of doctors in the country. The majority of these foreign doctors were practising in rural areas, which are not the favourite working areas of SA doctors. However, the new proposal stipulates that “The total foreign workforce shall not at any stage exceed 5% of the total health workforce”.

Foreign health professionals who are allowed to work in the health system will be allowed to do so for no longer than three years. Furthermore, “No active recruitment for permanent employment in South Africa will be directed at other developing countries in the African region”. The attempted restriction on the flow of health professionals from our fellow African neighbours is well intentioned. However, the OECD countries and other struggling developing countries will be more than happy to absorb these health professionals into their systems, with SA patients being the ultimate losers.

SA’s staff shortage is due in large part to unattractive working conditions within the public sector. The draft report proposes to address this issue by substantially increasing the remuneration of public health sector professionals. However, the National Health System (NHS) in Britain provides some precautionary evidence as to why conditions within the public health sector are not likely to be substantially improved by simply pouring more money into it.

The large amounts of extra public money transferred into the NHS by the British government (up from £34 billion in 1997 to an estimated £92 billion next year) have had, at best, limited success in improving the service. Even its supporters consider the NHS to be a national embarrassment and failure. Indeed, the former director of clinical governance in the NHS, Professor Aidan Halligan said, “What we have learnt is that throwing money at the problem only allows us to do more of what we have always done”.

Recently the British Department of Health (DOH) signed the first government-brokered deal allowing a private company to run traditional family doctor services. This move is largely in response to the appalling conditions within the public sector. According to the British DOH, “More than 250,000 NHS patients have had operations or scans faster than they otherwise would, thanks to the use of the independent sector”. Furthermore, the British DOH plans to buy 250,000 procedures a year from the private sector. The SA government could improve public patient care considerably by purchasing the services from the private sector for patients that are simply unable to afford the required procedures. Despite the SA government’s best intentions in wanting to improve the overall health and welfare of the nation it is obviously not capable of meeting unlimited demands.

If the SA health department wants to reverse the so-called brain drain and improve health care for the majority of South Africans, it has to improve the environment in which the private sector operates. There is a general consensus that the private sector provides services that are superior to those provided by the state so there is no reason for government to attempt to dominate healthcare because it is considered to be an essential service. For example, just because we need food to survive doesn’t mean that the government should take control of farming and food processing – history has demonstrated that such actions result in famine. In healthcare, government domination results in queues and staff shortages.

Author: Jasson Urbach an economist at the Free Market Foundation. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Free Market Foundation.

FMF Feature Article/ 13 June 2006