Budget shortages at the national department of health have left migrant medical students queuing for the mandatory one-year community service required to practice medicine independently in South Africa.
The department says the delays are not brought on by frozen posts; rather, they have been caused by a lack of funded posts.
Last year, Bhekisisa, the Mail & Guardian’s centre for health journalism, reported that health minister Aaron Motsoaledi threatened to take the provincial governments of Western Cape, KwaZulu-Natal and Gauteng to court for failing to meet their obligations to fund community service internships.
In 2017, the Junior Doctors Association of South Africa reported that nearly 300 medical graduates were left without placements.
Thabo Mokobane*, a 29-year-old doctor, is among other temporary residents who have been awaiting placements for more than seven months. “I don’t think they are still going to hire us, unless a special fund is made for us,” he says. Mokobane studied medicine and surgery at the University of KwaZulu-Natal. Though he has finished two years of internship at Ngwelezana Hospital in Empangeni, KwaZulu-Natal, he can’t practice as an independent medical practitioner until he has completed a year of community service.
“The department placed us in July, then revoked all placements because they said South Africans were not placed,” he explains. “They said we are supposed to wait for January. That’s when there will be another consideration.”
Hierarchy of placements
The health department says preference is given to South Africans, then permanent residents, and then, where resources allow, migrants. “This does not mean that we deny foreign nationals access to our clinical training platforms, rather we accommodate them within our available resources,” says health department spokesperson Popo Maja.
Mokobane doubts the department will be able to afford to hire him next year. “First, there were a few of us last year. Now there are two groups – we have doubled. As next year comes, there is a huge number of students coming from Cuba. It is just piling up.”
According to him, the problem is that there is no funding for new posts. “There are not enough doctors. The few that are there, are overworked,” he says.
Mokobane has subsequently returned to Botswana to find employment.
According to the department, the Cuban doctor programme will not affect the availability of internships as these doctors qualify in Cuba and don’t need additional training. “Indeed, many of them are professors and senior clinicians who assist in the supervision of interns and improve our local capacity,” says Maja.
The Nelson Mandela and Fidel Castro Medical Collaboration was formed in 1996 and caters for young South Africans from disadvantaged backgrounds. Students study in Cuba for five years and complete their final year in South African medical institutions. In April this year, Motsoaledi said the programme was too large and that it would be scaled back temporarily.
Government ‘not coping’
Motsoaledi told Business Day the “Cuban government is not … coping with these numbers, the provinces in their budgeting systems did not factor it very well, and it is too much for the South African universities to absorb.”
Dr Elma de Vries, the former chairperson of the Rural Doctors Association of Southern African, has previously criticised the programme for bringing back doctors who have not been trained to deal with HIV/Aids, TB or the complications associated with diabetes.
Currently, the department has received 2 115 applications for internship positions to begin in January next year.
Maja said, “To date, all eligible South Africans and permanent residents who studied in South Africa have been allocated. This required the approval of funding for an additional 442 posts, which has now saturated the Health Professional Council accredited posts.”
Another South African temporary resident, Peter Craft*, 28, has been unemployed for eight months. He claims that the department has treated him terribly. “We’ve been treated so badly, it’s actually disgusting,” says the Zimbabwean-born doctor.
“As a resident of a SADC member country, my fees were the same as the [fees of a South African-born student]. Essentially, the South African taxpayers subsidised my degree. In return, I have to give service back, which I am so happy to do, but the South African government won’t hire me,” he says.
He adds that with the country facing a shortage of doctors, there should be no medical practitioners sitting at home. “We’ve got this paradox where hospitals across the country are short of doctors, but they won’t place us.”
Welcome cash injection
In his 2018 medium-term budget policy statement, finance minister Tito Mboweni said National Treasury would re-prioritise R350 million to bring more than 2 000 health professionals into public health facilities.
The chairperson of the South African Medical Association, Dr Angelique Coetzee, says they acknowledge the attempt by the minister to address the need for more money in health, in particular the allocation of funds to address the shortage of critical clinical posts, but “more should still be done to improve the quality of health care in South Africa”.
Coetzee notes the shortage of staff at health facilities is arguably the biggest threat to quality health care services. “If this phenomenon is not halted, it has the potential to collapse the entire system,” she says.
*Not their real names