EDITORIAL: Let the private sector help

SA is confronted with a desperate shortage of health-care workers. Look no further than the latest critical skills list published by home affairs minister Aaron Motsoaledi last week. It contains an alarming catalogue of specialist doctors, nurses and dentists deemed lacking.

The recent experience of SA’s private hospital groups during the coronavirus pandemic is a case in point. As cases surged in various regions, private hospitals were forced to move nurses around the country because there were simply no extra hands available in the immediate vicinity when hospital admissions spiked.

Doctors and nurses are in short supply the world over. But the problem is particularly acute in SA, which trains and retains far too few health-care professionals for the size of its population.

Take medical specialists: there were fewer than 10,000 specialists for a population a little shy of 58-million in 2018, according to research by health consultancy Percept. This meant SA had 16.5 medical specialists per 100,000 population, ranging from seven specialists per 100,000 population in the public sector to 69 per 100,000 in the private sector. The government often  points out the terrible inequities between SA’s two-tier health-care systems, but even the private sector is falling short compared with other middle-income countries.

Estimates vary, but by all accounts SA faces a nursing crisis: the health department projects a shortage of 34,000 registered nurses by 2025, while the Hospital Association of SA (Hasa) puts the gap at between 21,000 and 61,000.

So there was a palpable sense of frustration at last week’s annual Hasa conference as speakers described the impediments the government has thrown in the way of private hospitals seeking to train more nurses. Nursing training is overseen by the department of higher education and training and the SA Nursing Council (SANC), which must approve the programmes offered by provincial nursing colleges, universities and private hospitals.

Private hospitals say they are inundated with applications for places but are being hamstrung by the nursing council’s refusal to approve more than a handful of spots. Several years ago, private hospital group Netcare graduated 500 nurses a year; today it produces less than a fifth of that figure, despite SA’s growing population and worsening disease burden.

This is no fly-by night institution offering dodgy qualifications: it is a JSE-listed company that, like its peers Mediclinic and Life Healthcare, has not only been at the forefront of SA’s response to the coronavirus pandemic but also offers some of the country’s most sophisticated medical care.

The SANC says it considers a number of factors, including the capacity of provincial clinics and hospitals to provide placements for student nurses, who need experience in the public sector. But it has not explained why it has so sharply curtailed the training offered by private hospitals.

The SANC’s absurd chokehold on the pipeline of new nurses is made worse by the health department’s antipathy towards the private sector, despite all the evidence that business is willing and able to help tackle SA’s health-care challenges.

At the onset of the coronavirus pandemic, the private sector helped procure life-saving supplies of personal protective equipment, and it has been an integral part of the government’s Covid-19 vaccination programme, which despite numerous setbacks has provided more than 37.2-million doses to more than 20-million adults. The immunisation drive was a hugely successful public-private partnership, with people able to obtain their jabs in any participating facility regardless of whether they belonged to a medical scheme or not.

Yet despite this recent experience, the government remains distracted by the political imperative to be seen to be implementing National Health Insurance, its deeply flawed plan for achieving universal health coverage. It has spent the past 15 years driving a policy that has yet to be implemented, at the expense of many smaller and simpler reforms that could have improved health-care for users of both public and private sector services.

When Covid-19 struck, SA was already short of doctors and nurses. The situation is now far worse: by the health department’s own estimates, around 1,500 health-care workers lost their lives to the virus.

It is time the government gets off its ideological perch, harnesses the goodwill shown during the coronavirus pandemic, and works hand in hand with business to improve the health of the nation.