Picture: 123RF/LANGSTRUP
Picture: 123RF/LANGSTRUP

The health department will wrap up the placement of final-year medical students in their internship posts this Friday. It has confirmed that all South African medical students, apart from 28 permanent residents and five applicants who did not register on time, have been stationed at training facilities and community service posts for next year.

Last week, the department randomly assigned the 300-odd students in limbo who were "second rounded" in a rushed attempt to ensure the January 1, 2018 deadline is met. Applications for appeals close today (December 11) while students who want to exchange posts among themselves have until this Thursday to do so.

Medical students are legally required to do two years of internship and a year of community service to complete their qualification. But significant delays in the allocations due to a budget deficit prompted a social media panic and a Department of Health sit-in protest by medical students concerned about whether they will have jobs next year.

Internship placements are supposed to be done in a series of three rounds according to students’ preferences. Bursary students (who are obliged to train in the province that their funding comes from) and those with special considerations get stationed first at their preferred hospital choice. The second-round allocations were supposed to be finalised in September.

Provincial governments are legally obliged to provide enough funded posts to absorb medical graduates, yet this year’s process is being held up by the Western Cape, Gauteng and KwaZulu-Natal claiming that provincial coffers have dried up.

Marika Champion, the communications director at the Western Cape’s health department, said: "The current economic reality and the growing burden of disease and drought in the Western Cape leave no space to accommodate extra interns without additional funding. We call upon the [national Department of Health] to approach national Treasury to assist with additional funding for provinces."

However, in heated arbitrations with the relevant premiers, Health Minister Dr Aaron Motsoaledi found that the Western Cape was now the only province not willing to shuffle around expenses for the urgently needed health posts. "How does that become my problem? Out of the R178bn allocated for health, I only get about 2%. They believe I’m asking them a favour here. The Western Cape is the only province that has filled less than half of its 564 accredited posts. Next year they only want to fill 181. That’s simply not fair."

Although the minister has been successful in forcing the hands of the provinces to find more posts, the question still remains of whether there is sustainable funding to pay the salaries for these health posts, given the health budget deficit and the Treasury’s planned expenditure cuts.

Junior Doctors Association of SA national secretary-general Dr Michael van Niekerk says the community service year was not necessary as SA was the only country in the world that required it. "What we need to start talking about is if Treasury is not going to allocate more funding to the [Department of Health] and this is going to be a constant battle and struggle, we need to start a discussion on whether the community service year is feasible or not"

In an e-mailed response to questions, the Treasury committed to considering putting measures in place to ensure the health post debacle did not recur every year. "Given the importance of this issue and the fact that it’s an issue of national concern, consideration should be given to ring-fencing the relevant budgets nationally and not just leave it to the discretion of provinces."

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