EDITORIAL: State bungling fails SA’s doctors

In the same year in which the minister of health, no less, was forced to resign in disgrace after it emerged that a business linked to his family, Digital Vibes, had scored a R150m communications tender, the government now drags its feet on finding the money to pay graduating doctors for their community service.

This dissonance would already be a pitiful-enough indictment on the paper pushers in the department of health, but the Digital Vibes scandal, and the fact that the country is gripped by a pandemic, make it particularly inexcusable.

According to the SA Medical Association (Sama), more than 4,000 interns and community service doctors have yet to be placed for work that should begin on January 1. The department, in one communication to medical graduates, claimed it is in "ongoing consultations" with the National Treasury and the provinces about releasing funding for placing those doctors in community service.

Bear in mind that doctors are obliged to do this community service to fully qualify. Little wonder that Sama is now mulling court action to compel the government to make a plan by December 16.

It is inexplicable that the state made no provision for this. There certainly was enough time to plan, given that it’s a long-term qualification.

More to the point, this is hardly an unwanted staffing problem, considering the dire shortage of medical staff in SA. According to the global rankings, SA has just 0.9 doctors per 1,000 people. Compare that to the 2018 global average of 3.34, and you can see how far behind the curve we are.

Unsurprisingly, rich countries score well here: Germany had 4.2 doctors per 1,000, Switzerland 4.3. However, SA is also easily bested by less affluent countries with similar or weaker GDP profiles: Brazil, for example, had 2.2 doctors per 1,000 in 2018 and Argentina 4. Cuba, which has made an admittedly dubious export industry of medical staff, had 8.4 doctors per 1,000 people.

Yet, in SA, newly qualified doctors find themselves in a state of Kafkaesque limbo, while the department, looted by its own top officials, can’t seem to find the petty cash to employ them.

"The [department] is barring us from working anywhere in SA while simultaneously failing to employ us all for the mandatory community service year," one intern was reported as saying.

"Community service ... was initially put in place to ensure service delivery in poorly resourced and rural areas. But if they can’t guarantee us posts, we have no other option but to go overseas, because we are legally not allowed to practise [otherwise]."

It doesn’t help, of course, that the graduating doctors are all too aware of how funds have been "misappropriated" during Covid. To now plead poverty shows a clanging tin ear for a contingent actually contributing to SA’s advancement.

It also speaks to chaos within a department that is still speaking boldly about implementing National Health Insurance (NHI).

The community service programme was implemented 23 years ago, and it could have been a beacon for a developmental state. A 2018 review in the SA Medical Journal found that in its first 15 years, the programme — initiated by then health minister Nkosazana Dlamini Zuma in 1998 — was "a successively positive one, and it has largely met its original objectives of redistribution of health professionals and professional development".

It hardly bears saying that SA can ill afford to lose the doctors it already has, not to mention those that the state spends good money producing, because of a shambolic placement system. And it is especially egregious considering the estimated R200m that SA spent last year on doctors imported from our struggle friends Cuba. Let alone the billions wasted on corrupt Covid contracts.