The Department of Health has effectively run out of money to hire newly graduated doctors, with an estimated 800 qualified doctors not being absorbed into the national health system.
“Annually, the department cites budget constraints as a barrier to hiring qualified medical doctors, yet no substantial measures are evident to solve the funding dilemma,” it said.
“This contributes immensely to the web of factors that prompt the continuous emigration of qualified doctors.”
Professor at the Wits School of Governance Alex van den Heever explained that the Department of Health was given sufficient funds at the beginning of the year. However, a failure to plan adequately resulted in it running out of money for new doctors.
Van den Heever told 702 that a lack of funds to hire new doctors comes from the department’s failure to budget for a salary increase for healthcare workers.
The Department of Health was given sufficient funds at the beginning of the current tax year, but because the bargaining council agreed on a 7.5% salary increase for workers, it ran out of money.
Van den Heever said the first problem was that this increase was not fully funded in the department’s budget, almost as if it did not expect such a significant salary increase for the year.
“This contributes to the shortage of funds, but it really talks to the fact that the government is not connected from one end to the other,” he said.
It appears that decisions made by the bargaining council are made without any thought of financial sustainability or budgetary constraints.
The decision to agree to a 7.5% salary increase for healthcare workers was not matched by a financial decision to fund this agreement adequately.
Simply put, Van den Heever said increases cannot be given if the department cannot afford it.
“There is a failure of long-term planning that basically means your production of new healthcare professionals is greater than your ability to absorb them.”
This equation should ideally be balanced, but the Department of Health has regularly failed to do so.
The lack of funds to hire new doctors is nothing new, with Van den Heever explaining that it is a legacy of repeated above-inflation increases for middle management and junior staff.
This has chewed up the ability of the department to pay for newly qualified doctors. “You simply cannot afford them,” he said.
Van den Heever’s comments echo those of the chairperson of the South African Medical Association (SAMA), Dr Mvuyisi Mzukwa.
He said the problem is rooted in poor planning and not only in cuts to the Department of Health’s budget.
As the public sector provides the majority of healthcare services in the country, there should be a clear understanding of the resources the department needs and how this may change in the future. This planning has not happened.
Mzukwa added that the government is concealing the number of openings in the public sector as it is not replacing doctors who retire. It is instead erasing the posts held by former doctors.
“In the state system, there is a dire shortage of healthcare workers, especially doctors. In rural areas, the shortage is particularly dire,” he said.
The shortage of healthcare workers extends from nurses to highly trained specialists that the public sector cannot employ for various reasons.
Mzukwa said many of these specialists end up working in the private sector, leaving the country, or remaining in their current posts rather than filling a specialised role.
“The problem is you are leaving the public healthcare sector in a dire state because there is a shortage of staff, and those that remain are overworked,” he explained.
This, in turn, has a chilling effect on future doctors who are wary of working in the state-run system because of the workload and deteriorating work conditions.