Severe doctor shortage in South Africa
Despite a doctor shortage in South Africa that is caused by budget constraints, the government is still pushing forward with NHI.
Health Minister Dr Aaron Motsoaledi explained on Newzroom Afrika that despite South Africa’s severe doctor shortage, there are insufficient resources to hire more healthcare professionals.
A significant reason for this is the austerity measures implemented by Finance Minister Enoch Godongwana, which have also impacted various sectors outside of healthcare.
“We have got severe austerity measures, very crippling budget cuts that affect not only our capacity to hire doctors but to perform quite a large number of functions,” Motsoaledi said.
Therefore, although he agrees with the grievances of doctors who are struggling to find employment, the minister said you simply cannot hire people that you cannot afford to pay – which is exactly the situation South Africa is in.
He explained that, once you complete your studies, you need to do a two-year internship to become a qualified doctor.
This two-year internship is a statutory requirement, which means the National Treasury must find room in the budget to place these interns – “whether the government likes it or not”.
In addition, after you complete your internship, you are legally required to do community service, which the government is also required to accommodate.
“After that you are a free person, you are a fully fledged doctor. You can go anywhere,” the minister said.
“If the state advertises a post, you can apply. If the post is in the private sector, you can apply. If you want to open your own private practice, you can do so. If you want to go and work elsewhere, you can.”
However, Motsoaledi explained that after community service, the state no longer has a statutory requirement to employ that prospective doctor.
“I hear words like ‘absorption’ after community service. There’s nothing like absorption. You apply for a job like any other job seeker, like any other graduate.”

As a doctor himself, Motsoaledi emphasised that he would like to get these people employed. However, the unemployment crisis isn’t limited to newly qualified doctors.
“I don’t want to give an impression that there’s a special deal for some people because they are doctors. We also have unemployed nurses, unemployed social workers – all of them unfortunately because of austerity measures and budgetary constraints.”
Recently, some jobs have been advertised across the country: 57 in Gauteng, 54 in Limpopo, 26 in Mpumalanga, 25 in the North West, 60 in the Northern Cape, and 73 in the Western Cape.
The closing date for all of these positions was December, which means that these appointments will still be made.
“But these are advertised jobs, and they can’t advertise more than this if they don’t have money to pay,” Motsoaledi said.
“You can’t hire people who you are not able to pay. Any employer anywhere in the world, public or private, will only hire people if you have got money to pay them for that employment.”
Motsoaledi explained that every country in the world struggles with a doctor shortage, but the situation is twice as bad for poor countries like South Africa.
Not only is there a shortage of doctors, but there are also not enough resources available to hire qualified doctors, which leaves room for wealthier countries to swoop in and recruit these doctors for themselves.
“For instance, in the Middle East, they don’t train doctors, they don’t train nurses. They just get them from African countries and pay them a lot of money because of their oil reserves, and you can’t compete with them.”

Some experts have warned that South Africa’s doctor shortage crisis would worsen if the NHI were to become a reality, with many doctors promising to leave the country.
However, Motsoaledi dismissed these concerns, saying that many people do not really understand what national healthcare means.
He noted that it is not a system you “enter when you have got all the doctors you need, all the equipment, all the facilities and everything that is that is needed”.
“That’s not what universal health cover, NHI, means.”
He added that, according to the World Health Organization, a country must spend at least 5% of its GDP on healthcare to ensure that its citizens get very good healthcare.
South Africa has far exceeded that at 8.5%, which is very close to the 9% average being spent by European countries.
Despite the country’s high healthcare expenditure, though, its healthcare system still leaves much to be desired.
While Motsoaledi agreed with those who blame the problems with South Africa’s healthcare system on corruption and mismanagement, he believes that inequality is the real problem.
“The core problem is the manner in which the money in South Africa is distributed.”
“51% of that money of that 8.5% of GDP go to support only 14% of the population, and a whopping 86% of the population remains on the remaining 49%. That is the issue of gross inequity, which NHI is there to solve.”
In short, he stated that South Africa does have the money, “but it is completely unevenly distributed in favour of only 14% of the population who are well-to-do, and when we implement NHI, that is our target. That’s the issue we want to solve, not the other things that people are mentioning.”
Although he said that the NHI would not be able to completely solve South Africa’s poor doctor-patient ratio, as no country has been able to do, it would put the country in a better position than it is currently in.
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