SOUTH AFRICA: Doctor brain drain continues
"It mirrors the depth of dissatisfaction among doctors over South Africa's public health system," Mike Waters, shadow minister of health for the official opposition Democratic Alliance, told University World News.
The statistics were published last month in reply to a parliamentary question and reveal the numbers of newly graduated doctors who did not register for community service. Of 5,689 who qualified over four years, 4,702 registered.
All doctors have to undertake community service to be accredited by the Health Professions Council of South Africa to practise medicine. The figures suggest many young doctors may have gone to work in other countries, meaning the government subsidy to those medical students is a lost investment.
The Department of Health endorses the competency of doctors after they have served 12 months at state-run health institutions, explained Ravick van der Merwe, an industrial relations adviser for the South African Medical Association. Before offering their services, doctors also have to undertake a year-long internship.
Community service doctors and interns are crucial to the public health system, which suffers a 40% vacancy problem. Newly graduated doctors are expected to 'give back' to the community, and they are often deployed to very remote and under-equipped hospitals where their skills are most needed. Working conditions are often extremely difficult.
South Africa employs 18,000 doctors in state-run hospitals - or one doctor for every 3,800 people without medical aid - and fewer than three doctors per 10,000 people. The World Health Organization suggests an average of eight doctors per 10,000 people but the figures are worse in rural areas.
"Considering the money they will earn after five years, new doctors might run away even before they enrol for community service. The remuneration that they get is not enough for some to pay back loans that they would have borrowed," Van der Merwe told University World News.
Grumbles about community service are not the only factors chasing doctors away. Professor Gina Joubert, of the faculty of health sciences at the University of Free State, recently wrote in an article Reasons for Doctor Migration, published in the South Africa Family Practice journal, that high levels of crime and violence, lack of prospects, HIV-Aids and a decline in quality in the education system were also pushing doctors to look elsewhere.
"The loss of doctors from South Africa has also been attributed to the high quality of medical education they receive here, a feature that would indisputably render them prime candidates for employment in various developed countries across the world," Joubert wrote.
Marije Versteeg, project director of the Rural Health Doctors Association said: "We live in a context of international competition for scarce resources, in this case human resources. Some countries offer better salaries and better working conditions. The public health system in South Africa is strained. Due to staff shortages, there is higher workload and extremely stressful work environment, especially in rural areas."
One way of trying to ease the medical brain drain is to select students who display social responsibility and a commitment to the country and to communities, especially in rural areas.
"Retaining sufficient health care professionals in rural areas requires an integrated and comprehensive approach that starts with the right selection criteria for medical students," said Versteeg.
This includes decentralised medical education in rural areas, enticing school students to choose a rural career, and ongoing support for rural health care professionals.
While lauding government strategies aimed at retaining doctors - such as the policy on compulsory community service, improving salaries through scarce skills and rural allowances, and recruiting foreign healthcare workers - Versteeg argued that measured against the inequitable distribution of health in rural areas, they were not adequate.
Some institutions, such as the University of the Witwatersrand, are trying to attract student doctors who have the 'heart for the job' using innovative means. The Wits Centre for Rural Health recruits students from rural areas who are jointly selected by Wits and the district.
The first students will graduate at the end of this year and there are plans to expand the programme.
"Government needs to support and work together with universities that have started implementing such approaches," said Versteeg.
Last May, public health doctors held protests over slow negotiations and subsequent implementation of the Occupation Specific Dispensation (OSD), an agreement tabled in 2001 on how increments should be implemented across the health sector.
The South Africa Committee of Health Science Deans has since written a letter to South African Health Minister Dr Aaron Motsoaledi urging him to remember the needs of doctor trainers when addressing the causes of recent doctor strikes.
"We submit that the conditions not only compromise service delivery and patient care but also adversely affect the education and training of health sciences students as this occurs largely in public sector clinical training platforms," said Professor Sabiha Essack, chair of the committee and Dean of the faculty of health sciences at the University of KwaZulu-Natal.
Essack said the academic health sciences were severely under-resourced, both in the number and level of qualification of the workforce. With implementation of the OSD, the private and public health sectors were now offering better remuneration packages than academia.
"Staffing of the academic health sciences will be compromised as a result of better remuneration in the public sector. Postgraduate recruitment will decrease," said Essack.
South Africa has been experiencing a brain drain for decades, undermining the regional economy. Previous studies have shown that 25% of medical graduates have been lost to the US alone.
And it is not only doctors who move to greener pastures. Official statistics estimate that between one and 1.6 million people skilled in professions and managerial occupations have left the country since 1994, the year South Africa became a democracy.