Universal health care is a laudable objective. It is the dream by every South African who doesn’t have a stony heart and a comfortably insulating bank balance.
Unfortunately, it’s just not clear who the hell is going to do the actual caring.
In a country where there is already an acute shortage of doctors and nurses, the authorities are doing their very best to get rid of those who remain. Two recent departures have hit the headlines.
HIV expert Dr Francoise Louis, one of the first practitioners in SA to prescribe antiretrovirals in defiance of government disapproval, has just returned to France after a seven-year struggle to register to practise. The final straw was an HPCSA demand that she produces a “certificate of mentorship” from the university where she qualified – a document that simply doesn’t exist in the French system.
Another is Uganda-trained Dr Michael Ribeiro, one of fewer than 20 surgeons in SA qualified to perform reconstructive microsurgery on hands. He was forced to work without a salary for eight years in the public sector, as the Health Department does not allow non-South African registrars to be paid while they doing their specialisation.
The final straw for Ribeiro was the HPCSA’s obstructiveness and incompetence when he applied to open an independent practice and to do a mix of public and private work. After 11 years of frustration and despite raising two children here, he is now leaving for Kenya.
These elite doctors are leaving not because they are seeking greener pastures – more money, better working conditions, physical security – but because the Health Professions Council (HPCSA) made their work impossible.
Of course, the HPCSA must guard against SA being flooded by poorly trained foreign doctors. But it insists on absurdly stringent regulations, including that foreign trained specialists and general practitioners first undergo protracted further education in SA, before being allowed to practice.
Anele Yawa, general secretary of the Treatment Action Campaign, which has called on the government to curb the powers of the HPCSA, described the process as “flawed and unnecessary”. “How do you explain a situation where a qualified doctor with a 10-year service record overseas now has to go to school for two to three years in South Africa?”
In contrast, the United Kingdom, which has a vastly better resources healthcare set-up, is doing the best it can to make it possible for highly-skilled professionals to work there. It has just announced that there will no longer be any restriction on the number of doctors and nurses who can apply for skilled worker visas.
To aggravate our home-grown problem, the HPCSA is dysfunctional. And that’s not journalistic hyperbole.
That was the main finding of a ministerial task team appointed by Health Minister Dr Aaron Motsoaledi in 2015 to investigate allegations of maladministration, irregularities, mismanagement and poor governance at the HPCSA. In response, the HPCSA simply showed Motsoaledi the middle finger, saying that the findings were “recommendations” and “advice” that did not necessarily have to be acted upon.
The top executives, instead of facing disciplinary inquiries for incompetence and criminal prosecution for corruption, got golden handshakes to leave. While there’s now a new executive in place, the organisational culture of obstructiveness remains unchanged.
Not that the government is any better than the HPCSA is creating an environment that draws and retains skills. Its indifference to the concerns expressed by medical professional bodies, as regards the manner in the which the proposed National Health Insurance (NHI) system will be implemented, is going to have grave consequences.
Last week, the SA Society of Anaesthesiologists (SASA) released data showing that almost a fifth of the country’s 2826 specialist anaesthesiologists are contemplating leaving SA. This would make catastrophic what is an already dire situation.
SASA points out that global minimum standard is to have at least five specialist anaesthesiologists per 100,000 people. In SA, the current situation is 2.51 per 100,000 overall, dropping to 0.9 in the public sector.
It’s not about money, stresses SASA’s Dr Lance Lasersohn, but about clinical autonomy, resource constraints and unmanageable patient loads. As it stands now, the proposed NHI is “[not] a viable option and could create harm…. We might just not have the capacity to service the entire population’s patients and then we are just left with people lying in hospitals.”
The African National Congress government and its tripartite alliance does not want to hear and this. Criticism of, or scepticism towards, the NHI are viewed as treachery and greed.
The Congress of SA Trade Unions has called on the government to ignore the critics: “We will not allow these funded lobbyists to distract…”, its spokesperson said this week. Cosatu merely takes its cue from Motsoaledi, who recently announced that opposition to the NHI is “orchestrated by the medical aids”.
That’s an astonishingly, gratuitously insulting remark from a Minister of Health towards the stakeholder groups whose co-operation and commitment he needs so desperately. We should remember his words, when Cabinet ministers and top government officials start flying to Singapore, London and Beijing for medical treatment.
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