Posts to change so doctors can do community service

Health Minister Aaron Motsoaledi has assured parliament a shortfall in community service for doctors and several other disciplines will be met by converting an oversupply in other fields.

Community service is a compulsory requirement for medical graduates, who can only register with their professional bodies and practise independently once they have fulfilled that obligation.

The policy, which also applies to 16 other disciplines, was designed to increase the number of healthcare professionals in under-serviced areas.

Still, in recent years, the public health system has struggled to absorb all those who must do community service, leaving hundreds of graduates in limbo since they cannot work in their chosen profession or train to become specialists until they fulfil their obligation.

In a written reply to questions by DA MP Karl le Roux, the minister said there were enough funded posts for nine in 10 medical students who would complete their training this year.

Provinces were also short of funded community service posts for pharmacists, environmental health practitioners, physiotherapists and diagnostic radiographers, he said.

At the end of 2024 as many as 2,330 medical interns were expected to complete their second and final year of internship, their last leg of training to qualify as a doctor. But there were only 2,128 funded community service posts for doctors next year, resulting in a shortfall of 202, the minister said.

The same issue was playing out in four other disciplines: provinces were short of community service posts for 117 environmental health practitioners, 70 pharmacists, 29 diagnostic radiographers and 18 physiotherapists. The problem was acute in environmental health, with funded community service posts for just 60% of the 295 eligible people, he said.

“To mitigate the shortfall, the department has already engaged provincial health department to convert certain posts across the nine provinces to medical community service posts.”

Provinces were expected to finalise their work to convert posts for community service positions by mid-October.

Luvuyo Baleni, the health department’s chief director for human resources, said post conversion was restricted to community service positions. Provinces had an oversupply of some community service posts for 2025 due to a reduction in the number of graduates in some disciplines, including nursing, psychology and medicine, he said.

The department of health had received 1,059 community service applications for nursing, compared to the 1,889 posts available, while there were 2,163 applicants for 2,493 medical internships. In psychology there were 242 posts but just 151 applicants, and in audiology there were 132 posts with just 109 applicants, Baleni said.

The Eastern Cape health department confirmed that only existing community service posts would be converted to ensure this year’s graduates could fulfil their statutory obligations. A total of 15 medical intern posts would be converted to 10 community service posts and the process would not affect service delivery, Eastern Cape health spokesperson Mkhululi Ndamase said.

The province was doing its best to provide services within its limited budget, he said.

“Ideally, we would appoint as many doctors as possible, but this is hamstrung by budgetary constraints,” he said.

Provincial health departments are battling to deliver services with shrinking budgets. In February, the Treasury set aside a consolidated budget for health that grows by a nominal 3.4% over the medium term, below its average inflation estimate of 4.7% over the next three years.

In September, Motsoaledi told parliament provinces had vacancy rates for doctors ranging from 22.4% in the Free State to 5.5% in the Western Cape, while that for nurses ranged from 28% in the Free State to 5% in the Eastern Cape.

The reduction in headcount had increased the workload for remaining staff, leading to higher stress levels and decreased job satisfaction, he said at the time.

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