'If you don’t fill these posts‚ the whole health structure will collapse'
South Africa is facing the risk of an even more severe shortage of specialist doctors - a scenario that would hit the state and private health sectors hard‚ and one that has the health minister “worried”.
In an unprecedented statement‚ the SA Committee of Medical Deans has publicly stated that the poor state of provincial health departments "destabilises" academic training of doctors.
It called for more provinces to be put under national administration and for public hearings into the state of government healthcare.
The head of the committee‚ Professor Martin Veller‚ who is the University of the Witwatersrand medical dean‚ said that fewer registrars - who are specialists in training - are likely to be employed by the state in Pretoria and Johannesburg after they qualify.
This is because positions have been frozen by the cash-strapped Gauteng department of health‚ as detailed in a letter sent to every hospital head and leaked to this publication. Secondly‚ specialists are currently not being hired by the state for the same reason.
This comes as others resign‚ so there could be too few to train registrars.
An insider said they have heard there is a planned 50% reduction in Wits’ training positions for future specialists. These are positions for training specialists such as anaesthetists‚ gynaecologists and oncologists. These specialists in training are already doctors‚ who work at Chris Hani Baragwanath Hospital and Charlotte Maxeke Hospital as well as many smaller hospitals around Gauteng.
A doctor explained: "The problem with not training enough registrars is that at teaching hospitals‚ registrars provide the majority of specialist services." Teaching hospitals include Helen Joseph hospital and the Steve Biko Hospital in addition to Charlotte Maxeke and Baragwanath.
The doctor explained what fewer registrars means for patients: "Without registrars‚ patients don’t get a specialised level of care. As such‚ fewer registrars means less service delivery and ultimately in the long term‚ fewer trained specialists - of which there is already a massive shortage."
A doctor in the state service said: "I would estimate that by 2019‚ Gauteng will be 40-50% down in absolute number of qualified doctors employed in the state. That's going to collapse an already terrible system further."
Health Minister Aaron Motsoaledi held a meeting with Prof Veller on Monday over the deans’ concerns. A day later‚ he told a news conference in Pretoria that if the province didn’t hire enough doctors and specialists in senior positions‚ he would consider putting Gauteng Health under administration.
"I am very unsettled‚” Motsoaledi said. "I am very unsettled that Wits medical school‚ Tukkies (Pretoria University) and Sefako Makgatho (previously Medunsa University) could lose training capacity. I am very worried about that. It will make our universities suffer if they don't fill them [posts]. If many of these things are not done‚ I will consider putting Gauteng under administration.”
He admitted that provinces "don’t always listen to national departments"‚ but that he had instructed Gauteng to fill critical posts. "I told them regardless of how difficult financial conditions are‚ you cannot not fill critical posts. Medical students need trainers...they need professors. If you don’t fill these posts‚ the whole health structure will collapse."
Dr Motsoaledi said Gauteng trained the highest number of doctors in Africa.
"The Gauteng health system is huge. It needs to be managed very well."
Prof Veller said that the dire state of provincial health departments across the country affected the quality of care given to patients‚ as well as the training of specialists and new doctors.
For example‚ he said that when operations were cancelled‚ doctors couldn't participate and specialists-in-training missed learning opportunities.
Another issue is the long waiting lists for treatment‚ which mean it may be too late to offer certain medical interventions to patients. As a result‚ doctors have less opportunity to be trained in these interventions.
He said shortages of drugs and consumables - such as masks and drips - also affected the treatment of patients and training of new doctors.
The health minister said he had a two-hour meeting with the dean on Monday.
Motsoaledi said: "Veller is telling the truth. I sat with him. We discussed this issue. The government needs to fill those posts. Our plan is to fill them."
But he could not promise that the Gauteng department of health would hire enough specialists and enough registrars. "I don’t have any power over provinces. All I can impress on them is to fill them."
Previously‚ the Gauteng Health department has denied that posts are frozen‚ saying critical posts will be filled.
Meanwhile‚ in their letter‚ the deans also asked what would happen to the 720 medical students returning from Cuba in July - who need to be trained in fifth year medical school and then complete their internships. This is a year of work in the state sector to ensure they qualify as doctors.
Even the heads of medical departments don’t know what will happen‚ saying training sites are not fully prepared‚ with less than two months before students arrive.
The minister said the students were sent by provinces to train in Cuba so the "national department of health has written to every province asking them to provide money to train and place students in South Africa".
With 60 days to go‚ Motsoaledi couldn't say if the provinces would come up with the money.
The news briefing by Motsoaledi on Tuesday came after health ombudsman Malegapuru on television described healthcare in South Africa as being on the brink of collapse.
Motsoaledi disputed this. But he admitted that poor management at hospitals‚ long waiting lists for treatment‚ irregular buying of goods and poor financial management by provinces are leading to difficulties in the “distressed” health system. He also acknowledged there were many critical posts which had not been filled in Gauteng and in the North West province.
Looking ahead‚ Motsoaledi said the national health department needed more power over the provincial hiring of staff and buying of expensive equipment. This would require a change to the National Health Act. Provinces currently get their budgets straight from Treasury‚ bypassing him.
The deans would like Parliament’s portfolio committee on health to host public hearings during June and July 2018 on the crises in provincial health departments‚ followed by corrective action by government. Their letter also requested that a National Governing Body for Human Resources for Health (incorporating Training and Development) be established by the end of July 2018.