Editorial Comment: Business Day
IT IS TO HEALTH Minister Aaron Motsoaledi's credit that he is acting decisively to address one of the critical concerns over the African National Congress's determined bid to introduce a compulsory National Health Insurance (NHI) scheme: the dire shortage of skilled medical personnel. Even if you assume that private sector health facilities and personnel will be persuaded to buy into the NHI concept - that too is a prerequisite for it to succeed - there would still be a gaping hole in the government's plan if the number and skills levels of workers in the sector were not increased significantly over the coming years before implementation of the scheme begins in earnest. Achieving this will indeed require a multibillion-rand investment, as Dr Motsoaledi pointed out when he introduced the Department of Health's human resources for health strategy this week. That is not a problem in principle; certainly, it is better to invest taxpayers' money in useful infrastructure like hospitals and medical schools than in fighter planes we can't use or toll roads the intended "beneficiaries" don't want. In broad terms, the new strategy entails revitalising the sadly neglected nursing colleges, establishing a new medical school in Limpopo, boosting the number of student doctors trained by existing medical schools, and investing billions of rand in the refurbishment of academic hospitals around the country.
SA produces about 1 200 doctors a year, a figure that has essentially been static for more than two decades. Dr Motsoaledi has been meeting the deans of the university health sciences faculties and medical schools over the past months, and they have all apparently agreed in principle to increase their intake of students from next year. The key here is resources - the state will clearly have to provide more funds, but more students mean more lecturers, a scarce resource in itself given the level of experience and expertise required. Similarly, it will not be enough simply to throw money at the nursing colleges; the quality of SA's medical personnel is already as much an issue as the quantity, especially at the nursing level. This goes to the nub of the problem - there is more to the shortage of doctors and nurses in SA than the fact that the state has failed to train enough people. Medical personnel have also been leaving the profession in droves, with the exodus especially acute in the state sector. There is little sense in doubling - or tripling, if Dr Motsoaledi gets his way - the number of doctors who graduate in SA every year if their training is inadequate, or the "push" factors that cause so many to emigrate are not addressed.
There is a particular risk that if the establishment of an NHI scheme is bungled and the options that remain open to skilled medical specialists in the private sector at present are closed down due to private facilities being starved of funds, the exodus of medical personnel from SA could increase. It is therefore vital the government takes the concerns of the medical profession seriously. Research shows it is seldom a single factor that persuades a doctor to pack his or her bags, but an accumulation of factors. Some, like SA's high rate of violent crime and the slow-motion collapse of the state school system, are beyond Dr Motsoaledi's powers to resolve. But others are specific to state hospitals and must be addressed post haste, including unhygienic working conditions, undisciplined nursing staff, a shortage of equipment, and too few consultant posts, which force newly qualified specialists to move to the private sector or emigrate if they want to progress in their careers. The NHI will succeed only if state facilities are made friendlier towards patients and medical personnel. That will require a significant outlay of not just financial but also political capital, especially when it comes to changing the attitudes of unionised health workers.
