Medical doctors marched demanding employment from the Department of Health. Photo: Supplied
The Department of Health says placing young doctors for community service has become “complicated”, as most prefer working in urban areas rather than in poorer and rural communities, leaving many areas without much-needed public health services.
South Africa requires medical graduates to undertake compulsory two-year community service as part of their training before they can take up positions in private or public institutions of their choosing.
However, the processes have become a headache for many, some of whom had studied abroad and find themselves without community placements or unemployed after two years of community service.
The medics belonging to Cosatu affiliate, the SA Medical Association Trade Union (Samatu) took to the streets in four provinces on Thursday, demanding employment.
According to the department’s spokesperson, Foster Mohale, many unemployed doctors are simply too fussy about where they are placed.
“We find that we have openings in deep rural areas for community service, where there’s not even a cellphone network, but they tell us they can’t work far from home.
“They come with all sorts of excuses – mother is sick or other reasons. So, it’s a very complicated process.”
Foster Mohale
The government insists that after their community service, doctors need to find employment for themselves as their contract with the state ends.
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When asked why the government isn’t abolishing the community service requirement and release doctors to continue with their lives after graduation, Mohale said the state has an obligation to ensure that South African doctors are adequately trained.
“Unfortunately, it’s government’s obligation, otherwise we will end up having doctors who are not exposed to the environment or who are not adequately equipped for work.
“Doctors are like pilots, they need further training after qualification, we can’t let them take up jobs without on-the-job training. They have to be ready to see patients. Our job ends after the two-year service, they have to apply like everyone else.”
Mohale said when Samatu indicated that they had a list of jobless people who completed community service, the department discovered that many on the list had no registration numbers with Health Professions Council of South Africa (HPCSA) as required, while some had no identity numbers.
“We asked them to go back and clean up that list, especially when it comes to HPCSA registration,” said Mohale.
The graduates are allowed to swap with each other and relocate to work in their preferred areas. Mohale said this is done once a year, and some from rich families pay others thousands of rand in order to take their places in preferred locations.
According to Samatu secretary-general Dr Cedric Sihlangu, the list of unemployed doctors keeps increasing as more of them are forced to sit at home.
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Many emigrate or go into the private health sector because government won’t employ them, while those manning hospitals are burned out and stressed because of the difficult working environment they find themselves in, said Sihlangu.
“More than 1 000 qualified doctors don’t have jobs. You have a doctor whom government has invested in, idling at home when the public is desperate for health services,” he told SAfm on Thursday.
“Those who go to the private sector serve 10% of the population, 90% of our people don’t have access to private care. They have no money to afford those services, so many of them rely on public health care and their options are very limited.”
He said the problem was that politicians preside over a public health system that they don’t use.
“Ministers or directors have medical aid and use private services. In fact, when they have a headache, they are sent to a specialist – a neurologist is ready for them. They see a cardiologist for chest pains yet the bulk of our people are confined to public facilities where there are no doctors, which is untenable.
“If we are really envisaging the National Health Insurance [NHI] that’s coming, it cannot be that doctors are sitting at home while our people have no access to proper public health care.”
Speaking to The Citizen following their march to the Department of Health this week, chairperson and spokesperson for the SA Medical Association (Sama) Dr Mvuyisi Mzukwa said his organisation has been complaining for years about the shortage of nurses and doctors, but these concerns have fallen on deaf ears.
He said it was heartening to see young doctors taking to the streets because they don’t have jobs.
“The problem is that they are told to find their own employment after community service. We never even job hunted during our time.
“I finished community service and was employed, there was not even an interview, I was called to come in physically so they can be certain it is me, and that was it.
“We have been telling the government about the shortage of skills, especially doctors. We lost doctors and nurses during the Covid pandemic, we expect a sympathetic government but no, they want us to remain burned out.”
One doctor oversees at least 3 000 patients in public hospitals, while the health budget keeps decreasing, said Mzukwa.
“The annual budget decreases by 1% every year. The public is being told NHI is not ready, but that is because it needs qualified people on the ground giving good quality service, but that is not what they [politicians] are doing.”
Recently, graduates were told by the department to look elsewhere for work or open private practice.
Mzukwa said lack of equipment leaves many stressed because they are unable to work. In some provinces, the department shut down orthopaedic centres because there is no equipment, said Mzukwa.
“We received emails recently that Eastern Cape and Limpopo orthopaedic services are closed down because there is no equipment. I know many colleagues who leave the public sector because no equipment means you cannot treat your patients. So, they go overseas where they are equipped for their jobs properly, and paid well, because this country produces the best medical doctors.”
“I mean it’s a mess, the public health system is on its knees. I get offended when politicians call health workers heroes. Why call us heroes when you ignore the patients’ need for good care?
Over a decade since the NHI was piloted and R5 billion later, there has been little or no improvement in the quality of public health service at the test sites, with poor hygiene, drug stockouts, and long waiting hours still the order of the day.
Samatu’s memorandum of demands was received by Health Minister Joe Phaahla in Pretoria.
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