Response to NHI: Medical brain drain risk

Since the National Assembly passed the National Health Insurance (NHI) Bill on 12 June, 2023, the debate over it has raged on.

South Africa has some of the best-skilled medical professionals in the world, but it is facing a brain drain. Raeesa Khan of private higher education institution Mancosa said the consequences of this were dire.

“As these skilled professionals leave, SA must grapple with severe understaffing, overcrowded hospitals and a disparity in access to quality medical care,” said Khan.

Rural communities more vulnerable

Rural communities were more vulnerable as medical resources become scarcer and were concentrated in urban communities.

According to the department of health, SA has a vacancy rate of 18.6% for specialist medical personnel and 13.7% for nurses.

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The Democratic Nursing Organisation of SA recently raised concerns about the shortage of nurses in public health facilities, with 20 000 nurses unemployed.

Khan said globalisation has led to an increased global demand for healthcare workers.

“Without substantial investments in healthcare sectors, developing countries will continue to experience the adverse effects of healthcare worker migration.” But “most of the reasons pushing healthcare workers to emigrate are rooted in structural and socioeconomic factors”.

Trust between government and the medical profession has decreased

South African Medical Association (Sama) spokesperson Dr Mvuyisi Mzukwa said the trust between government and the profession has decreased.

A survey conducted by mutual financial services company PPS indicated that out of the 2 905 medical professionals who participated, 58% of respondents were pessimistic about the NHI.

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They were concerned about capacity and infrastructure limitations, the potential financial burden on taxpayers and government’s ability to roll out the NHI effectively. Khan added that government had not adequately addressed the issues undermining the healthcare sector.

Public health facilities are overcrowded, short of staff, pay is low and health budgets are constantly reduced, said Khan.

While the aim of the NHI was to provide universal healthcare coverage to all South Africans and improve access to healthcare services, implementing it has raised specific questions regarding the future of medical care in SA, resource allocation and funding.

The NHI Bill states that NHI will be funded from “general taxes, contributions of persons earning above a set amount and monthly contributions made by the employees to the fund”.

According to a survey conducted by Sama, 38% of its members intend to leave SA in response to the anticipated implementation of the NHI.

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Different views

Mancosa’s School of Healthcare manager Mehnaaz Olla said: “Some view it as an opportunity to provide quality healthcare for all South Africans.

“Others are concerned about the uncertainty and changes in remuneration, job security and the current state of the medical profession in SA, which they believe encourages emigration.”

SA has a two-tier healthcare system: the public sector which serves most of the population and is government-funded, and the private sector which caters to 16% of the population.

“Integrating these two sectors is crucial to addressing the disparities and enhancing access to healthcare,” Olla said.