Monday, July 14, 2008
With
more South African doctors now working abroad than in the country's
ailing public health sector, the government needs to start aggressively
recruiting health workers from other countries, according to a
non-profit recruitment organisation.
Dr Clarence Mini, of
Africa Health Placements, which specialises in placing public-health
professionals, told a national tuberculosis conference in the port city
of Durban earlier this month that more than 4,000 doctor's posts were
currently unfilled in South Africa's state hospitals, while 3,000 South
African-qualified doctors are working in the United Kingdom and 2,000
in the United States.
Health workers have become a highly
mobile resource that countries have to compete for, Mini told
delegates. First-world countries that offered better salaries and
working conditions have managed to attract the lion's share of those
resources: the United States now has about 550 doctors per 100,000
citizens, compared to South Africa's 65.
To make matters
worse, 75 percent of South Africa's doctors work in the private sector,
and most of those remaining in the public sector work in urban areas,
while in rural areas the doctor-to-patient ratio can be as low as three
doctors to 100,000 people. In the context of South Africa's HIV/AIDS
burden, this amounts to a crisis.
One of the quickest and
cheapest solutions to the problem, argued Mini, was to recruit foreign
doctors and nurses: it cost about R2 million (US$263,000) to train a
doctor, compared to about R100,000 (US$13,000) to recruit one from
overseas.
The South African government has taken the stance
that recruiting health workers from other African countries with
similarly or even more poorly staffed pubic health sectors is not the
answer.
Responding
to Mini's presentation, health department director-general Thami
Mseleku said that health ministers from Zambia and the Democratic
Republic of Congo had pleaded with him not to employ their doctors.
"How can we tell the UK not to recruit our doctors if we do the same?"
he asked.
South Africa's human-resource plan has set a target
of employing just five percent of doctors from other countries.
Currently, about 15 percent of doctors are foreign, compared to an
average of about 25 percent in the developed world.
According
to Prof Helen Schneider of the University of Witwatersrand's Centre for
Health Policy, in Johannesburg, the government has tried to recruit
only from countries such as Cuba and the Philippines, which have
surplus doctors.
"My understanding of the department of
health's official position has been that if one is going to recruit
foreign health workers, you need to do it in an ethical way," she told
IRIN/PlusNews.
Mini urged the government to start by, at
least, recognising the qualifications of African doctors already in the
country as refugees and asylum seekers. "Instead of making them car
attendants, let's get them into hospitals to help our patients," he
said.
He also asked why the bureaucratic requirements could
not be cut down for doctors from developed countries who wanted the
experience of working in a rural South African health facility.
South
Africa also needs to increase the number of medical school graduates to
keep up with demand, said Mini. Over the last decade, intake at the
country's eight medical schools had remained the same, while the number
who actually graduated had decreased.
Keeping those graduates
in the country and in the public health sector should be the next
priority. "If all of South Africa's graduates had remained in the
country, we wouldn't have this crisis," said Mini.
The Centre
for Health Policy recently reviewed a number of studies carried out in
low- and middle-income countries to examine the effect of interventions
to retain health workers.
The authors found that while money
was important, salary increases were not usually enough to prevent
health workers from migrating; feeling valued and recognised, and
having opportunities for career development, were also of crucial
importance.
Source: IRIN NEWS http://irinnews.org