People are not commodities

‘Stop stealing our doctors’ is the heading to a news article published June 10, 2015 in the Citizen. In it, the director-general of the South African Department of Health claims, “The UK has been grabbing our health workers…[We are] signing a memorandum of understanding with the UK to get some of our health workers back…You shouldn’t steal from countries that do not have…You must stop stealing from us”.

People are not commodities. No government, whether South African or British can sign agreements on behalf of individuals. To do so without the consent of those individuals, to use the term that commonly describes such practices, is “human trafficking”. Doctors and nurses who decide to leave their homes and work elsewhere cannot be blamed for the situations they leave behind. The free movement of labour is a fundamental and inalienable right of individuals.

South Africa’s chronic shortage of medical personnel has arisen as a result of an ill-conceived policy introduced several years ago by government that limits the number of foreign doctors allowed to practice in South Africa. Also introduced was the policy that there shall be “No active recruitment for permanent employment in South Africa [from]… other developing countries in the African region”. To alleviate the chronic situation South Africa’s finds itself in would be to reverse these policies and open our doors to skilled foreign health professionals.

The attempt to restrict the flow of health professionals from our neighbouring African countries is well intentioned. However, OECD countries and other struggling developing countries will be more than happy to absorb these health professionals into their systems, and South African patients will be the ultimate losers.

All healthcare systems rely on the use of professionals who have been trained elsewhere. For example, a quarter of the staff working in the UK’s National Health Service and an estimatedone-quarter of practising doctors in the United States were trained abroad.

South Africa not only restricts the number of foreign trained professionals, but also makes it extremely difficult for those who want to come and practice medicine in this country. According to a report published by Wits University’s African Centre for Migration and Society last year, “At best it will take a foreign-qualified doctor or nurse two or three years to get a job in SA, but it can take as many as 10 years”. The report notes that the administrative processes in the assessment and recruitment of foreign doctors and nurses for the public health system involved at least 10 steps and seven institutions. As a result of the cumbersome and inefficient procedures only 1.5 percent (2,640) of South Africa’s public-sector health workforce (173,080) are foreigners.

In addition to restricting the number of foreign healthcare professionals, the South African government also holds a monopoly on the training of doctors. Every year thousands of potential candidates, even those who achieve several distinctions in their matric examinations, are turned away because the number of positions available within SA’s government-run medical schools is limited to about 1,500 positions, a number only fractionally higher than that set in the early 1970s. Despite the chronic shortage, the South African government continues to severely and artificially restrict the availability of locally trained professionals even though, since the 1970s,  the population that has more than doubled and the country suffers from an extraordinarily high disease burden.

A long-term strategy to ease the chronic shortages would require the government to relax its controls on tertiary education facilities, make entrance to training facilities less restrictive, and allow the private sector to establish private medical schools so that thousands of South Africa’s brightest students can pursue their dream of studying medicine. Whether the schools operate on a for-profit or non-profit basis, their establishment can only alleviate the problem.

If this is done, it will eliminate a significant amount of the burden currently faced by the public sector. South African private hospitals are well-established centres of excellence and world-renowned for their high levels of care. Privately run education facilities, if conducted in co-operation with these hospitals, will attract not only a large number of internationally recognised lecturers, which will increase the available pool of knowledge, but also international students, who potentially will stay and work in this country.

Privately run medical schools cannot solve the chronic medical staff shortage overnight but will certainly aid a long-term effort to increase the number of medical professionals in the country and make it possible for South African patients to receive the care and attention they deserve.

Author: Jasson Urbach is an Economist and director of the Free Market Foundation.

This article first appeared in the July edition of the ENT news

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