On a recent flight from Johannesburg to London, I sat next to a South African nurse who was returning from a short holiday to her job in Wales. Queeneth, decided to swap working at Chris Hani Baragwanath Hospital in Soweto, for a quiet, well paid job in a nursing home in the north of Wales. Although she admitted that she missed South Africa terribly, she isn’t planning to return for at least 10 years. “The money is far too good and I get treated well” she admitted to me. If we are going to be able to tackle our current and future healthcare problems, we will need Queeneth and her qualified colleagues to come back – or rather not to leave in the first place. In part that will require a change in government thinking.
South Africa’s Minister of Health was recently elected as one of five vice presidents of the World Health Assembly (WHA). Her election could be both good and bad news for the health of millions of people around the world. The Minister’s position on malaria control has been excellent and the policies that she promotes to control the disease have saved thousands of lives. The news will be good if her new position gives her the power to extend South Africa’s malaria policies elsewhere. The news will be less good however if other South African healthcare policies are allowed to take root at the Assembly.
The ANC government inherited a two tier healthcare system – one for whites and one for blacks, coloureds and Indians. It has had to make some tough decisions in trying to improve healthcare for all and indeed has brought in a number of far-reaching reforms. One of the problems with the reforms however is that they tend to punish the private sector and have left private and state doctors feeling disgruntled, to say the least.
Among the reforms, newly qualified doctors are required to complete 2 years of community service before they can begin practising medicine in the private sector. While the compulsory service may provide them with some good experience, the mere fact that doctors are treated as cattle of the state doesn’t do much to encourage them to remain in the country.
Most state doctors and nurses are poorly paid and work under very trying conditions. Apart from the poor pay and long hours, working conditions are often unsafe. “Sometimes we feel threatened, especially if we have to drive to clinics in dangerous areas,” says Dr Ralf Brummerhoff, psychiatric registrar at the University of Witwaterand. His concerns are real; last week a colleague of his was shot and her car stolen as she entered Chris Hani Baragwanath Hospital.
Yet instead of trying to offer better pay and conditions, the government appears to be turning on doctors themselves. The new Health Act which was passed last year requires doctors to obtain a certificate of need before they can practice in a particular area. In an effort to ensure a greater spread of health professionals around the country, the government looks set to deny doctors the right to practise in some urban areas and may force them to set up practices where the Minister deems appropriate.
In many poor and rural areas where there are no pharmacies, patients usually get their medicines from doctors. Yet laws, that are currently being challenged, outlaw the right of doctors to dispense medicines and now require a doctor to get a licence to dispense. Doctors are expected to go through an expensive and time-consuming procedure to apply for the licence, which may or may not be granted by the Department of Health. Doctors are understandably outraged, not only with the interference in their businesses, but with the effect that this will have on their patients, particularly poor and vulnerable patients.
The government’s aggressive position towards research based drug manufacturers is very well documented. The new drug pricing regulations will ensure that South Africa is far less profitable than before and therefore less worthy of investment. Much of the continuing professional development was paid for by these companies in the past and so without their continued investment and commitment to the country, medical personnel may well fall behind their peers in other countries.
Earlier this year, South Africa’s doctors, led by Dr Kgosi Letlape of the South African Medical Association marched on parliament to demonstrate against government policies. We have reached a low point when educated professionals are treated so badly that they have to resort to street demonstrations. If South Africa wants to keep its medical personnel it should start treating healthcare as more of a business and encourage the private sector, which can pay its staff more and treats them better, to invest. Yet unfortunately the government has done quite the opposite; hence the exodus of Queeneth and her colleagues.
The Minister of Health has shown great foresight and courage by going against WHO policies on malaria control and her actions on malaria alone mean that more children are now in schools, preparing for a brighter future rather than suffering from malaria in some forgotten clinic. Stemming the flow of qualified personnel out of the country will require equal foresight and requires a better understanding of the needs of doctors, nurses, pharmacists and drug companies. As a Minister who is used to taking difficult decisions she is certainly capable of doing the right thing for our healthcare sector – the alternative is too terrible to contemplate.
Author: Tren is a director of the South Africa based health advocacy group, Africa Fighting Malaria. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Free Market Foundation.
FMF Feature Artickle / 1 June 2004 - Policy Bulletin / 29 September 2009