It is an ignominious situation that doctors that have completed their studies, can’t complete their internships due to a reported lack of funds and when the country already has a dearth of them. It’s even more criminal and shameful that government now wants to establish a fund to recruit Cuban doctors to work here – much the same as engineers a few years ago.
It must be borne in mind that South Africa is indeed a developing (albeit middle-income) country with limited resources amid a moribund economy. This, however, should not be an excuse not to appoint doctors who have been trained at great expense and who are in great demand. This may well be rectified if the necessary political will is present, but unfortunately it is not.
Corruption, incompetence and claims
Venality, the reckless squandering of funds, official ineptitude, and the perverse allocation of funds in the public health sphere are some of the most serious challenges faced by this sector. For years an overabundance of money has been flowing to administrative functions (salaries for bureaucrats and not medical staff) of the various health departments. This means far too little is left to render the core services by upgrading and buying equipment and appointing doctors and nurses.
Moreover, large amounts of cash are wasted on account of medical negligence and corruption. Only the Western Cape received a clean audit in the Auditor General’s (AG) latest audit opinions. In KwaZulu-Natal (KZN) this department lost R1.3 million after procuring hand sanitizer during Covid-19 that deviated from Treasury directives. The North West health department wrote off patient debt (yes, government services actually cost something) totalling more than R65 million without taking reasonable steps to collect it. The Gauteng department awarded an IT contract without following a competitive bid process and subsequently lost R150 million. The relevant accounting officer concluded in an investigation that criminal charges were necessary and the matter was referred to the National Prosecuting Authority (NPA). Nothing came of it.
In many provinces the extent of claims for medical negligence exceeds their entire annual budget. The Eastern Cape is a serial offender in this regard and the AG found that 75% of all claims in the province result in court orders. The provincial health department has since been increasing their legal capacity to stave off these claims – something that obviously costs more money. As a poorer province with a large population, they can ill-afford this.
Granted, all claims’ potential costs are not yet final due to ongoing court cases, but claimants are quite successful in suing health departments and getting settlements or court orders. Many of these cases are the result of fake doctors masquerading as real ones. They are obviously paid less than real ones, who sit at home or emigrate. Across South Africa most of these medical claims centre on babies that are born with cerebral palsy. To be sure, medical negligence breeds much opportunism among litigious lawyers that revel in victims’ cases (and the payouts), but government undoubtedly provide extremely fertile ground for this to occur.
There is a plethora of examples provided by the AG and many never even become known, which makes the scale of the problem even more problematic.
Grants won’t heal you
The issue of priorities is especially pertinent in this context. To harp on unworkable and unaffordable ideas such as a universal income grant (on top of existing grants) might score you some political points in an election year. The reality is that neglecting something as vital as health, in favour of small amounts of money, bears a tremendous opportunity cost. It truncates the life expectancy of certain groups and the country as a whole, causes the population to be sicker and less productive in the long run, and increases the burden on the state and households.
A few hundred extra Rands per month will barely help you to eat and live healthier and ultimately cause you to be healthier. Multiply this by 21 million recipients amid an economy that is showing anaemic growth, and the economic impact of these grants is abundantly clear. Also, think about what an extra grant would mean for you if you are unemployed and must take care of a child with cerebral palsy. And a grant means precious little if you have a medical emergency while being dependent on a maladroit and uncaring government for saving your life.
Even if these pernicious factors are largely or completely eliminated, the state would still have to husband and prudently leverage their resources if public healthcare is to be improved. Any government must. Yet, this snapshot of arguably the most important sector in the country shows that there is in fact a large bundle of cash available to appoint more doctors (and nurses) to complete their internships and be of further service later. If doctors can’t do their internships, they cannot practice as doctors. Sooner or later, prospective medical students will start eschewing this prestigious and noble profession if this quandary persists. They will leave the country to study and work overseas, and this will assuredly exacerbate the shortage of doctors while having a calamitous impact on the country.
Dr Brink is a business consultant, entrepreneur and analyst based in Paarl.
