Nurses and doctors are still endangered species despite efforts by the Department of Health to retain them, the 2002 South African Health Review has found.
The annual review published by the Health System Trust is the most comprehensive look at issues affecting the health care sector.
The review found that 43% of doctors plan to work overseas after completing their community service. This number has increased from 34% in 1999. The review attributes the exodus of health workers to lack of management, stress, work overload and emotional burnout, which lead to a decrease in productivity and low staff morale.
The Department of Health implemented compulsory community service in 1998 for doctors, dentists and pharmacists to improve the delivery of public health services. This year community service has been extended to seven other professional groups to fill gaps in the health care service.
The South African Medical Association estimates that 5 000 doctors have left the country, with the number likely to increase if urgent measures are not put in place.
More than half of the young, white doctors interviewed intended to work overseas, compared to 10% of African doctors and 40% of coloured and Indian doctors.
Most of the doctors felt that they had made a difference during their community service year. However this had had no effect on their career plans and had merely delayed them by a year.
“This is in contradiction to the hopes of the Department of Health that establishing compulsory service would positively influence health professionals’ future contributions.”
Recommendations in the review include that the department provide incentives for these young professionals to return to South Africa and implement recruitment and retention plans to prevent the brain drain.
A chapter on the “voices” of primary health care workers shows their frustration at the lack of resources and the inadequate training they received. Health care workers felt discouraged because they were unable to utilise their skills, were overworked and had no time for the individual needs of patients.
The government can forget about a functioning health system if public health workers are not remunerated adequately, trained, supported and evenly distributed, says the review.
The review laments the absence of the National Health Bill, which, after seven years in draft form, has yet to be passed. The lack of national legislation creates confusion for provinces in finalising their laws, it says.
The review calls on African leaders to advocate for the control of tuberculosis (TB), malaria and HIV/ Aids, and to keep the world’s attention on the effect these diseases have on development.
There is little evidence that TB and malaria infections are abating. The National TB Control Programme has a three-year plan and aims to reach an 85% cure rate for TB patients. South Africa is ninth on the list of 22 high TB burden countries.
“An estimated 4,7-million South Africans are infected with HIV and 1,6-million of these will develop TB,” says the review.
TB/HIV pilot sites in four provinces have illustrated the need for community mobilisation. “Both malaria and TB programmes are not doing well due to poorly functioning health systems,” says the review.
The Global Fund for HIV/Aids, TB and Malaria should be supported, together with other interventions like the Stop TB and Roll Back Malaria campaigns in Southern African countries, the review says.
A section of the review dealing with nutrition found that 72% of children survive on a diet of only maize and sugar. It says children between the ages of one and nine had diets that were poor in nutrients. In its review the National Food Consumption Survey found that bread consumption was low.
One in five children in South Africa is stunted and one in 10 is underweight. Adequate human resources are needed at primary and secondary health care levels if the implementation of integrated nutritional interventions is to succeed.
Dr Patiswa Njongwe, chairperson of the Health System Trust board, says this year there has been an increase in the number of Aids patients seeking health care from already overstretched public sector facilities, particularly clinics in under-serviced communities. “Health care workers at all levels of the health care system grapple with the burden of caring for the sick, and coping with the [HIV/Aids] epidemic,” he says.
The health review says the provision of antiretroviral treatment is inevitable, and that 20 000 people are already being treated with anti-retroviral drugs. “In the next three to seven years universal access to antiretroviral drugs in South African will become a reality”.
A survey of of 728 Aids households revealed that 34% of their monthly income goes to health care.
“The study highlights the need for policy-makers to address the health needs of people with Aids. Without a comprehensive approach to this problem existing poverty will be deepened.”