Health Minister Aaron Motsoaledi on Tuesday announced a healthy R1.24-billion would be spent to “revitalise nursing colleges” and improve infrastructure to train more nurses, as part of the department’s new human resource policy.
Motsoaledi unveiled the health department’s first human resource strategy to deal with the country’s severe shortages of doctors and nurses, at the University of Witwatersrand’s medical school in Johannesburg.
He had promised to address staff shortages in the public healthcare sector, when he unveiled the national health insurance green paper in August.
Department spokesperson Fidel Hadebe said nursing colleges standing empty would have to be fixed up so that they were fit for use.
“For the current financial year we will spend in R220-million, and R510-million each in subsequent years,” Motsoaledi said. “Even if Wits University takes an extra 1000 [medical] students it would not meet our needs.”
He said the shortage of healthcare professionals extended beyond South Africa and there are currently four million vacancies globally.
South African universities currently train 1200 doctors each year.
Training more staff
The plan proposed an increase in the number of medical students trained every year; investing more money in training facilities and nursing colleges; and building a new medical school in Limpopo. It also suggested a focus on primary health care by increasing nurses in schools and municipalities to prevent people from going straight to hospital.
Earlier this year Motsoaledi asked the deans of South Africa’s medical schools to train 40 more students per year. He said Wits University was the first to do so by taking in an extra 40 at the beginning of the year at the cost of R8-million.
The Wits’ medical faculty dean, Professor Ahmed Wadee, said the country was short of every type of medical specialist and it would take a long time to fix because it took “six to eight years to train specialists after they had qualified as doctors”.
South African Medical Association president Dr Norman Mabaso previously told the Mail & Guardian the country had 24 000 doctors in 1990, while in 2008 this had only increased to about 34 000. It took 18 years to produce 10 000 doctors, which he said was unacceptable.
A short-term solution from the health department included employing 400 retired nurses willing to work. Motsoaledi said they told him “they are retired but not yet tired”.
Private vs Public
Motsoaledi echoed this sentiment and said bad planning was to blame for the predicament South Africa finds itself in.
“Some problems are self-made,” he said. “Further evidence indicates that the training and production of certain key health worker categories have stagnated or reversed over the years. The weak management skills in the public service aggravate the situation even further.”
Motsoaledi said that staff did not like to work in the public sector and more had to be done to make sure management of hospitals were up to scratch.
“Studies have demonstrated that it is not only financial incentives that make them leave but sometimes how they are managed or mismanaged. The public health sector has to ensure that environment in which health workers operate is conducive,” he said.
Motsoaledi said in order for national health insurance (NHI) to work, there had to be enough staff distributed equitably around the country.
The NHI green paper policy document, released in August this year, mentions that there is a disparity between numbers of staff in the public sector and those in the private but does not address how to change it.
Despite his frequent complaints about the over-commercialisation of medicine, Motsoaledi dodged a question about how the ministry planned to attract health care workers from the private sector back to the government sector.
The minister was critical of the costs of private health care and said many people told him he was mad about wanting to fix the public health care sector. “I will not stop this madness of mine,” he told audience.
“People tell me the health care sector is not going to work but it has to work — 84% of our population rely on the public health care sector.”
The NHI policy document that the minister launched was also critical of private health care and suggested prices on private industry needed to be regulated.
The document noted that private hospital costs have increased by 121% and specialist costs by 120% over the past decade. It targets those increases as unacceptable and “out of proportion” to the services provided, suggesting that pricing in private healthcare needed to be “radically transformed”.