A pharmacist does a stock take of antiretroviral drugs at the rural Emmaus Hospital, 20km from Bergville, Kwa Zulu/Natal. (Photo by Naashon Zalk/Bloomberg via Getty Images)
The shortage of primary care physicians, together with tough economic conditions, continue to burden the country’s health sector, leaving pharmacists with a bigger role to play in providing basic healthcare services, according to Pharma Dynamics.
For the past decade South Africa has witnessed an alarming exodus of highly trained medical professionals. According to health insurance agency Profmed, almost 1 000 healthcare professionals have emigrated since 2015.
Drug firm Pharma Dynamics spokesperson Nicole Jennings said less than a decade ago, pharmacists were the most underused resource in the medical field but, because of the shortage of doctors, had stepped in to help fill some of the gap.
“Modern society moulded their profession into medical shopkeeping, but pharmacists have much more to offer. They undergo rigorous educational training similar to that of doctors, but are often in a better position to devote more time to patients,” she said.
A survey by the South African Medical Association (SAMA), a non-statutory professional association for public and private sector medical practitioners, revealed that roughly 40% of the doctors who participated from both the public sector and private practice were considering emigrating.
The association’s chairperson, Mvuyisi Mzukwa, told the Mail & Guardian that an earlier study by the South African Migration Project (SAMP), which conducts applied research on migration and development issues, showed that about 71% of the doctors who emigrate are pushed out by excessive taxes, unsatisfactory fringe benefits and poor remuneration, which were cited by 90%, 82% and 63% of the respondents respectively.
Another push factor cited by the SAMP is the dissatisfaction over relationships with management.
Jennings said: “Recent studies suggest that South African patients visit community pharmacies more often than they do doctors. Therefore, community pharmacies provide patients with easy access to healthcare professionals closer to home.
“Another positive is that the number of community-based pharmacies in the country are increasing, which again makes them ideally placed to provide expanded healthcare services.”
In addition, she said, doctors are primarily responsible for diagnosing medical conditions, prescribing medications and creating treatment plans. They have limited time for each patient because of the number of patients they need to see in a day.
“In contrast, pharmacists often have more time to spend with patients in retail pharmacy settings, answering questions and providing medication counselling. In some cases, pharmacists in clinical or hospital settings may also have more direct patient interaction, particularly in medication therapy management programmes.”
With the need for everyone in the country to have high-quality healthcare, refocusing the profession of pharmacy from primarily supplying medicine to providing services that attend to patient needs will allow pharmacists to play a more active role in the country’s care system, while also reducing costs and optimising health outcomes, Jennings said.
The SAMA study highlighted that the doctor-to-patient ratio in the country is 0.79 per 1 000 of the population with other country benchmarks being five per 1 000.
Mzukwa said even the implementation of the National Health Insurance (NHI) would not stop the continuing migration of primary care physicians
The NHI Bill, passed by the National Assembly in June, aims to narrow the gap between the rich and poor in terms of the standards of healthcare, bringing equality to its provision as enshrined in the Constitution, according to the government.
Critics are urging President Cyril Ramaphosa not to sign the new law, which they see as regressively socialist, while proponents say without drastic state intervention, practitioners and private medical schemes will continue to follow the money and serve a fraction of the population.
Mzukwa said rather than the government focusing on the bill, it should have dealt with structural issues such as poor hospital infrastructure, safety concerns, lack of employment opportunities after community service and an inadequate healthcare workforce to deliver healthcare. This, he said, had led to the mass exodus of doctors and other health workers to other countries for better working conditions.
“The passing of the bill is certain to exacerbate the emigration of doctors and allied health workers as it will be difficult for them to provide the essential and life-saving services that they give, and their livelihoods are also threatened,” Mzukwa said.
Department of health spokesperson Foster Mohale said professionals such as doctors, nurses and educators had been leaving the public sector for the private sector, and were also going abroad for various reasons including attractive salaries.
“Their reasons differ from one person to the other; we do not think their decisions have anything to do with the NHI,” he said.