In response to the earlier feature in the Sunday Times ‘SA is the winner as local doctors stay put” (22 March 2015) RHAP’s Director Marije Versteeg-Mojanaga questions if we are really “winning” in this letter covered in the Sunday Times of 5 April.
Your article “SA is the winner as local doctors stay put” (22 March) refers. South Africa can do with good news stories and it is encouraging to read about the motivations of some of the South African doctors that have decided to stay in the country instead of moving abroad. Yet, the article provides no evidence to back up that indeed we are “winning”. The first concern is one of numbers; the article reports that 194 doctors graduated at Wits University in 2000, yet only 111 (57%) have been traced of which 89 (45% of total graduates) practice in the country. That begs the question, where are the other remaining 83 doctors (43%)? It is likely that a good number is abroad. According to the United Kingdom’s General Medical Council, the UK alone had 5695 South African doctors in their employ in the year 2012. That is the equivalent of 5 times the total of annual medical graduates of all eight medical schools in South Africa. The second concern is the definition of “winning”. While the article show that at least 45% of the total graduates of the year 2000 still practice in South Africa, it does not tell us where they practice. The International Office of Migration’s research on Mobility of Health Professionals (2012) found that only 25% of all doctors in South Africa work in the public sector. A fraction thereof works in the rural public sector – yet rural people make up 43,6% of the total population. Are we really “winning” if the majority of doctors in the country serve a minority of urban patients in the private sector? It is hard to say without a sound monitoring system, but different research studies and media reports indicate the opposite. Currently neither the Department of Health, the Health Councils nor Academic institutions measure the distribution of public and private sector healthcare workers within provinces and between urban and rural areas in a systematic manner. Universities have a duty to produce the healthcare workforce that the country needs. This starts by selecting the right students, who are keen to work for underserved populations. And it ends by knowing exactly where these students end up, by tracking them over time. With an estimated Government subsidized cost of R717 035 per individual doctor’s education we all deserve to know if we are getting value for money.
Marije Versteeg-Mojanaga, Director – Rural Health Advocacy Project