Rural Health Crisis Looms

Posted in The New Age , June 12 2017

Rural health crisis looms

DESPITE a multibillion-rand investment by the government to improve access to quality healthcare in the country’s rural areas, an alarming shortage of doctors threatens to torpedo this intervention.

Provinces affected by the doctor shortage include Gauteng, North West, KwaZulu-Natal, the Eastern Cape and Limpopo.

According to research by the Rural Health Advocacy Project (RHAP), one doctor is servicing a population of 138000 at a primary referral site for 11 rural clinics as doctors continue to shun rural health facilities. The New Age got a glimpse of the challenges rural hospitals face during a visit to Jubilee District Hospital in Temba, Hammanskraal.

Long winding queues and hours of waiting are the order of the day. A patient, who walked about 6km to the hospital, said they had become accustomed to the long queues. “When we come here we know we will have to wait for nothing less than three hours.

We usually meet people from the North West who don’t have their own hospital,” she said. The hospital caters for patients from areas including Moretele, Bosplaas, Ramaphosa, Dertig and Makapanstad. RHAP director Marije Versteeg-Mojanaga reiterated the situation at Canzibe, a district hospital in the Eastern Cape, where one doctor is available for a population of 138000, was not an isolated case. Versteeg-Mojanaga said Canzibe went down from seven to one doctor in a year.

“The Eastern Cape department of health has said it is recruiting three new doctors to start by July 1. So, if these three doctors get appointed, they still have a reduction from seven to four, which is almost 50%,” she said. She said that it was “absolutely imperative that these three doctors start urgently”.

Eastern Cape health spokesperson Sizwe Kupelo said two doctors from Zithulele Hospital were temporarily assisting at Canzibe. “The department is embarking on a recruitment process,” Kupelo said. North West rural health facilities are also badly affected by the shortage. “The North West presented in Parliament that it is rationalising staff which sees numbers at some hospitals reduced by 50%,” she said.

National Department of Health spokesperson Popo Maja said the general insufficient supply of doctors in public health was not unique to South Africa. “The shortage of doctors is a worldwide phenomenon. The government has introduced over the years intervention with differing degrees of success,” he said.

Maja said they had made strides with the Cuban doctors’ training programme, but the department was still far from reaching its target. Versteeg-Mojanaga explained that posts are either abolished entirely from the organogram or they are temporarily frozen, sometimes for months, until funding becomes available to fill the posts.

“The situation is particularly dire in rural areas and as you may have gathered the recruitment and retention of staff is a particular challenge in the rural context. So, when a rural doctor resigns or if their contract is not renewed it cannot easily be remedied,” she said.

The KZN health department recently said a R3.2bn budget shortfall left 11.5% of jobs unfilled. KZN department of health spokesperson Sam Mkhwanazi said the department was discussing challenges including staff shortages within the government and with its social partners such as labour unions with a view to finding solutions.

Limpopo department of health MEC Phophi Ramathuba said attracting doctors was difficult. “We are a rural province so it’s difficult to get young doctors to come to work in a rural province where they do not know where their kids will go to school and where the roads are so terrible.

It is a challenge because we are seen as a rural area,” Ramathuba said. The Free State province has set aside R246m in training funds for doctors, some of them in foreign countries such as Cuba and Russia.

The province is expecting to receive 116 Cuban-trained students this year to complete their 18 months of internship training. MEC for health Butana Kompmela said in his budget vote that a task team had been established to look at how they were going to expand the training platform in the province.

“This team includes the University of the Free State medical school led by the dean, Prof Gert Van Zyl. We will continue to support these students and others in the world to accumulate international experience and be fit for our South African health needs,” he said.

A representative for the Rural Doctors Association of South Africa, Indira Govender, said on a busy month-end day, she can see up to 50 patients. Estimates are that South Africa has between 66 and 88 rural hospitals in its 22 rural district municipalities.

Govender says the government can come up with initiatives to make working in rural areas attractive. She suggests the provision of decent accommodation, proper schools and improved internet connectivity.