Section B Part A a

In 2004 one of the most important

measures introduced to combat the
problem was the Scarce Skills Allowance.
This consists of a 15% allowance for
healthcare workers. Furthermore, an
additional allowance of 18-22% was given
to doctors working in the public sector.
This allowance acknowledges the
presence of shortage and acts as a
deterrent against emigration of health
professionals.

Since 1998, doctors, pharmacists and

dentists having just finished their
internship must carry out a paid year of
community service. Health systems in
rural areas depend greatly upon the intake
of young doctors. A 3-year training period
was imposed as well as the internship in
whatever district the student has
matriculated in. This, in addition to
passing a medical exam and approval by a
supervising doctor, must be completed to
be a certified physician.(1)

The department of Health has been using

another approach to try meeting the need
for healthcare workers: Bring in
practitioners from Cuba. Cuba is known to
have a high rate of doctor-to-population
(about 59 to 10,000 compared to 6.7 to
10,000 in South Africa).

The Government has also financed the

South African Network of Skills Abroad’s
(SANSA) project to help expatriates
returning to South Africa.

Scholarship plans are being explored by

the Government to decrease brain drain.
In this plan, graduates are given financial
support for their education but will need to
work in their country after they
graduate(2).
b)

The HIV pandemic contributes to the problem. It is

estimated that 16% of the health worker force is HIV
positive(3). Late detection of HIV due to inadequate
facilities often eventually leads to death. Barriers
such as stigmatization and confidentiality in health
service provision must be taken into consideration.
Nonetheless, there are some exemplary staff care
programs being initiated such as at McCord Hospital
in Durban and Mseleni Hospital in northern KwaZulu-
Natal. In McCord Hospital, free healthcare is provided
for the staff (4). Staff morale is also increased via
support groups addressing emotional burden of
caring for dying patients(4). As for the Mseleni
Hospital, Antiretroviral therapy (ART) for staff has
been free since 2005(2). A self-declared HIV positive
lay counselor receiving ART is involved in counseling
and testing of staff.

These hospitals have shown good initiatives in

providing well-managed in-house programs for
medical staff. However, the implementation of such
programs faces challenges, as the prevalence of HIV
among health workers is not well known. The health
system must take measures to protect health
workers from occupational exposure to HIV and TB to
improve health worker retention and job satisfaction
(5).

Non-governmental, faith-based and community-

based organizations stepped up to combat the
shortage, too. As well as employees, volunteers are
recruited from for-profit business employee volunteer
programs, developed recently (6).

Approximately 60 000 to 80 000 non-profit

organizations have projects in South Africa today (6).
Unfortunately, some areas rely predominantly on
such organizations. Examples include the role of non-
profit organizations in palliative care, and faith based
organizations, like the Salvation Army, in the care of
people infected with HIV and AIDS. Supplementing
this, the Catholic Church, operate three hospitals, 32
public health care clinics, and many hospices and
day centers (6). In addition, 200,000 traditional
healers participate in the country's healthcare;
playing an important role in the field of psychology
and mental well-being. Moreover, there are self-
employed health care providers in all fields of
medicine that meet the primary care needs of 7.1
million South Africans for a fee (6).

The African Health Placements is a donor and

corporate-funded project aimed at addressing health
worker shortages in the public sector. This project
recruits foreign healthcare workers from developed
countries and South African qualified workers moving
from private to public sectors (6).

SECTION B PART 2

A study by the Centre of Rural Health,

University of Kwazulu-Natal collected two
sets of data from 159 hospitals on November
2003, and May 2004, two months after
implementation of the Rural Allowance and
Scarce Skills Allowance. The majority of
respondents (51%) stated that the new RA
influenced them to work in rural areas (7).
The findings suggest that the allowances
attracted more health personnel to work in a
rural setting, combating shortages in rural
areas. In the first survey, finance was the
primary factor for respondents’ choice of site
of practice; however, in the second survey it
was the third considered factor behind
career opportunities and job satisfaction. 7

Many communities in South Africa have

become dependant on the one-year
compulsory community work of doctors.
Although they compensate somewhat for the
shortage of HCW’s, there is sometimes no
supervision and support of junior doctors,
and due to inexperience they rely too much
on tests rather than diagnostic skills.8
Although the plan was introduced to
consolidate social solidarity and decrease
brain drain, the number of doctors planning
to work overseas increased from 34% in
1999 (when the compulsory community
service was introduced) to 43% in 2001,
showing the limited success of the scheme.9

Forcing prospective doctors to stay an

additional year does not solve the problem
underlying the shortage in their numbers. It
merely prolongs the inexorable. To eradicate
this national affliction, short term, temporary
solutions must be disregarded and replaced
by a focus on making long-term changes. (1)

The World Organization of Family Doctors

(WONCA) in 2002 recommended recipient
 countries of health care emigration pay
compensation, a “brain drain tax” to the
country of origin, making recruitment more
costly, thereby discouraging it.
Compensation received could then be
ploughed back into the health system, into
the recruitment of more homegrown doctors
and medical equipment. Problems with this
theory would be distribution of
compensation and administrative problems,
accused of corruption (10)
Strenghts-
1-Scarce Skills Allowance and Rural Allowance,
financial incentive to remain in the country
2-Compulsory Community Service and Scholarships,
prevent graduates from leaving the country early.
3-Recruitment of Foreign Workers

Weakness-
1-Compulsory Community Service, workers education
undermined.
2-Technologically, infrastructural, and salary-wise.
South Africa is still not on par with Western
healthcare systems.
3.

1. Tshabalala-Msimang, Manto. Programme to Address

Shortage of Doctors. 2004 April 1. [cited 09 October
27]. Available from:
http://www.healthlink.org.za/news/20040330
2. Department of labour South Africa. The shortage of
medical doctors in South Africa [Internet]. South Africa;
2007 [cited 2009 Nov 19]. Available from:
http://www.uif.gov.za/downloads/documents/research-
documents/Medical%20Doctors_DoL_Report.pdf 1

3. Health Gap, UGCH, AMSA [document on the Internet].

Healthcare Worker Shortage Crisis in Africa: Fact Sheet
[updated 2007, cited 9/10/2009] Available from
http://www.healthgap.org/hcw/documents/HealthcareWorker
ShortageFact_Sheet_UCGH.pdf

4. Uebel KE, Nash J, Avalos A. Caring for the Caregivers:

Models of HIV/AIDS Care and Treatment Provision for Health
Care Workers in Southern Africa. The Journal of Infectious
Diseases. 2007; 196, S3.

5. The World Bank [webpage]. Where HIV/AIDS and

Africa’s Health Worker Shortage Meet. [updated 2009, cited
1 Nov 2009]. Available from
http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,conten
tMDK:21861007~menuPK:34457~pagePK:34370~piPK:3442
4~theSitePK:4607,00.html

6. Schaay N, Sanders D. International Perspective on

Primary Health Care Over the Past 30 Years. In:
Barron P, Roma-Reardon J, editors. South African
health review 2008. Durban: Health Systems Trust;
2008. p. 223-36
Available from:
http://www.hst.org.za/publications/841
7
Reid S. “Monitoring the effect of the new rural
allowance for health professionals” Durban: Healh
Systems Trust; 11/2004; Cited 13/11/2009 Available
from: http://www.healthlink.org.za/publications/643
8
Anthony Zabarowski “Community Service in an
urban hospital” Durban: Health Systems Trust.
11/2000; Cited 13/11/2009

9
Reid S ‘Community Service for Health Professionals’
In P Ijumba, A Ntuli, P Barron (editors), South African
Health Review 2002. Health Systems Trust, Durban
Cited 16/11/2009

Padarath, Ashnie ‘Health Personnel in South Africa:

10

Confronting maldistribution and brain drain’

EQUINET. 2003. Cited 16/10/2009