In 2015 the Millennium Development Goals reached their deadline, with South Africa among the countries that did not meet all of their targets. South Africa’s health system is faced with a number of challenges – the burden of communicable diseases, high HIV infection rates, diseases related to poor diet, and a shortage of health-care professionals in both the public-and-private sector.

In any complex system, the approach that must be taken to addressing challenges must itself be complex. This two-part series looks at the health practitioners, and the health facilities to consider where opportunities and challenges exist.

The Constitution makes a commitment to providing affordable healthcare for people. With only a small percentage of South Africans on a medical aid that enables them to seek private health care, the public health system is most South Africans’ first port of call when ill. It’s obvious then that what is needed is enough adequately equipped public facilities to meet the demand.

But, where facilities exist, often the challenge is to ensure a sufficient supply of doctors who want to and are qualified to work in the public health sector. This requires an education system that can produce matriculants with good enough results to qualify to study medicine and other health related courses.

Even if all matriculants were perfectly qualified to study medicine, South Africa’s nine medical schools can only accommodate a certain number of new medical students each year because of their physical and human resources required to train them. These schools produce between 1000 and 1200 graduates per annum. Unfortunately, this is not enough to meet the patient demand.

When medical students graduate they are required to undertake two years of community service in order to register as a doctor. There they work long hours, often under non-desirable conditions. To progress many of them will choose to specialize, taking further years of study. For many others, after these three years of hard work, they leave to work in the private sector or go overseas. And so, despite all the effort and public funds, the numbers of doctors still remains lower than needed.

These challenges equate to a ratio of 0.8 doctors per 1000 people. So what are the options to make the best of this situation? Some potential options could include:

• Increasing the training channels, for example empowering nurses; training Clinical Associates – new cadre of health worker;
• Enabling foreign doctors to come and work in South Africa by making it easier for them to get work permits;
• Requiring private sector doctors to undertake community service in public hospitals regularly, and
• Improving the pay and working conditions of the public sector to reduce the drain of doctors to the private sector or the overseas markets.

Some of these solutions might encourage more doctors to remain in the system. Another is to look at the state of the health system as a whole – something that will be considered in the next part of this blog.