Rural hospitals in South Africaare facing a serious doctor shortage in 2012 as a result of delays in registering foreign qualified doctors and the failure to place community service doctors in underserved hospitals.
Many of the foreign qualified doctors who provide essential medical care in remote and rural parts of South Africa are from the Developed World (United Kingdom, Europe, Canada, USA, Australia and New Zealand) and their training and experience is considered equivalent to that of South African trained doctors so they can be registered here without passing extra examinations.
But several rural hospitals are facing the prospect of severe doctor shortages in 2012 as the "non-exam track" foreign qualified doctors have to wait many months to be registered by the Health Professions Council of South Africa. There are increasingly time-consuming bureaucratic requirements, resulting from concerns about "bogus doctors".
Madwaleni Hospital, a 180-bed district hospital in the Eastern Cape, is an example of this grim reality. Four foreign qualified doctors, three from the Netherlands and one from the UK, willing to work at Madwaleni have been waiting several months to be registered.
Adding to the dire situation, Madwaleni has not been allocated any community service doctors for 2012.
As a result, the hospital currently has only four doctors, and two senior doctors are leaving next month (FEB). Unless they are replaced by senior doctors, the two junior doctors have indicated that would have no option but to also leave.
Madwaleni has 14 posts for doctors and until recently, it had a stable work force of between eight and 10 doctors. Over the past six years, 18 foreign doctors have contributed years of service to vastly improving the health care provided to a deep rural community.
The doctors also created a core group which encouraged other foreign doctors and community service doctors to consider Madwaleni as a place to work, knowing that they will be supported as part of a competent team and not left to run a rural hospital by themselves.
The hospital, only 40km away from Nelson Mandela's birthplace, has seven wards, an outpatients department and an HIV wellness and antiretroviral unit, which in the past has been held up as a best practice model.
Marije Versteeg of the Rural Health Advocacy Project said the Madwaleni situation would never have been allowed to happen in an urban hospital and that even though this was an extreme case, it was not isolated.
She said there was an urgent need for community service doctors to be allocated where the need was greatest - in rural hospitals.
"You have a situation where there are many community service doctors placed in the Eastern Cape urban hospitals, but very few or none in the rural hospitals," she said.
Versteeg said foreign qualified doctors would go to other parts of the world if the perception was that South Africa did not want them.
"It is taking way too long for a placement to happen and we are competing with many other countries desperate for these human resources."
Saul Kornik of Africa Health Placements, an organisation that recruits healthcare workers to work in rural and underserved areas, said there had been an over-reaction to one bogus doctor getting through the system.
"Let us not over-react and exclude hundreds of doctors who want to work here," he pleaded.
Kornik said it took at least six months and often more for well-qualified foreign doctors from the "non-exam track" countries to be registered.
Professor Steve Reid, head of the Primary Healthcare directorate at the University of Cape Town, said the HPCSA needed to provide evidence that foreign qualified doctors, who are post internship, need more experience before they can work in rural hospitals.
"They are essentially the equivalent of South African community service doctors who are posted to rural areas post-internship. One needs to ask on what basis these decisions are made," he said, referring to indications that the HPCSA was going to add further requirements.
"Rural health services are, by their nature, very fragile and vulnerable and often dependent on a few key people," he added.
Reid said there was an urgent need for a national policy, which would oblige the provinces to allocate their community service doctors to rural hospitals where there are no interns. KwaZulu-Natal was already moving in that direction with a proactive policy for the province. Under the current system, most community service doctors are placed in urban hospitals.
HPCSA acting registrar and CEO Dr Kgosi Letlape said "in the past things were done for expediency, so now if it takes 10 years (to register a doctor) that is how long it takes and if it takes three months, that is how long it takes".
He claimed that the delays in registering doctors were due to non-compliance with the HPCSA process by the applicants and not due to the council's inefficiency.
However, one of the doctors waiting to work at Madwaleni has been waiting since November for HPCSA registration despite submitting all the required documents. Other doctors are waiting even longer with no indication that they have not complied.
He declined to confirm that South Africa specifically needed foreign qualified doctors.
"The safety of patients is paramount and whatever we do cannot be considered an over reaction," said Letlape.
Versteeg said putting patient safety and quality of care first was non-negotiable.
"This then requires foreign qualified doctors in hospitals where there are no or very few South African doctors. To avoid situations where patients in emergencies see no doctor at all, possibly dying from a lack of care, the registration process needs to be faster," she said.