Health-e News Service - January 25, 2012
Rural hospitals in South Africa are 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
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
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
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
"It is taking way too long for a placement to happen and we are
competing with many other countries desperate for these human
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
"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
"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.