The state has money for doctors


It screams to heaven that doctors who have graduated cannot complete their service year due to an alleged lack of funds. However, it is more criminal and scandalous that the government wants to create a fund to recruit Cuban doctors to work in South Africa – like engineers several years ago.

It must be taken into account that South Africa is indeed a developing (yet middle-income) country with limited resources in a restrictive economic environment. However, this cannot serve as an excuse for not hiring doctors – who are expensively trained and of critical importance. It can be rectified if the necessary will is shown, but unfortunately this is not happening at the moment.

Corruption, incompetence and demands

Corruption, reckless wastage of funds, incompetence and the perverse allocation of funds in the public health sphere are some of the major challenges crippling this sector. For years, for example, hopelessly too much money has been allocated to the administrative functions (read: salaries for officials and not medics) of the health department. This means that there is hopelessly too little left to deliver the core services by replacing and upgrading equipment as well as hiring medics such as nurses and doctors.

In addition to this, large amounts of money are wasted due to medical negligence and, among other things, corruption. Only the Western Cape’s health department received a clean audit in the Auditor General’s (AG) latest audit opinions. In KwaZulu-Natal, this department lost R1.3 million after they purchased hand sanitizer during Covid-19 that was too expensive and contrary to directives by the treasury.

The North West Health Department has written off more than R65 million in patient debt (yes, even the state’s services are not free) without taking reasonable steps to collect it. The Gauteng department awarded a contract for information technology without a competitive process and thereby lost almost R150 million. The accounting officer’s investigation revealed that criminal charges were indeed necessary and the matter was referred to the national prosecuting authority. Nothing further came of this in the meantime.

In many provinces, the scale of medical negligence claims alone exceeds the entire health budget. The Eastern Cape is a serial offender in this regard and the AG found that 75% of all claims in the province result in court orders. The provincial health department subsequently started to create more legal capacity to fend off these cases – which obviously requires more money. As a poorer province with a large and poor population, they can hardly afford it.

Granted, the claims’ potential costs are not yet final because court cases are still ongoing, but much of it is being paid out to plaintiffs due to settlements and court orders. Most of these cases are the result of bogus doctors doing work for which they are not qualified. Obviously they are then compensated less than real doctors while real doctors sit at home and emigrate. Law across South Africa’s provinces deals with most of the medical claims for babies born with cerebral palsy. Obviously, many of these claims are accompanied by opportunistic lawyers who lick their lips for these victims’ cases (and the payouts), but this state of affairs is problematic from the outset because the government allows this negligence.

There are many more such examples that are cited by the OG and others that are not even recoverable, but the scale of the problem and costs are striking and clear.

Grants don’t make you healthy

The question of priorities is of great importance in this context. Preoccupying yourself with ridiculous and unworkable ideas like a universal income allowance (on top of previous allowances) might provide some political points in an election year. But the truth is that abandoning something like health, in favor of small monthly alms, carries an enormous opportunity cost. This shortens the life expectancy of certain groups and the country as a whole, ultimately causes a sicker and less productive population, and increases the burden on the state and households.

A few hundred rand extra per month will hardly make you eat better in order to be more healthy. Multiply by around 21 million beneficiaries and considering an economy that is hardly growing, and its economic impact on other spending priorities is clear. For example, also think about what an extra allowance means to you if you do not have a job and also have to take care of a child with cerebral palsy. In addition, if you have a medical emergency, an allowance means nothing if you nevertheless depend on a clumsy and insensitive state to save your life.

Even if these harmful factors are largely or even completely eliminated, the government will still have to use their resources wisely and sparingly to improve public health care. Any government must. But this snapshot of what is surely the most important sector in South Africa shows that there is essentially a lot of money in hiring real doctors to do their service year and even beyond.

If doctors do not complete their service year, they cannot practice. Soon, prospective medical students will shun this prestigious profession if this situation continues. They go abroad to study and work there or pursue something else, and this can only further worsen the doctor shortage and have disastrous consequences for the country.