By Bulela Vava, Atlantic Fellow for Health Equity in South Africa
South African public healthcare is back in the headlines for a familiar reason this time of year. This morning, I saw the now infamous headline: “Doctors Jobless.”
Such headlines have become common during this period, with commentaries flooding newspapers, digital platforms, and television news outlets.
South Africa has been facing a severe unemployment crisis that affects millions, particularly the youth, for nearly a decade. This issue was once thought to mainly affect unskilled workers. But now both skilled and unskilled workers, including healthcare professionals, are among the casualties.
However, the narrative around this crisis has often been one-sided, focusing heavily on the negative effects on medical doctors while neglecting similar challenges faced by ‘marginalised’ professionals who are essential to maintaining the healthcare system.
I term this the “pothole phenomenon”. It’s characterised by the loud and disproportionate reactions to the appearance of a pothole – a sign of structural decay resulting from gross neglect, mismanagement, and poor governance – especially in once-affluent neighbourhoods. The responses from a few often gain visibility that overshadows similar issues occurring in less visible but greatly affected communities.
The voices of oral health professionals, rehabilitation, therapeutic and mental health practitioners must emerge from the shadows. Often sidelined in discussions about the healthcare worker unemployment crisis, some have given up protesting and have turned to independent practice to make ends meet. This reality feels foreign to medical and nursing professionals who have become accustomed to the benefits of public service.
The medical professions, particularly the medical and nursing communities, have claimed a monopoly over South African healthcare, especially public healthcare. This situation stems from the country’s burden of disease and an overestimation of the role that medical professionals play in achieving a healthy South Africa.
It is misguided to treat the reality facing thousands of non-medical and non-nursing healthcare professions as a mere footnote in the dominant narratives about healthcare worker unemployment in South Africa. When discussing matters surrounding health it is detrimental to embrace a narrative that seemingly singles out medical professionals as the most affected. This bias is problematic and does little to promote the view of healthcare as a comprehensive ecosystem with various stakeholders working together to achieve societal health.
Shouting from the rooftops for the government to hire healthcare professionals without careful consideration of the burden of disease and where the need for healthcare is greatest is shortsighted, unsustainable, and detrimental to South Africa’s healthcare system. A critical dialogue is required to plan a sustainable and accessible healthcare future, with a focus on exploring reforms in human resources for health. This includes prioritising a cost-effective and innovative healthcare workforce mix that considers the context of public healthcare and is grounded in the primary healthcare approach.
Hiring a single medical doctor can cost nearly R1million. This makes it essential to consider the role of clinical associates in improving and strengthening health service delivery. It is ill-conceived and financially irresponsible to invest in one practitioner when the same work could be accomplished at half the cost by effectively utilising the skills and expertise of other healthcare professionals.
Perhaps it is time to align the basic competencies of healthcare professionals with the burden of disease by investing in interprofessional and cross-cutting basic competencies that are not confined to a single profession. This approach should prioritise population health outcomes. This innovative thinking is necessary for our system to survive and adequately respond to society’s healthcare needs. If simply flooding the system with new medical doctors or nurses were effective, we wouldn’t be lamenting the state of public healthcare in South Africa today.
We need to strike a balance, improve leadership and governance, and embrace task-sharing across professions as essential to building a sustainable and accessible healthcare system, which everyone in South Africa deserves. Inclusive healthcare is central to achieving equitable healthcare for all.
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Bulela Vava is an Atlantic Fellow for Health Equity in South Africa based at Tekano and President of the Public Oral Health Forum, a network of oral health professionals committed to improving oral health outcomes in South Africa through strategic advocacy, education, research, and collaboration.
The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
