“As recently as 26 January this year, in our presentation on the proposed National Health Insurance to the Parliamentary Committee for Health, we made clear how far behind we are in terms of medical skills available and how stalled our production of these skills has become over the years,” says Bomela.
In its presentation to the Parliamentary Committee for Health, HASA pointed to Organisation for Economic Co-operation and Development (OECD) statistics that show South Africa lags far behind a basket of comparative countries for nurse and doctor numbers per 1,000 inhabitants with ratios of 1.3 (Turkey 2.1; Russia 8.1; Norway 17.8) and 0.8 (Turkey 1.9; New Zealand 3.3; Austria 5.2) respectively. In the category active medical schools per million inhabitants, South Africa’s ratio of 0.16 similarly lags behind countries like Libya (1.88), Brazil (1.50), and Colombia (1.15).
“Leaving out skills previously included on the critical skills list sends the message that we have overcome the problem we had – but that is simply not the case. It cannot be, as the nursing profession has already long struggled to attract new recruits, a situation that is exacerbated by the amendments to the nurse training curriculum and the accreditation of training facilities that has stalled the numbers of new nurses being trained – in a moment when a significant number of nurses in the profession are already over 50 years of age and will be retiring soon,” he adds. “It is furthermore difficult to reconcile the 2030 Human Resources for Health Strategy which, for instance, projects a shortage of 34,000 nurses by 2025 if nothing is done to attract and retain falling numbers of nursing aspirants, with this critical skills list,” says Bomela.
According to Bomela, the shortage of nurses and doctors, and the slow development of medical skills pose serious questions for healthcare delivery now, and in the future under the proposed universal healthcare service system. “If anything,” says Bomela, “in the first two waves of Covid when medical staff were laid low through infections, we came to see very clearly how threadbare our human resources for health are and how vulnerable these shortages make the healthcare system. Nor, frankly, was the vaccine drive left unaffected by the shortage of medical staff – as we know, the vaccine rollout slowed to a trickle at times due to staff shortages.”
Our national situation is clear, says Bomela: we are not training enough medical skills to overcome existing dire shortages in doctors and nurses in general, and particularly among specialists and nurses with specialist skills. Already, medical facilities are struggling to fill posts. Already, faced with a shortage in this country, the association has had to lobby government to enable members to recruit nurses with specialist skills from overseas.
Already, in various parts of the country, specialist skills are in such short supply that waiting lists are lengthening beyond months and into years. We must continue to use the critical skills list as an immediate solution to an existing acute problem, says Bomela, while we work to overcome our longer term human resources for health crisis.
“The Hospital Association of South Africa and its members call on the Government, in particular the Department of Home Affairs, to amend the critical skills list to include medical skills required not only to facilitate critical care, but also to pave the way for the efficient operation of the public health system which is the bedrock for the proposed universal healthcare system,” says Bomela.
