Sufficient ratios of doctors and nurses relative to a country’s overall population prefigure quality healthcare and patient safety. With only 23 HCWs to every 10 000 people, SA falls short of UN targets[i].
Experts suggest, however, that the figure is misleading, and while the overall proportion may seem manageable – especially compared to neighbouring SADC states – the crux of the problem is the unequal distribution of HCWs and healthcare services. While SA’s private sector has 17.5 doctors per 10 000 people – approximately the global average – the public sector has just 3[ii].
A recent WHO ‘State of World Nursing’ report highlights the need for every nation to train 8% more nurses each year to avoid a potentially catastrophic global shortfall of over 10 million nurses by 2030[iii].
“Many young South Africans are seeking livelihoods in healthcare, but all too often their aspirations are thwarted by structural obstacles – bureaucratic red-tape; poor or dangerous workplace circumstances; and other socio-economic difficulties outside of the work environment.” Says Cynthia Makarutse, Event Organiser for the Africa Health 2022 Conference.
“When they do find jobs, they often face unsustainable working conditions. Resource and supply shortages make it impossible for them to ensure an adequate standard of care, which leads to a high incidence of burnout and depression, especially among public sector nurses,” she notes.
Makarutse explains that, on one hand, SA has significantly escalated issues around HCW training and retention, leading to a 61% increase in medical graduates commencing public hospital internships since 2017[iv].
“This year alone some 2500 new doctors, nurses, pharmacists, interns, and community service personnel have joined the HCW workforce[v]. Unfortunately, however, provincial health department budgets have not kept pace with the number of newly trained HCW, and public facilities find themselves unable to absorb the new doctors.”
“An under-resourced public sector; inadequate training programs; and the backlog in accreditation for training institutions that dates back to 2015[vi], are some of the hurdles young would-be doctors and nurses in SA face,” Makarutse explains. Unsurprisingly SA faces a ‘brain drain’ as many HCWs are emigrating[vii].
“At this year’s Nursing track at Africa Health 2022 in Johannesburg, industry figureheads like Fasie Smith, Dr. Sharon Vasuthevan, and Dr. Sue Armstrong will delve into the challenges of ensuring that we train enough nurses. With titles including ‘Staffing nightmare and solutions – an executive perspective’, and ‘Shortage of nurses in SA: fact or fiction the event promises a space for a vibrant authoritative conversation on this key issue.”
“An urgent increase in a training capacity is a key component of the proposed solutions to the HCW shortage in SA[viii], but equally, policymakers must act to address the systemic fault lines and structural barriers – working conditions, facility infrastructure, supply chain stability – to ensure that all the already trained currently unemployed HCWs are placed in positions.”
“Furthermore, SA’s rural areas present an opportunity to design models of care that cater to the unique needs of local communities, as thousands of rural youths, eager to become HCWs could potentially return to work in their hometowns, servicing these severely under-resourced spaces[ix].”
Studies show that reaching target minimum ratios of HCWs in various specialisations would drive substantial cost savings to the national health system, improving patient outcomes, reducing readmissions, and avoiding currently pervasive) negligence litigation against the state[x].
“As in much of Africa, medical professionals in SA have proven resilient in the face of enormous hardship, and crafted novel solutions to mitigate the impact of human resource – and other – constraints, demonstrating a commitment to patient safety and quality standards,” says Makarutse.
“The gap in HCWs requires a systems approach, including improving general education right down to school level. It’s a structural issue requiring inclusive paradigms to solve. Many of the socio-economic drivers behind the HCW shortages in SA are the very same issues behind the increased burden of disease in developing nations. The solutions we’re exploring are interdisciplinary, involving multiple stakeholders and sectors, including patients themselves.”
