• Home
• About AHP
  • Who we are
  • What we do
  • Our partners
  • Our people
  • Our board
  • People We Like
  • Document Library
  • AHP milestones
  • Hall of Fame
• Why Choose Africa?
  • The challenge
  • The work opportunity
  • Lifestyle and logistics
  • The impact you can make
  • The stories
• More Info
  • Health Professionals
    • Options and Applications
    • Work Experience
    • Learning Opportunity
    • Post-graduate Training
    • Lifestyle and Logistics
    • Dinners for doctors
    • Frequently Asked Questions
    • Apply Now
  • Donors & Partners
    • The need
    • The AHP model
    • Sustainability
    • Expansion plans
    • Documentation
    • Reports and statistics
    • Make a donation
    • Get involved
  • Facility Managers
    • The challenge
    • AHP offering and approach
    • Scope
    • Services Offered
    • Documentation
    • Get in touch
  • Government
    • The Challenge
    • The AHP Model
    • Sustainability
    • Consulting Services
    • Present Donors
    • Documentation
    • Get in touch
• Newsroom
  • All News
  • AHP News
  • Doctors Stories
  • Health System News
  • Hospital News
  • Hospital Profiles
• Gallery
• Facilities Guide
• Apply Now
• Donate
• Contact Us

Newsroom

Where are all the local doctors?

Despite having the resources to recruit both local-qualified and foreign-qualified medical professionals, the majority of AHP placements are non-South Africans. Why are more foreign-qualified doctors applying for placements than those who qualified locally?

There is no single answer to this conundrum. With the current levels of unemployment there is the traditional argument that foreign doctors are ‘taking jobs’ from local medics.

“It feels as though local doctors are being ignored in preference of those [foreign-qualified doctors] who are not likely to stay in the country once they complete their training. Even if they stay, they are again being given preference [over] us as local doctors.” 2011 Community Service Officer

However, in reality foreign-qualified doctors, especially those recruited by AHP, service understaffed rural hospitals who struggle to recruit local-qualified doctors. In a country that faces chronic skills shortages, these foreign-qualified doctors contribute greatly to improving the quality and availability of healthcare, especially in rural areas.

The fact remains that there are severe obstacles to recruiting local doctors for the public sector. Recently, AHP conducted a national survey of Community Service Officers (CSOs), limited to doctors and dentists, on behalf of the Department of Health and the HPCSA. Among other issues, the considerable length of the South African medical qualification process was clear from this survey. Medical doctors are required to complete not only a two year internship at a public hospital, but also an additional year of community service (a second year of community service is currently being debated). As a result, by the time these graduates are eligible to practice medicine, they have already spent at least three years in the public sector.

That being said, there are a multitude of other factors that influence the decision to work in rural health. It was clear from the 2011 CSO Survey that these medical graduates’ experience during their internship and community service largely determines their overall attitude to the public sector. From the initial findings, over 30% of the CSOs survey respondents indicated their attitude to community service had become more negative during their year, while 67.1% indicated they do not intend to stay on at their current healthcare facility.

One of the primary goals of the community service programme is to provide doctors for underserved areas with the hope that they will remain after the completion of their community service obligations. Unfortunately, from this recent study it is clear that this aim is not being achieved. This is not purely due to the rural setting or even salary demands. Rather it is because the private sector offers a more attractive package both in terms of healthcare facility management and particularly for young doctors who need medical supervision

“Management is the biggest problem that is being faced [in the public healthcare sector]. Money is not an issue per se it’s just the way the medical professionals are being treated. They feel undervalued.” 2011 Community Service Officer

“Supervision is still needed and resources are a problem as they are limited. Being under staffed is the biggest problem in most public healthcare facilities.” 2011 Community Service Officer

“Supervision and teaching were very good, I've gained much experience but our hospital is currently undergoing major problems with management and services which makes the working environment frustrating and difficult.” 2011 Community Service Officer

Despite numerous challenges, there are success stories. Bethesda Hospital in the Umbombo village in rural KwaZulu-Natal is one such example. Despite its extremely rural setting, since the improvement in HCF management and receiving ongoing assistance from AHP this hospital receives requests from CSOs to stay on after they complete their community service obligations. What this example indicates is that it is rarely the rural setting or public sector salary that dissuades doctors from staying on, but rather the general experience. Bethesda offers good support and supervision for young doctors and CSOs, with a successful hospital management team ensuring all processes smoothly. In light of this, Bethesda has an excellent reputation for offering a competitive package attracting doctors from across the country. Here lies the potential for other rural healthcare facilities to improve their services and attract local-qualified doctors who might otherwise have gone to the private sector.

With the chronic shortage of these skills, the unequal distribution of medical staff between the public and private sectors, and urban and rural districts, there is much to do in the way of ensuring local doctors (whose studies are being subsidised by the government) do not take their skills elsewhere. What is more concerning is there seems to be additional obstacles for those few local-qualified doctors wishing to remain in the public sector after their CSO year.

“I would love to stay working in a government hospital, however when I try to contact hospitals I either get no reply or told there is no vacancies.” 2011 Community Service Officer

In an effort to attract local talent and revitalise primary healthcare, the National Department of Health launched their human resources in health plan. This initiative is focused on improving maternal and child health, HIV/Aids, TB and other chronic diseases. The plan has three branches; improving school-based care, improving home-based care and providing specialist teams for all 52 districts across South Africa. These specialist teams will offer expertise in these primary care areas in an effort to alleviate pressure on already overburdened healthcare facilities and push South Africa one step closer to meeting its Millennium Development Goals. The potential of this plan is phenomenal and by coupling competitive salaries and experience these specialist teams offer an attractive opportunity for local-qualified doctors to work in the public sector. AHP is proud to assist the Department of Health with this initiative. Visit our website for more information on these and other similar opportunities in the South African public health sector.