Dr Justin D D de Freitas
This opinion piece was originally posted by Dr De Freitas on myNews24 on 20/01/2017, reproduced with his permission on Thumela.
I would like to begin by saying I have a tremendous amount of respect for Minister Motsoaledi and the progress he has made in improving the healthcare services rendered to the people of our country; especially with regards to the ARV rollout program, HPV vaccination, and the recently introduced CCMDD.
Unfortunately when it comes to dealing with matters related to the clinical personnel that staff institutions under his care, his ministry repeatedly refuse to acknowledge the systemic failures at a budgeting, planning and systems level that almost annually have lead to a mismatch between doctors willing and able to provide a service and their placement at institutions where these services are in desperate need.
2016/17 is not the first year these problems have been brought to the media’s attention. For at least the last 3 years, articles appear between October and January relating to allocation issues, hospitals short of clinical staff, and doctors without jobs in the new year. Every year the response from the DOH remains the same: there is no problem, junior doctors complain too much.
This cycle has been no different with claims made of newly qualified medical school graduates without internship posts, community service doctors misallocated and notification of posts delayed, and post community service doctors having posts rescinded due to them being ‘frozen’ (a term which goes by numerous other pseudonyms).
In his press briefing, Minister Motsoaledi has no doubt presented accurate statistics that on the surface seem to reflect that all is well, there are jobs for everyone, and once again doctors are complaining too much and ‘too picky’ as his spokesperson likes to point out. However, it is the statistics he negates to mention as well as the stories behind those statistics that give the full picture of the problem facing the provincial departments.
He reports that 99,9% of interns have been placed but declines to add that on reporting to their facilities at the beginning of January some were turned away as there was no funding for their positions or they were misallocated. His statistics reflect 100% placement of Community service doctors but does not comment on the havoc the allocation system wrought by swapping individuals choices or notifying them well towards the end of December. Finally, he mentions 147 posts for the 135 post community service doctors who are reportedly unemployed.These statistics in particular require further clarification.
Near the end of 2016 word went around the various health facilities in Kwa Zulu Natal that the DOH was once again ‘freezing posts’. This time around they called the process ‘ratification’. For those unfamiliar with government employment a ‘post’ refers to a potential or occupied job that has budgetary allocation for the employee. ‘Freezing’ of posts in essence means that although that employment opportunity previously existed (and was possibly even advertised and interviewed for) the department is no longer able to appoint someone to that position and that it remains unavailable until further notice, most commonly due to budget constraints. Previously this tactic was applied to registrar posts (doctors training to become specialists) in the province subsequently leading to a significant decrease in the number of newly trained specialists coming through the system. However, it was now applied to Medical officer and Allied health professionals (physiotherapists, occupational therapists, dietitians, pharmacists etc.)
The net effect of this was that job opportunities that existed across the province from clinics, to rural district hospitals, to urban tertiary facilities suddenly evaporated. Whereas previously there were hundreds of unfilled posts across the country it has seemingly been cut down to 147 (as per the minister’s statistics). Doctors and allied professionals who were expecting to work at a facility the following year, many who had undergone interviews and some who had been verbally promised a post now found themselves without work around mid November to early December. Ever the optimists, most decided to stick it out hoping the decision would be reversed some even carrying on working into the new year unpaid in the hope their efforts would be recognized and the posts would eventually be allocated to them. These posts that were frozen were not restricted to urban settings as the Minister would have you believe but across the province and the country employment opportunities in numerous rural district hospitals, with some of the worst patient to doctor ratios in the country, no longer existed.
This occurs on an annual basis due to systemic budgeting failures in provincial departments across the country, most notably KwaZulu Natal, not to mention the suspicious and often faulty resource acquisitions at facilities that strongly suggest significant wasteful expenditure if not corruption.
The 147 posts that remain available are certainly not located in areas of most need but rather where there remains a budget to fund them. The 135 doctors list is simply the tip of the iceberg, those that decided to put there name forward to representatives as individuals whose employment for 2017 vanished in front of their eyes and not the huge number who simply sought alternative employment or negated to submit their names.
While junior doctors across the country are fully aware of the financial difficulties facing our healthcare institutions, something we come into contact with on a daily basis, the repeated denials by the department of health and the ministry of these problems only serve to further erode the little trust that remains between the two parties.Honesty and fair appraisal of the underlying causes behind this recurring problem would be a huge step in the right direction towards rebuilding an essential relationship and preventing any further repercussions to the healthcare sector and the patients it serves.
The Thumela Team thanks Justin for his article! If you wish to submit an article of your own, please contact us at firstname.lastname@example.org
*The views and opinions expressed in this article are that of the author and not necessarily of Thumela as a whole*