Human Resources, a persistent problem for the NHI

_{18 months into the initial phase of the National Health Insurance (NHI) scheme and South Africa is still short of 14 351 doctors, according to a recent survey conducted by the South African Institute for Race Relations (SAIRR).}

_{The current shortage of professional medical staff is likely to seriously hamper the government’s proposed National Health Insurance (NHI), medical experts say.}

_{The NHI is a system where universal health care coverage is proposed for every South African citizen however the transformation of the health system has been hindered by inadequate staff numbers and an inequitable distribution of health workers between the public and private sector.} 

_{The SAIRR survey found that staff shortages are not being adequately addressed by government and almost 56% of doctors’ posts are empty. Almost 46% of nursing posts also remain unfilled.} 

_{Lerato Moloi, a researcher at the SAIRR, says “these figures are alarming” and such high vacancies make NHI seem unachievable.}

_{“The two most critical aspects of the NHI are how are we going to fund it and how are we going to staff it” adds Doctor Mark Sonderup, a specialist at UCT Medical School.} 

_{The current health system is overwhelmed by very few resources that is compounded by the increasing population figures where both nurse-to-patient and doctor-to-patient ratios are excessively high,  says South African Medical Association’s (SAMA) public sector doctors' committee chairwoman, Dr Phophi Ramathuba.}

_{Despite these concerns the 2012/2013 South African Health Review states that “training of new doctors has been increased through increasing the intake in training institutions and sending 1000 medical students to Cuba to be trained”. In addition, since the launch of the National Human Resources for Health strategy in October 2011, an extra 40 doctors started training in South Africa in 2011/2012 and 125 in 2012/2013.}

_{In spite of this progress, numbers of doctors graduating from South African universities is decreasing. Between 2004 and 2008 there was a more 6%decline in medical graduates. Specialists who are being trained at the country’s eight medical schools are also not being properly absorbed into the public health sector. “To produce doctors and specialists, you need a functional academic sector. The capacity that we’ve had to train doctors has been under enormous pressure. The capacity to train doctors has been limited. What we need is more medical schools. Despite HIV/Aids, our population is growing. There is an increase in the number of immigrants. We have not kept up with that,” Sonderup says.}

_{In order for the NHI to be a success, the country needs to double the number of doctors it trains each year. The establishment of new medical schools and ensuring vacancies at existing schools are filled is critical to solving the problem and curbing the deficiency. The progress highlighted by the SAHR is insufficient to address the severe staff shortages currently plaguing the country’s health system. Health Minister Dr Aaron Motsoaledi told parliament he had asked deans of medial faculties to think innovative ways to increase student intake but the effects of this ‘request’ remain to be seen in the country’s production of medical graduates.}

_{The human resource problem also goes beyond higher education. A research report published in the South African Medical Journal in 2011 shows that at the time there were estimated 27 641 doctors practicing in South Africa, approximately 23 407 South African-born doctors were believed to be practicing overseas. It is clear that South Africa needs to ‘train and retain’ more doctors in order for the government’s proposed NHI to be a success.}

_{“While government's NHI plan has theoretical merit, in practice it will be exceedingly difficult to implement, particularly within the envisaged time frame of 14 years," Hospital workers union, HOSPERSA, said in a statement to News24 in 2010. The union also went on to say that foreign doctors will have to be recruited if NHI is to be successfully implemented. Sonderup also emphasises the need to recruit more doctors if NHI stands any chance of achieving success. “We have got to turn the tide of people who are still leaving. And we have got to go back and try to actively recruit those who have left. If we got just one-tenth back, we would have the equivalent of a year’s worth of graduates,” he says.}

_{However all is not doomed for the success of NHI. In April of this year the Mail and 
Guardian reported that 350 private doctors will start working part time for the country's NHI system this month at public health facilities. The clinics and hospitals are based at the NHI scheme's 11 pilot sites. Whether this will be enough to address the key challenge of providing and funding human resources within the envisaged timeframe of 14 years remains to be seen.}