Healing our Healthcare

South African public healthcare is in a state of crisis. We train some of the best healthcare workers in the world. Send a South African doctor to Haiti, to India, to a war-stricken zone, and they know what to do. They are used to working with restricted resources under harsh conditions. They save lives and are GOOD at it.

Yet I repeat: South African healthcare is in a state of crisis.

We may produce (generally) excellent doctors, but we don’t produce enough. The best ones tend to leave the country for greener pastures – read: higher salaries and better security. And labour laws combined with a general lack of managerial ownership prevents any form of consequence when doctors are slacking.

The minister of health, Dr Aaron Motsoaledi, seems to be hard at work to improve the status quo. There are reports that he wants current medical schools to increase their annual intake of medical students; while he also wants to initiate plans for one or two new medical schools.

The country currently has eight medical schools, which graduates a combined 1200 new doctors per annum.

A member of Parliament also recently claimed that, at this point, “We need quantity more than quality.”

With that, I couldn’t disagree more.

While I appreciate Dr Motsoaledi’s efforts – and I think he is one of the top members of the cabinet – there is a huge problem with his plan, and it hinges on general economics.

Medical schools simply do not have the capacity to increase their intake (and therefore also their output) of doctors-to-be. Doing so would require bigger classrooms, more staff, and bigger tertiary hospitals too, since these hospitals do only have space for a certain amount of fumbling students.

Medical education is already extremely expensive. In the majority of South African universities, it is the most expensive course on offer. And that is before adding the costs of textbooks, stethoscopes and diagnostic kits.

In order to remain in decent standing with the rest of the world, these schools also need to maintain a good level of research – which requires even more funding.

These universities therefore can simply not afford to accommodate more students as it is not financially viable to do so. If our fees continue to increase, many of us will simply not be able to continue their studies – and there one will already lose many potential doctors.

Looking at the state of our country’s finances (which, to be honest, is also not too great), it seems that the government will need to do one of the following – doing both will simply be too expensive.

1. EITHER build new medical schools (but ensure they are of good quality)
2. OR increase the financial support of existing medical schools.

Furthermore, methods of monitoring medical schools and doctors are essential. Clinical Skills Logbooks should become a national standard, and a good balance of practical and theoretical training should be policy. Furthermore, the government should at NO POINT jump in and qualify doctors who have not met the required levels of skill and theory (which apparently has happened). This only detriments the public and these individuals.

There must be clear-cut consequences for lazy doctors, or those who put their patients in harm’s way. This is not difficult or expensive, it merely takes some time and planning.

Improving South Africa’s health care situation is right up there with improving our education – two things which have the ingredients necessary to make our country great, but are simply not being monitored, supported and utilised effectively.

Never before has it been so clear that a holistic approach is the only approach.