South Africa compares unfavourably with middle-income countries on the ratios of medical and dental professionals, and many districts have limited access to specialists and subspecialists.
Even South Africa’s private sector has fewer doctors per 100 000 people than most countries in the world.
A comprehensive report produced by Econex after a request from the Hospital Association of SA paints a bleak picture, especially in light of the planned National Health Insurance (NHI) scheme.
In 2013, there were just 25 state doctors and 92 private sector doctors per 100 000 people in South Africa.
The average is 60 per 100 000, while the world average is 152.
Even in India (70), Brazil (189) and China (194), there are more doctors per 100 000 people.
This is while pressure on South Africa is growing as a result of HIV/Aids, tuberculosis, violent crime, a high mortality rate among children younger than five, women who die during pregnancy, diabetes, heart disease and psychiatric illness.
The standard practice is that people visit their general practitioner three times a year.
If that was done locally, there would be a shortage of 4 100 doctors in the country, according to the report.
A constant increase in the number of trained doctors is necessary to meet the needs of the populace, which is growing at a rate of 1.58% a year.
It is uncertain how many doctors have emigrated, but between 2004 and 2009, 17% of doctors who qualified did not report for community service.
To be registered with the Health Professions Council of SA, you have to complete a year’s community service.
This could mean these doctors are leaving the country. Most South African doctors go to Canada, New Zealand, Australia, the US and the UK.
Between 70% and 80% of doctors also prefer not to work for the state.
The main reason for this is not poor pay, but poor working conditions.
Other reasons include a lack of equipment and medical provisions, a heavy workload, and insufficient protection against HIV and tuberculosis infections.
Foreign doctors, on the other hand, are eager to work in South Africa, but bureaucratic red tape prevents that. In the report, this is referred to as “severe delays and inefficiency by the Foreign Workforce Management Programme”.
In 2006, the department of health indicated that it wanted to increase the number of doctors who were being trained annually from about 1 300 to about 2 400, but nothing came of that.
In the meantime, Health Minister Aaron Motsoaledi said it was going to be increased to 3 600 in anticipation of the NHI scheme.
The plan is to train doctors in Cuba and China but according to the report, money is needed locally to train specialists.
It costs about R3.1 million per specialist and a post has to be available at one of the eight academic hospitals.
If private hospitals that serve as colleges also get accreditation for this, it would lighten the load considerably.
In India and Brazil, the model of private colleges has helped. In Brazil, training from the state is free, but students have to pay at private colleges.