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Joe Phaahla: Budget constraints to blame for unemployed medical graduates

Joe Phaahla: Budget constraints to blame for unemployed medical graduates
Takudzwa Pongweni
By Takudzwa Pongweni
5 Feb 2024
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Following a public outcry over the high number of unemployed doctors in the country, Health Minister Dr Joe Phaahla said the department did not have the money to employ them, but that more posts would soon become available.

‘As government, we would really wish for a situation where all graduates who have completed all these statutory requirements of internships and community service can get immediate employment in the public health sector, but of course, they do face a number of challenges in that regard,” said Health Minister Dr Joe Phaahla.

Phaahla was speaking on Monday at a media briefing to address issues related to the employment of medical doctors and other health professionals in the country. This comes after unhappiness over doctors who have completed the statutory community service programme but remain unemployed.

Read more in Daily Maverick: I’m an unemployed doctor, like many medical peers, despite SA’s health skills shortage

Training and deployment


Medical school graduates must complete two years of internship training at designated health facilities accredited by the Health Professions Council of South Africa (HPCSA). After this, they have to do a year of community service in a facility designated by the National Department of Health in consultation with provincial health departments. 

“The hospitals which are designed for community service are slightly different from the internship because the internship is regarded as practical skills training and that’s why it is designed by HPCSA… the purpose of introducing community service was to improve clinical skills and also provide services in the underserved areas,” said Phaahla. 

Teaching hospitals and central hospitals are eligible to train interns but cannot be used for community service as they are not considered to be under-serviced. 

“For community service, it will be rural hospitals, township hospitals and other marginalised areas,” he said.

Once a doctor has finished community service, they are registered with the HPCSA in the Medical Officer Independent Practice category, meaning they can work independently without supervision, including as a single private practitioner.

Phaahla clarified that the issue of funded posts did not affect the training of medical doctors. He said all graduates who were eligible for an internship had been placed as well as those who had finished their internships and were eligible for community service.

“I want to say unequivocally in terms of internships and community service – which we regard as a statutory obligation by the state – we don’t have graduates fresh from medical school who are stranded in terms of getting internships. Those posts are funded and everybody eligible has been allocated,” he said. 

This is possible due to the human resources training and development grant.

“We do allocate to provinces. That amount is protected, it is ring-fenced, and provinces also do add because this category of doctors also provide very valuable services at the facilities where they are working,” said Phaahla.

The current issue


Unlike internships and community service, which are statutory requirements and subject to placement by the department of health, medical officers can make individual choices to either specialise, enter private practice or stay in the public service. 

“Because it is not organised in the same way as the statutory obligation, we don’t have the data – once people exit community service they are free,” said Phaahla.

The department relies on information and numbers collated by medical associations and unions such as the South African Medical Association Trade Union (Samatu) and the South African Medical Association. 

At the beginning of January 2024, Samatu submitted a list of 825 medical doctors who were deemed to be unemployed. The department checked the list against the public service payroll system and it was found that out of the 825 doctors on the list, 694 had only just completed their community service on 31 December 2023.

Most have applied for medical officer posts in the various provinces, while some doctors on the list still need to complete their community service obligations, said Phaahla. 

“We have to check with provinces where there are available posts and provinces have to advertise the posts… we then work with them to identify where there are vacancies and we share that information with organisations and unions representing doctors,” said Phaahla. 

Provinces face significant challenges due to budget constraints.

“There is a lot of pressure on the budgets… another challenge came with the 7.5% salary adjustment agreement at the Public Service Bargaining Council,” he said. 

Read more in Daily Maverick: Health minister warns of negative impact of ‘cost containment’ on quality of healthcare services

Up to 65% of annual health budgets in some instances is spent on health worker salaries. Provincial health departments also pay doctors for overtime work and offer rural allowances for doctors working in these areas. 

“The risk in terms of this is that it crowds everything, in terms of medicines, linen, clinical equipment like x-rays, ultrasounds… everything you need to run the services becomes quite crowded,” said Phaahla. 

More trainee doctors


Phaahla said the number of doctors being trained had increased.

“There has been a continuous improvement in the qualification of doctors and their employment in the public service,” he said. 

In January 2018, there were 1,472 medical interns and at the beginning of 2023, there were 2,365. There are 2,210 medical interns for 2024.

“You can see the level of growth – these increases over these years have happened despite the funding constraints,” he said.

Phaahla said there were 1,340 doctors completing community service in 2020, and in 2024 there were 2,101. 

“You can see from that, just over 700 increase in the cohort of new doctors who have come into the service as either interns or community service,” he said. 

“We would have wished that even as they complete their training, it would be good if they were spoilt for choice, but the pressure on the fiscus is there, which makes it difficult.”

Phaahla said that medical negligence claims also contributed to budget constraints.

“We are doing everything possible to reduce the medico-legal claims. Last year, one province paid R900-million in medico-legal claims. If we reduced that, it would free a lot of the money,” he said. 

Provinces placing doctors


Phaahla said they were working with provincial health departments who were also engaging their provincial treasuries to find ways of addressing the unemployment of health professionals, including medical doctors.

All the provinces have identified posts that have already been advertised or indicated which posts will be advertised in the coming months. 

“As we speak, across provinces we have been able to find 239 posts which are there for the uptake. Gauteng, Eastern Cape, Free State and  Mpumalanga have quite a number of those,” said Phaahla.

In the next six months, 375 posts will be advertised. 

Limpopo has been unable to release posts as there is an ongoing court case between the Limpopo Department of Health and the South African Medical Association Trade Union. 

“Limpopo tried to fit some more opportunities by reorganising the overtime component to structure it so that it can spread the money out to more people so they can have more people employed, but then the trade union is challenging that,” said Phaahla. 

“When they [Limpopo Department of Health] wanted to advertise, their provincial treasury advised them not to advertise because the matter is still in court.” 

Phaahla said they would like the process to be seamless so that once an individual had completed their internship and community service, they would be free to look for any available opportunities. 

“It is multi-pronged. We are working with provinces and identifying vacancies so that we can advise those who approach us about where they can apply,” he said. 

Cholera cases


The country has recorded 46 suspected cholera cases and five laboratory-confirmed cases between 1 January and 1 February 2024. These included two cases in Limpopo and one in Gauteng. All cases had recently travelled to Zimbabwe.

“Last week, Limpopo identified two [infected] siblings in the Blouberg local municipality. There are other people presenting symptoms so we are working with the province to identify and trace contacts in the family and the surrounding areas so that we can find the source,” he said.

Phaahla said there was no need for panic as the country was not experiencing a widespread outbreak. However, the department called for people to maintain proper personal hygiene, and especially children at home and in schools. DM

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