Date: 12 February 2024
Dear,
Western Cape Premier, Premier Alan Winde
Western Cape Finance MEC, MEC Mireille Wenger
Western Cape Health MEC, Dr Nomafrench Mbombo
National Minister of Finance, Minister Enoch Godongwana
President of the Republic of South Africa, His Excellency Cyril Ramaphosa
UNEMPLOYED GRADE 1 MEDICAL OFFICERS, READY TO MAKE A DIFFERENCE.
We the undersigned, unemployed medical officers in the Western Cape, write this letter to bring awareness to our plight and to raise concern over the detriment that healthcare budget cuts have brought and will likely continue to bring to our society. We have completed our community service year, as recently as December 2023, and as far back as December 2022.
First, we would dispel outright the myth, and the rhetoric peddled by representatives of the National Department of Health, that we do not want to work in the public sector, that we would rather work in the private sector, and that we do not want to work in rural areas. These remarks were made and repeated many times across various media platforms in the past year, and they are on record. As a collective, we denounce these claims. We are committed healthcare practitioners that have served and would like to continue to serve our communities.
We have trained as interns, and practised as community service medical officers in the same system that is now under threat. We have experienced first-hand the impact of austerity and budget cuts on our daily work in healthcare facilities. On a macro level, we have seen the pressure on whole departments mount to breaking point, as they struggle to reallocate human resources to cover for vacant and unfunded posts - Where once there was a doctor, now there is none.
We have witnessed at the personnel level, colleagues overburdened with ever-increasing patient loads, while team member numbers dwindle around them. In other parts of the country, colleagues speak of interns and community service doctors being tasked with keeping departments running with little to no supervision. We have been these doctors in some cases. The mental and physical health effects this has on all clinicians affected cannot be overstated. In fact, the numerous studies linking clinician burnout to poor outcomes, as well as contributing to the high rate of physician suicide relative to the general population is evidence enough. [1]
The lasting effects of these budget measures are felt by the end-user; our patients, whose care should never be compromised, but often is. This might be due to a doctor, nurse or allied healthcare worker trying to do a job that 3 or 4 people should be doing, or equipment not being available. Patients spend a large portion of a day waiting for help, sometimes at every point of contact – from primary care to an overburdened regional referral system. These lasting effects relate to patient morbidity and mortality, and it is not difficult to attribute these outcomes directly to human resource constraints. [2]
The research paints a clear picture. A study conducted in Chile - a country with slightly more than twice the GDP per capita of South Africa, but with health expenditure at 9% of GDP which is close to our own as of 2021 at 8.58% - showed unequivocally that increased waiting times for secondary and tertiary care contributed to increased mortality in patients. [3] Furthermore, patient waiting times at primary emergency care centres, or first-point-of-contact, that exceeded 5 hours was associated with heightened risk of 30-day mortality. [4]
It is alarming to note that between the years 2018 to 2020, South Africa’s healthcare spending decreased year on year. In fact, Healthcare spending in 2011 was recorded at 694 USD per capita which has since seen a drop yearly, and in 2020 was 489 USD per capita. In addition to the decrease in health expenditure, the system has seen a fall in the number of staff at health facilities during this period. In 2021, South Africa registered 8.09 medical doctors per 10 000 population. This was below the WHO guideline of 1 doctor per 1000 population. In May 2022, minister Joe Phaahla revealed that the number had decreased to 3.1 doctors per 10 000 patients. [5] [6]
In the face of these austerity measures and further projected budget cuts, our patients bear the true cost, in the form of pain, disability and sufferance. This is a disservice to the people of our province and country, who depend on its government to have their best interests at the forefront of decision making. Furthermore, it is a disservice to healthcare professionals who would be in a position to improve quality of life, were it not for confounding circumstances due to these resource constraints. There were already tangible difficulties meeting the needs of the populace in both regards – thus it stands to reason that continued austerity will further exacerbate this, and ultimately be catastrophic for the health of our society. Healthcare is an investment without which any other long-term growth strategy is likely to fail. A populace with a high disease burden is objectively less productive than the inverse. [7] [8]
We are of the opinion that this is not new information to any concerned party. Given the dire circumstances, the need for reiteration cannot be overemphasised, if for no other reason than to highlight the plight of the average citizen faced with the lack of critical services. We also need to highlight the plight of new, unemployed grade 1 Medical Officers, who exist to bridge the seemingly ever-growing gap in service delivery, but lamentably, contribute further to youth unemployment as it stands. Relatively far-removed from the day-to-day experience of policy makers, our populace faces the brunt of their decisions. Thus, the demand for empathy and a sense of duty for the basest requirements of citizens is tantamount to preserving their humanity, dignity, and rights.
It appears unlikely that any clever manoeuvering or tricks to manage the province’s and, by extension, the country’s health needs with a further restrained budget is in any citizen’s best interest. Simply put, the continuous shrinking of healthcare expenditure is unsustainable.
Sustainable decisions must be at the forefront, for the long-term health of our people. As the population continues to rise, there will continue to be healthcare workers produced, patients will continue to need doctors, nurses, and allied health. This is not negotiable for a growing economy. We therefore implore you, our elected officials, to prioritise our nation’s health. And in doing so, preserving its dignity, and its right to truly accessible health and well being.
Contact: [email protected]
[1] https://www.qxmd.com/r/15569903
[2] https://pubmed.ncbi.nlm.nih.gov/30129945/
[3] https://doi.org/10.1186/s12889-019-6526-6
[4] https://emj.bmj.com/content/39/3/168
[5] macrotrends.net/countries/ZAF/south-africa/healthc...
[6] da.org.za/2022/05/critical-shortage-of-doctors-in-...
"We the undersigned, unemployed medical officers in the Western Cape, and fellow healthcare workers, write this letter to bring awareness to our plight and to raise concern over the detriment that healthcare budget cuts have brought and will likely continue to bring to our society. We have completed our community service year, as recently as December 2023, and as far back as December 2022."