Open letter to the Honourable Minister of Health, Dr. Aaron Motsoaledi and the

Honorable Minister of Finance, Mr. Pravin Gordhan

Re: The future of our rural health care services

Dear Dr. Motsoaledi and Mr. Gordhan,

Do you think that workers in any other industry would accept a below inflation offer, particularly if their

employer publicly acknowledges that they are underpaid?

This is what you are offering the majority of rural doctors.

To illustrate this, we would like to share a few statistics from the current OSD offer. In the overall offer

currently:

·                 80% of all categories of doctors covered in the offer get an increase of less than 10%.The majority (63% of categories of doctors) of ‘increases’ are below inflation

·                 Concentrating on the categories of doctors that are working in the rural areas the picture is even more

 severe: 84% of categories of doctors working in rural areas are offered an ‘€˜increase’€™ of less than 4%

·                 The only categories of doctors working in rural areas that are offered an increase of more than 4% are community service doctors and the entry-grade medical officers. All of the senior doctors ‘€“ from Senior Medical Officer to Chief Medical Officers ‘€“ are offered less than 4%

·                 Many of the doctors are offered ‘€˜increases’€™ of as low as 0,4%

·                 The highest ‘raise’ that any category of manager gets is 2.6%

These are shocking figures – even more so in the context of statements in which you acknowledge

that doctors salaries need to be substantially adjusted.

Judging from this offer, we feel that it is not recognised how difficult it is to recruit doctors to work in

rural areas. Currently there is an estimated 34% vacancy rate for doctors in the public service

nationally ‘€“ and well over 50% vacancy rates for doctors in virtually all rural areas. Despite the underresourcing,

many rural hospitals are managing to provide a surprisingly good service to the

communities they serve.

We also feel that the offer appears not to show insight into what rural doctors actually do and under

what circumstances we are expected to function ‘€“ and that, in many cases, junior doctors in rural

areas only function well when they have senior support and supervision. The district level services

depend on medical officers to provide medical services. The innovation, commitment and

perseverance shown by many senior doctors in providing the best possible care in a largely

dysfunctional health care system with gross lack of adequate equipment and supplies is rewarded

with an offer that, in real terms, decreases their salary!

In our view, a more serious effect of the current offer is that it undermines the health care system

where the majority of patients are being seen. If it becomes even harder to attract and retain medical

officers in the public sector the District Health System (DHS) is in danger of collapsing. The current

offer is not only anti-rural, it also undermines Primary Health Care and the DHS. The

offer flies in the face of the vision and mission of the Department of Health, guiding principles

such as Batho Pele and numerous commitments and declarations of the Department of Health in

particular and government in general – from the ANC health plan of 1992 to the Abuja Declaration of

2001 to the Birchwood Declaration last year, just to mention a few, as well as the renewed

commitment to Primary Health Care, including primary care physicians, in the resolution passed

unanimously by the World Health Assembly in May this year. Furthermore, it is also difficult to

understand the current OSD offer in the context of the government’s (and ANC’s) priority commitment

to improve service delivery – particularly in health and particularly to rural areas.

The degree of underfunding of the public health care system ‘€“ especially in rural areas ‘€“ has been

well documented. In real terms the funds allocated by the central government to the public sector

have not increased over the past decade. This is despite an increase in population, an increase in the

disease burden and an increase of the portion of the population that is dependent on the public health

care sector. During this time a number of expensive, labour intensive programs have been introduced,

such as the ARV roll out. All of this has occurred without any significant increase in funding.

It therefore perhaps is not particularly surprising that the OSD offer is as poor as it is. It continues to

reflect the (lack of) value that the government has placed on people living in rural areas, the public

health care sector and on its health care workers during the past decade, rather than signaling a new

direction for the health care system or in a commitment to being pro-rural. Without a significant

increase in the funding of public health care, the system is going to collapse.

This crisis may well be the defining moment for the health care system in the country.

We acknowledge that the problems in the current health care system cannot be rectified overnight

and that for lasting improvements to occur, it is going to take strong leadership and the massive

commitment of health care workers on the ground, amongst others. Many of the doctors working in

rural hospitals and clinics are already deeply committed to improving the health and the health care

for the people we serve. However, the current offer is an abuse of this commitment. We need to take

every opportunity to move in the direction of improving the service and retaining doctors in the current

system. We need to take every opportunity to inspire doctors and nurses to work in extreme

conditions to provide care for desperately ill and poor people.

We would like to call on you urgently to amend the offer and table a realistic one that would provide

an attractive career path in rural health. We furthermore urge the Minister of Finance to make the

funds available to start redressing the gross inequities of the past decade. This needs to go beyond

just providing funds for a substantial OSD ‘€“ it needs to include adequately funding vacant posts, the

provision of adequate resources to run hospitals and proper management of these resources, as well

as supporting front-line workers to be able to fulfill the constitutional imperative of access for all South

Africans to quality health care.

This is written with an earnest desire to make a positive contribution to the development of rural health

care services. We hope to continue engaging positively with government going forward and eagerly

anticipate further discussions with you, Dr Motsoaledi, when you attend the annual RuDASA Rural

Health Conference in August 2009.

Yours faithfully,

Dr. Karl le Roux

Chairperson

On behalf of the RuDASA Executive Committee