NHI: Poor conditions scare GPs away
Poor conditions in some National Health Insurance (NHI) pilot districts are causing general practitioners (GPs) to think twice about working in public health
Recruiting GPs to work part-time in public health is one of the health department’s key strategies to address the national shortage of doctors.
Almost five years after the 10 NHI pilots were announced, 253 GPs have been employed by the Department of Health to work part-time – mostly in clinics.
Gert Sibande has 35 contracted GPs to work in its clinics, but the long hours, equipment failure and lack of leadership are some of the reasons doctors are finding it hard to stay.
“At the moment, we have no drips at this clinic, meaning if a patient can come in here bleeding I won’t be able to help them,” said a GP who asked not to be named.
The doctor, who has been with the pilot since its inception, said the lack of resources was a direct threat to patients’ lives.
In one of the clinics where she works, she alleged that patient files went missing daily and she had lost a patient to cancer a few weeks ago because of this negligence.
“I got a call from the laboratory confirming my suspicions (that the patient had cancer) and they told me the patient had to be treated without delay at Steve Biko Hospital in Pretoria. But we couldn’t find her file so I couldn’t call her,” she told Health-e News.
When the patient’s file was finally found two weeks later and the doctor visited her home, she found that the patient was already dead.
Meanwhile the Mpumalanga provincial government has acknowledged that a lack of skilled senior staff in the district is one of the reasons for its failure to retain and attract health professionals.
Deputy Director General for the NHI in Mpumalanga, Dr Savera Mohangi, said the lack of leadership had left doctors frustrated and led to communities losing faith in the primary healthcare system.
“At Ermelo Hospital, the CEO left, the finance manager moved elsewhere and the clinic manager has also left. There is no leadership, so when doctors need tools to work they get no answers or the response is very slow,” said Mohangi.
She added that the provincial government’s main focus was now on improving the skills of the district’s executive management before everything collapses.
Recruitment centralised to boost numbers
But Mpumalanga is not the only province struggling to attract doctors. The Eastern Cape’s OR Tambo district has only contracted one doctor, while the Northern Cape’s Pixley ka Seme has only 10 GPs.quote float= right]“Doctors are expected to work more than four hours, which is impossible because they have their private practices”
Umzinyathi officials said many GPs felt that the R381 hourly rate being offered by the department was too low.[
However, national health spokesperson Popo Maja said: “GPs are reimbursed for their services at an hourly rate and they are also reimbursed for their time that they spend on the road going to and coming from the public health facilities, as well as for the kilometres that they travel to and from public service facilities.”
Meanwhile, Professor Morgan Chetty, chief executive officer of the KwaZulu-Natal Managed Care Coalition, said the GP recruitment “is chaotic and was not carefully thought through”.
“Doctors are expected to work more than four hours, which is impossible because they have their private practices,” Chetty told Health-e News.
In 2013, the National Department of Health took over the recruitment of doctors from the districts. Last November, it appointed the Foundation for Professional Development (FDP) to recruit GPs.
The FDP managed to more than triple the number of GPs working in Gert Sibande from 10 to 35 in just four months.
FDP managing director Dr Gustaaf Wolvaardt said his organisation had used “social media platforms and out website, but more than 50 percent of recruitment was word of mouth”.
He said the FDP’s tender agreement with the National Department of Health was to appoint at least 150 doctors in the nine of the 10 NHI districts, which they had achieved.
Centralisation may not be a long-term solution
Meanwhile, Professor Alex van der Heever from the School of Public and Development Management at Wits University has called on government to restructure governance and boost primary healthcare services before rolling out NHI. [quote float= right]“At the moment we have no drips at this clinic, meaning if a patient can come in here bleeding I won’t be able to help them”
“The government needs to start working from the bottom up. Right now they think that by centralising everything all the problems are resolved, but they are wrong,” he said.
According to Statistics South Africa’s General Household Survey, about 60 percent of the population use local clinics, 24 percent use private GPs, and nine percent use public hospitals for their first consultation.
Van der Heever said that if local clinics and hospitals were not empowered to take their own decisions, everything would fail.
“The procurement system is so corrupt that it takes a clinic three months to get stock, whereas in a private setting it arrives the same day. Public facilities sit for months with broken equipment because of the poor procurement processes.”
Human rights advocacy group Section27 said as long as working conditions are not improved doctors will keep leaving in droves. National Organiser Sifiso Nkala alleged that the misuse of money in the Mpumalanga health department was also contributing to the poor service communities are receiving.
Last June, the Mpumalanga Department of Health was placed under administration after it underspent on infrastructure and struggled to budget for goods and services and experienced budget overruns. – Health-e News.
- Read more from Health-e News’ NHI investigation