The number of healthcare professionals in South Africa rose by 52% from about 36000 to 54800 from 2000 to 2017 with an unexpected concomitant rise in average age, the Board of Healthcare Funders (BHF) noted earlier today when releasing the results of a provider distribution investigation sourced from PCNS numbers.
In its report announcement, the BHF has explained that the survey looked at both the public and private sectors including not only general practitioners (GPs) and specialists, but also allied health professionals such as medical technologists, radiologists and pathologists.
“The report compiled further to this undertaking,” it adds in its media release, “highlights areas of concern, notably significant variations between provinces in respect of the distribution of human resources, but there are also some reasons for optimism as the country moves towards universal healthcare.”
“A 52% increase in active healthcare professionals was noted, from about 36 000 in 2000 to 54 800 in 2017. Surprisingly, however, this increase occurred in tandem with an increase in their average age in most disciplines. This unexpected observation is worrying as it suggests that there has been an increase in the number of older professionals moving from state facilities to the private sector,” said Charlton Murove, head of the BHF’s research unit and the author of the report.
The private sector services medical scheme beneficiaries, numbering 8.9 million in 2017, and other patients accessing health services through paying cash or via insurance products. “In 2000, there were 7.0 million beneficiaries, so there has been an increase over the years. But there has clearly been an even larger increase in healthcare professionals in the private sector (52% vs 27%).”
The report, the media release continues, found that the distribution of healthcare providers is disproportionate in terms of geographical location and population needs. Gauteng and the Western Cape have more per 10 000 population compared to more rural provinces such as Limpopo and Mpumalanga. This disproportionate distribution is acute in more specialised disciplines. The provider numbers in the latter provinces are well below the national Department of Health targets of healthcare providers per 10 000 population. This disproportionate distribution is evident in both the private and public sectors. Over and above this, there is a disproportionate number of providers practising in the private sector compared to the public sector. This leaves a high burden of care for those in public facilities. “The increasing number of providers in the private sector and the aforementioned increase in their average age suggests two things; training programmes to recruit new providers are inadequate and the public sector has lost staff to the private sector over the years,” Murove added.
Those registered on the PCNS, the BHF has observed, do not seem to stay in practice for long. A high number leave before reaching retirement. About half of male healthcare professionals de-register their PCNS numbers before they reach the age of 50. The rates of exit are significantly higher among women; about half leave private practice before the age of 45: “For a country below its target number of healthcare providers per 10 000 population, this observation is very worrying.”
Rates of exit of men do not differ much by provincial location. Gauteng experiences the highest number of exits. Women’s rates of exit differ markedly by provincial location, however, with Limpopo experiencing the highest rates and the Western Cape the lowest.
Rates of exit also vary according to discipline. Male healthcare providers practising in laboratories, medical technologists, pathologists and radiologists had the highest rates; 23% higher than male GPs. Specialists (anaesthetists, medical and surgical specialists) had the lowest – about 50% lower than GPs.
Similar observations were made for women. The differences across disciplines were much wider, though – those practising in laboratories had exit rates 41% higher than female GPs, while specialists’ rates of exit were about 60% lower than those of GPs.
But while the maldistribution of human resources and the rates of exit are alarming, the report also made some positive findings. “The number of GPs in private practice is 15.69 per 10 000 population, which is higher than the Department of Health target of 3.66 per 10 000 population. This presents an opportunity for both medical schemes and the state, as GPs may be contracted into arrangements where they serve a targeted population group. The government’s plans for rolling out NHI are possible given the number of GPs in the private sector – if they can be contracted to service the rest of the South African population. (In Gauteng and the Western Cape, even the number of specialists is above target.)
“The training of healthcare professionals should be considered as a lever to improve the provider/patient ratio, especially among specialists. Greater focus must be placed on increasing the number of specialists. The increasing average age points partly to a small base of new providers entering from training facilities,” Murove concluded.
*The full report is available from the BHF. For a copy, or more information, contact Sindisiwe Kubeka on 011-537-0240 or at firstname.lastname@example.org
SOURCE: Board of Healthcare Funders media release