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The Democratic Alliance intends to propose legislation that would allow healthcare professionals to do community service and internships in private hospitals. Such a legislative change risks exacerbating some of South Africa’s healthcare inequalities, argues Bulela Vava.
The unemployment crisis in South Africa has become increasingly untenable. It not only effects young people in general, but also graduates. This problem of graduate unemployment is sending a message that even education is no longer the safety net it used to be.
Among the casualties, unemployed healthcare workers are not spared. Time and time again, hundreds of early career healthcare workers find themselves helpless, either struggling to secure community service or internship placements or to join the healthcare workforce after they complete compulsory community service.
This has led to a crisis with far-ranging impacts, in particular for rural and township economies that often have the highest burden of healthcare needs but with a disproportionately low allocation of the required human resources.
Wrong solution
In a move to address this problem, Michéle Clark, DA member of parliament who also sits on the portfolio committee for health, intends to introduce an Amendment Bill to the Health Professions Act.
At its core, the draft bill aims to introduce measures allowing the private sector to employ community service and intern health professionals, a move aimed at tackling the rising unemployment rates among healthcare graduates. While this initiative appears progressive on the surface, a deeper dive into its implications reveals a complex scenario that may not yield the intended benefits, particularly for marginalised communities in rural and township areas.
Concerns with the draft bill
The draft bill deserves reserved support, but also raises some real concerns.
On the one hand, the idea of harnessing the private sector’s resources to create employment opportunities for community service and intern healthcare workers is commendable. The public health system, already burdened by budget constraints, would benefit from the additional workforce without bearing the full financial responsibility. Moreover, unemployed healthcare workers – many of whom are left disillusioned after years of rigorous training—would finally have a chance to gain much-needed experience and earn a livelihood.
On the other hand, the proposed bill’s implementation without a careful appreciation of both the context and complexity of the problem it seeks to solve raises some red flags.
The most pressing concern lies in its potential impact on healthcare equity. By allowing the private sector to employ these young professionals, there is a risk that the focus will skew towards profit-driven goals, leaving rural and under-resourced communities underserved. A significant majority of people living in rural and township communities cannot afford the often-exorbitant costs associated with accessing private healthcare, and this makes for a bad business investment case for the private sector.
Historically, the private healthcare sector in South Africa has been concentrated in urban and affluent areas where patient populations can afford care. The rural and township communities, where healthcare access is already severely limited, may continue to see little to no substantial investment from private entities. This geographical maldistribution of healthcare services only serves to widen the gap in health outcomes between the rich and the poor.
Moreover, the introduction of private employment for internship and community service professionals could lead to a two-tier system where the private sector attracts the best talent due to better working conditions and remuneration, leaving the public sector with fewer resources. This would widen the disparity between public and private healthcare services, which is already a major barrier to achieving equitable health outcomes in the country.
The way forward
Government is not without blame in this unfolding crisis, and its role cannot be overlooked. For years, there has been a failure to adequately plan and invest in the healthcare workforce, resulting in many newly qualified healthcare professionals being unemployed. The public sector’s inability to absorb these graduates has created a bottleneck that leaves many young professionals idle despite the country’s dire need for healthcare services. With its inability or lack of urgency to resolve the problem, the passing of this proposed amendment by the government could appear to be a move to outsource its responsibility to the private sector, a move that might provide short-term relief but does little to resolve the underlying problems.
To truly address the unemployment of healthcare workers and the access to healthcare crisis in South Africa, a more comprehensive approach is needed. One that looks beyond mere employment and instead focuses on equitable distribution of healthcare services. The amendment bill should include clear provisions and incentives for the private sector to deploy community service and intern professionals in underserved areas. It should also enforce legally binding accountability measures to ensure that private sector involvement does not come at the expense of the greater public good.
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Additionally, government must prioritise leadership and governance reforms in the public health sector in the interest of the public, focus on addressing push factors such as dilapidated infrastructure and poor working conditions and build on decentralised training for improved healthcare coverage. While this proposed amendment may not readily address this, a review of the current community service policy is needed, facilitated by an inclusive and comprehensive consultative process.
Ultimately, strengthening the public healthcare system is crucial to counterbalancing the influence of a profit-driven private sector and ensuring that marginalised communities receive the quality care they deserve.
*Vava is an Atlantic Fellow for Health Equity in South Africa and President of the Public Oral Health Forum, a network of oral health professionals committed to improving oral health outcomes in South Africa through strategic advocacy, education, research, and collaboration.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
