Doctor shortage hits rural SA
There are 13 doctors and two specialists available for every 100 000 people without medical aid in South Africa’s rural areas.
With 22.3 million of the nation’s population living in rural areas, this translates to one general practitioner for every 7 692 people.
These shocking figures are contained in the latest South African Health Review, which also reveals that only 30% of all doctors in South Africa work in the public healthcare sector.
About 84% of South Africans rely on public healthcare because they have no health insurance.
The report, released in February, also highlights the huge disparity in the distribution of doctors between rural and urban provinces.
In North West, where 60% of the population lived in rural areas in 2010, there were 16 public and private sector general practitioners, and 1.6 specialists, for every 100 000 people.
In Western Cape, there were 34.2 general practitioners for every 100 000 people, and Gauteng had 31.5 general practitioners and 21.9 specialists for the same number of people.
Explaining the disparity between the number of doctors in urban and rural areas, Professor Ian Couper, the director of the Centre for Rural Health at the University of the Witwatersrand (Wits), said: “It is the same with every country – health professionals just don’t want to work in rural areas.
“The fact that South Africa is already dealing with a shortage of doctors in general makes the situation much more severe for rural areas.”
Professor Hoffie Conradie, who is the director of Ukwanda Rural Clinical School at Stellenbosch University, agreed with Couper.
He said: “The majority of the few doctors the country has are working in urban areas, leaving only 12% of their colleagues serving half of the population living in rural areas.”
South Africa produces about 1 300 doctors yearly, but only 35 of them end up working in rural areas in the long term.
But some medical schools – namely Stellenbosch, Wits and KwaZulu-Natal universities – are working to bolster these numbers.
These institutions have dedicated sections of their medical schools to promote rural healthcare.
They offer practical training in rural hospitals, which exposes students to the health issues facing rural South African communities.
Conradie explained this was done with the hope that students would return to and work in rural areas when they qualified.
Couper said: “It has been proven that students who were exposed to rural health (care) are four to seven times more likely to return and work in rural areas after graduating.”
Stellenbosch University’s Ukwanda Centre for Rural Health in Worcester produced its first eight students to be trained in rural health last year.
They are currently doing internships in various rural hospitals around the nation.
Couper said the shortage of doctors in rural areas would take a long time to be fixed, but a few things could be done in the short term to attract doctors to those places.
He said: “The government could start by improving living and working conditions.”
His view was echoed by Dr Poppy Ramathuba, the chairperson of the public-sector doctors division at the South African Medical Association.
Ramathuba said: “It’s not that doctors don’t want to serve rural communities, but the poor working condition, the standard of education and lack of infrastructure are some of the reasons why most doctors prefer to work in urban areas.”
Retha Grobbelaar of Africa Health Placements, an organisation that helps government recruit foreign and local doctors for public healthcare facilities in rural and under-served areas, agreed.
She said: “Doctors often mention poor management and working conditions as push factors. They feel management does not always appreciate them and that they do not receive the support they need.
“Staff shortages make it a very stressful working environment and eventually doctors leave.”