Fit for Purpose? the Appropriate Education of Health Professionals in South Africa.
Sixty years ago Sidney and Emily Kark had a vision to make health care accessible to all South Africans, particularly those in rural and under-served areas. (1) They established a comprehensive primary health care model that was replicated in over 40 rural communities before the apartheid government abolished their plan. In the light of these historic initiatives, what have health sciences training institutions achieved in the past 50 years to address the health care priorities of South Africans who are most in need? In 2008 there were approximately 250 000 health care professionals employed in South Africa, with a calculated shortage of about 80 000 in the public sector and vacancy rates for doctors in excess of 50% in several provinces. (2) There is a serious overall shortage of health care personnel and the maldistribution of the health workforce between the public sector and private sector is great. At least 70% of all doctors work in the private sector, leaving only approximately 10 600 doctors to provide service for the 85% of South Africans who do not have private health insurance. (3) While the public-private health care situation is far from equitable, the situation in the rural areas of South Africa is appalling. At least 46% of South Africa’s 49 million rural residents are served by only 12% of our doctors, mostly from the public sector, and 19% of our nurses. (4) Not only are the public health services grossly insufficient and inequitable, but some of our medical schools have the greatest proportion of emigrating health care professionals in the world. (5) The facts speak for themselves – we need to train more health care professionals, improve the retention of health care personnel in South Africa, improve doctor-to-population ratios in public health care facilities, and distribute doctors better so as to address the health care needs of marginalised communities.