Linda Azikiwe [name changed] is a board-certified specialist from an African country, trained at an Ivy League medical school in the United States (US).¹ She practised for three years in the US. Azikiwe wants to work in South Africa, “One of the reasons I was excited to move to South Africa was because I was aware of the significant need.”

With less than one doctor for every 1,000 people, South Africa has a shortage of medical staff. By contrast, the rate for developed countries is two to five doctors per 1,000 people.² Over 25% of doctors in the US are foreign, while over 30% in the UK are.³ Yet, as of 2006, less than 10% of South Africa’s workforce was staffed by foreign doctors.⁴ Additionally, many South African doctors work abroad. In a recent study, only half of South African health workers were said to be satisfied with their job, and this has been linked to their intention to leave.⁵

Azikwe applied to the HPCSA to register as a doctor in April 2013 when she was still in the US. Thereafter, she battled to get any information about her pending application, and was told by staff at the HPCSA that they did not know how long registration might take.

“For many it can take up to nine months or longer to get a decision from the HPCSA. I was a little aggressive in calling, emailing and following up so I got a decision sooner. In early June I started to follow up which was in itself a difficult task. By the end of June I was told that the application was referred to the [institution dealing with my speciality]. In mid-August I received their decision. I was told I would have to do additional training and take certifying examinations in order to register, even though other American US-trained [doctors with my speciality] were able to register straight away,” explains Azikiwe. Her application was rejected and she has since re-applied as a General Practitioner.

Azikiwe explains the reasons for the HPCSA’s inefficiency, “[First], they are understaffed hence overwhelmed. Second, there is no standardisation of what is required and how they make decisions.” According to Azikiwe, while American nationals can register straight away with their US qualification, African nationals have to do additional training despite having the same qualification.

The Foreign Workforce Management Program application contains questions about the applicant’s country of origin, and specifically, whether the country is a ‘developing’ country or not. “It appears there is discrimination based on developing/non-developing nations at least regarding who needs to take exams and who does not,” Azikiwe said about the process.

GroundUp has tried in vain to confirm whether or not Azikiwe is correct on this point, but the HPCSA has simply failed to respond meaningfully to our questions.

Government policy and foreign doctors

Government policy is to only recruit doctors from countries with a large number of trained professionals, such as Cuba or the Philippines, in a bid to not ‘drain’ other developing countries of their medical staff. This has been the government’s stance since 1995, when it issued a press statement saying that the Department of Health should discourage doctors from developing countries from coming to South Africa in a bid not to “deprive our [South Africa’s] neighbours of their scarce resources in order to meet our needs.”⁶

A publication by the HSRC in 2008 explains this in detail:

In 2006 the Department of Health introduced a policy limiting the employment of foreign health professionals to three year contracts which are non-renewable. The National Human Resources for Health Planning Framework proposes further that the total foreign workforce should not at any stage exceed 5 per cent of the total health workforce.⁴

The HPCSA policy appears to be in line with this, and is aimed at deterring doctors from developing countries seeking work in South Africa, with the intention of encouraging them to return to their home country where there are serious health worker shortages. Africa Health Placements (AHP) is a non-profit organisation set up in part in response to this problem. It helps foreign doctors to work in Africa, including South Africa. It assists foreign doctors with speeding up the registration process with the HPCSA.⁷. Another organisation, Rural Doctors Association South Africa (RuDASA), lobbies for the improvement of health services in rural areas specifically. RuDASA recognizes that South Africa will “remain reliant on the services of foreign qualified doctors to staff our rural health services for many years to come.”⁸

RuDASA says that recent barriers to registration and lack of cooperation from authorities when considering work permit applications for doctors from the developing world has prevented many willing health professionals from coming to South Africa.

Editorial

After receiving complaints from several doctors and organisations about the HPCSA’s slow, unresponsive and unconcerned behaviour, GroundUp can confirm that this has also been our experience with the HPCSA.

The frustration Azikiwe felt dealing with the HPCSA is understandable. GroundUp waited three days for a response to our initial set of questions to HPCSA. We received a bland answer of no use to this article. We are still awaiting a response to follow up questions. HPCSA personnel and council members delayed their answers to straightforward questions. When we pushed them with persistent phone calls and emails, we were referred back and forth between different people.

A doctor we spoke to complained that telephone calls and letters he sends to the HPCSA do not get answered. Requests that need to be discussed at HPCSA council meetings fail to get discussed. One community organisation in Cape Town has had to litigate against the HPCSA simply to get it to respond properly to a request.

The HPCSA makes it very difficult for foreign doctors, especially those from the developing world, to complete the registration process in South Africa so that they can practice here. The HPCSA’s motivation for this is not without reason. Nor is it solely responsible.

As the Department of Health 1995 statement referred to in the article above explains, “Although South Africa is very short of doctors in rural and other underserved areas, the Department of Health does not want to deprive our neighbours of their scarce resources in order to meet our needs.” If it is HPCSA policy to deter doctors from developing countries from working in South Africa, it is in line with a stated aim of the health department. It is understandable that the Department of Health does not want to poach doctors from other developing countries, but many doctors from those countries have left or intend to leave anyway. Their next step after South Africa, if they cannot register here, is unlikely to be back to their home country, but rather to a wealthier country which has no scruples about using their services. At the current rate of producing doctors who stay in the country, the health needs of South Africa cannot be met adequately. Registering more doctors who have been trained overseas is not the full answer either but it can reduce the burden on the health system.

While South Africa should not actively recruit from countries with more dire health worker shortages, neither should it deter those intent on working here from doing so. And the HPCSA should not put unnecessary bureaucratic hurdles in the way of foreign doctors registering.

However even more urgent is for the HPCSA to get a basic problem sorted out: it needs to return telephone calls and respond to emails.

Footnotes