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The National Health Insurance (NHI), for which membership will be compulsory, is a funding scheme that aims to address healthcare inequity in South Africa. The scheme will do this by creating a fund that the government will use to buy healthcare services at set fees from accredited public and private health providers. The NHI Bill was passed in the National Assembly in June 2023. It has to go to the National Council of Provinces for approval.

HomeArticlesPublic private partnerships may answer doctor shortage

Public private partnerships may answer doctor shortage

Politicians and industry experts say that partnerships between the public and private sectors may solve the doctor and nurse shortages in SA.

Public private partnerships are the answer to South Africa’s growing shortage of healthcare professionals, political leaders and health policymakers said at the opening of the Board of Healthcare Funders (BHF) conference in Cape Town on Sunday. 

BHF is an industry organisation that represents the most South African medical schemes and also those in other Southern African Development Community countries.  

According to Western Cape Premier Helen Zille, she’s been “amazed to see how great the shortage of nurses potentially is in our country”. “We need to forge public private partnerships to deal with this challenge because more than 40% of our nurses are above 50 years old,” she said. 

The Public Health Association of South Africa estimates that there is an overall shortage of 80 000 healthcare professionals in the country, and that 70% of doctors work in the private sector, which serves only 16% of the population. 

“The bottom line is that we are producing the same amount of healthcare professionals as 1990s levels,” said head of the University of Cape Town’s medical school, Bongani Mayosi. According to Mayosi, between 1 200 and 1 400 doctors annually graduate from South African medical schools. “Some people say we need to at least double the amount of all healthcare professionals we are currently producing,” he said. 

Economist Roelof Botha said: “The population is growing all the time and that’s not going to turn around in our lifetime. Africa’s population will outstrip China by 2030.” 

With the increase of people in the country, the number of doctors and nurses need to grow accordingly for our health system to cope, he said.

Zille said public private partnerships could help medical schools increase their capacity to produce doctors. “Such partnerships in our medical schools are something we really need to roll out as much as we can. I was shocked to hear at the Cabinet lekgotla, that was held last Thursday, that in fact we send more medical students to Cuba to train than in all South Africa’s medical schools put together,” she said.

Previous PPP success 

According to Mayosi , public private partnerships  have been successful with regard to the  “training of highly specialised doctors”. Registrars, or specialists-in-training, work in academic, and therefore state, hospitals. 

“There are however only a certain number of government posts available for training at these hospitals,” he said. For example, at Groote Schuur Academic Hospital in Cape Town there are six neurologists. “There is the capacity to train at least twice this number but there are only two government-funded posts,” he said. 

Private organisations have responded to this by funding some of these posts in state hospitals. “A cardiologist might be sponsored one year and a nephrologist the next but these initiatives are currently too small to have any visible impact,” said Mayosi.

However, the Life Healthcare Foundation, a corporate social investment project of the private health care group, Life, recently scaled up their investment. Mayosi said 36 specialists from different departments will be funded over a period of two years at academic hospitals around the country. “They funded half of this year’s round of 36 and will do the same next year,” he said. 

Although the funding of specialists won’t increase the number of general practitioners (GPs), Mayosi said this investment is vital because these specialists will become trainers in their own right. “Over a short period of time we’ll get a large number of teachers – and new schools need professors.”

A ninth medical school is currently being built in Polokwane. “We probably also need a 10th in the near future,” said Mayosi. 

Zille said that if there is anything she has learnt in her time in government it’s that “no entity or institution can achieve its goals alone: this country needs to be built on partnerships”.

According to Mayosi, if South Africa wants to solve the doctor and nurse shortages “we need all hands on deck. We need the resources of both the public and private sectors: if we have collaboration over a sustained period then we’re likely to succeed.” 

Amy Green was a health reporter at Bhekisisa from 2013 until 2016.