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Fast-tracking unregistered healthcare workers into the system isn’t without its risks, but it’s not without its solutions either, say foreign-trained doctors.


The South African Nursing Council (SANC) is fast-tracking applications by private hospital groups and provincial health departments to re-register retired nurses to prepare for what experts say is an expected wave of COVID-19 cases. But foreign-trained healthcare workers in South Africa say they’re still being sidelined in the response.

All nurses have to be registered with SANC to practice in the country, but nurses’ registrations lapse if they retire or fail to pay annual fees to the body. Now, the council says it’s allowing potential employers of nurses with out-of-date registrations to apply on their behalf, streamlining the process to get the healthcare workers back into understaffed wards, says SANC senior communications manager Adri van Eeden.

The body will, however, not be accepting applications from individual nurses looking to re-register during the outbreak.

And fast-tracking does not apply to new or foreign-trained nurses.

South Africa’s national lockdown has helped reduce new cases of the coronavirus known as SARS-Cov-2, chairperson of the Ministerial Advisory Committee on COVID-19 Salim Abdool Karim told the nation in a televised address on 13 April. But Abdool Karim cautioned that it was unlikely the country would avoid a sharp increase in cases in the future. He explained that South Africa was already gearing up for an eventual wave of cases by, for instance, erecting field hospitals and increasing its capacity to conduct burials.

On April 27, more than 200 health professionals from Cuba arrived in South Africa to assist with the Covid-19 outbreak. In a press briefing, Health Minister Zweli Mkhize said that Cuba already sends doctors to South Africa as part of a longstanding partnership and that South Africa would be looking to capitalise on the Caribbean country’s community-based primary healthcare expertise.

Cuba is known for strong primary healthcare systems that helped the country achieve one of the world’s highest life expectancies, according to World Bank data, despite spending less per person on health than many other nations.

But, some doctors say South Africa could be doing more to make use of foreign and foreign-trained healthcare workers already within its borders.

Foreign-trained doctors turn up for UK emergency rooms

Within just weeks, the United Kingdom added more than 11 000 doctors to its workforce during the coronavirus outbreak by granting temporary registration to doctors who had given up their registration in the past three years, its General Medical Council announced in late March.

The regulator was able to do this quickly, it says on its website, because it actively emailed doctors as part of an opt-out programme, meaning that clinicians were part of the project unless they declined to participate.

Final year medical students were also allowed to provisionally register to serve during the coronavirus outbreak in the UK.

Writing for Bhekisisia, South African doctor Koot Kotze, who is studying in the UK, argued that South Africa might be able to capitalise on foreign-trained and qualified healthcare workers already in the country. That is, if these workers were able to act as “acute care assistants” during the outbreak alongside registered emergency room doctors.

Health department: No registration, no way

Currently, foreign-trained healthcare workers who are not nurses — South African or not — must apply to have their qualifications recognised by the Health Professions Council of South Africa (HPCSA), the national health department and the Education Commission for Foreign Medical Graduates in the United States. They must also pass HPCSA board exams, which have been postponed during the lockdown.

Foreign-trained doctors say the process can take up to two years, but the HPCSA has refuted these claims, according to TimesLive.

Meanwhile, the national health department’s spokesperson, Popo Maja, says the department will only consider medical professionals who are properly registered with the HPCSA and other statutory bodies.

Watch: Is it time to get a mask?

“We have many South Africans who trained in foreign countries but have repeatedly failed board exams set by HPCSA,” Maja told Bhekisisa. “The HPCSA is mandated to ensure that doctors are well qualified and do not put patients at risk.”

Bhekisisa asked the HPCSA whether it was considering implementing any of the measures for foreign-trained workers used in the UK. HPCSA spokesperson Priscilla Sekhonyane says there’s no provision in the council’s regulations to temporarily allow foreign-trained healthcare workers to assist during the outbreak.

Grant temporary registration for foreign-trained doctors to work in limited roles at hospitals, say doctors

Some internationally-trained South African doctors insist that they have not been given the opportunity to assist in South Africa’s response because they cannot register with the HPCSA.

This includes Jehane Le Grange, a South African doctor trained in China.

“Despite having a matric A-aggregate and two degrees, I could not get into any of the eight medical universities in South Africa back in 2012. So I went and studied at a top Chinese university,” Le Grange told Bhekisisa.

Historically, the HPCSA has had difficulty in registering international medical graduates and the issue was taken up to Parliament as recently as 2018, Le Grange and others write in a recent article published in the South African Medical Journal (SAMJ).  Meanwhile, a 2018 national health department policy to better incorporate foreign-trained healthcare workers into the South Africa system, has yet to be implemented, they say.

Watch: Has South Africa’s coronavirus lockdown worked so far?

According to the results of a survey that Le Grange and his co-authors included in their SAMJ article, about 70% of 644 internationally-trained South African doctors, were not medically practising in South Africa and some were unemployed. The authors surveyed the doctors over a period of two days. Most survey participants currently in the country said they would be willing to help out during the outbreak.

Although the authors acknowledge that using unregistered doctors temporarily during the outbreak is not without risk, they argue that ensuring foreign-trained doctors meet a predefined set of minimum standards as part of recruitment — as is done in the United States — could help mitigate this. They suggest using such doctors in limited, hospital-based roles much like the United Kingdom has chosen to do.

Le Grange concludes: “These doctors have the training but they don’t have the legal mandate in the form of HPCSA registration, and they can’t currently obtain any registration without taking the board exam, so they sit idle during COVID-19.”

[Updated 24 April 2020 10:51am This story was updated to include HPCSA comment that came in after deadline.]

[Updated 27 April 2020 10:25am This story was updated to reflect the arrival of more than 200 health professionals from Cuba on April 27th — our story was published before the arrival of the group.]