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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 Act was signed into law on 15 May 2024 but before it will come into effect, Parliament will need to enact further legislation (including ones providing for its funding).

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We’re launching new medical schools but will we have jobs for their graduates?

The future of South Africa’s doctors rests on provincial purses.


One of the first lessons we’re taught in medical school is that the safest way to practice medicine is to know what we don’t know.

As junior doctors, we’re concerned about the next chapter in our careers, and we’re ready to ask some crucial questions.

In 2014, young medical officers banded together to petition for a reduction in working hours of junior doctors who can spend up to 36 hours on duty at a time.

The answer to ending unsafe working hours, Health Minister Aaron Motsoaledi said, was to train and employ more doctors.

This year’s graduating class of doctors will number 600 more than it did five years ago. And in 2019, the country will welcome a further 1000 Cuban-trained medical graduates returning to work in South Africa.

Meanwhile, provincial health budgets are already taking strain.

A rural community healthcare worker, or “mentor mother”, visits a client in the Eastern Cape.

In January, Bhekisisa reported that some provincial health departments might have formal or informal hiring freezes as provincial health budgets struggle to keep up with rising costs.

In a country in which the World Bank estimates there is less than one medical professional for every 1000 citizens, we are launching new medical schools but ironically may have no hope of employing all of their graduates.

Medical hopefuls plough through six gruelling years of medical school, after which they apply through a national system to be placed for a two-year internship. This same system is used to place them again later for a mandatory year of community service.

Doctors must complete both their internships and community service before they’re able to register as independent medical practitioners in South Africa.

In 2016, the Junior Doctors Association of South Africa and the South African Medical Association helped the national department of health transition to an online application system for internship and community service posts. In its first trial run that year, the system left a reported 150 doctors unemployed at the end of the application cycle in December, although Motsoaledi accused many of simply not wanting to serve in rural communities.

Some of these unplaced doctors waited until September 2017 before taking up posts.

This backlog was cited as a cause for the six-month delay in the opening of this year’s applications through the electronic system — which also included those from other professionals, such as nurses, pharmacists and dentists.

Further delays were supposedly a result of universities not submitting numbers of prospective graduates.

Meanwhile, provinces allegedly stalled in verifying the number of medical students on provincial bursaries who would need to complete internships or community service in their home provinces as part of their bursary contracts.

And, crucially, provinces struggled to let the national health department know how many posts they could afford to provide to interns and community service applicants.

In other words, the national government may be responsible for ensuring young professionals can complete the requirements to practice in South Africa, but the real power to guarantee this still lies with provincial treasuries.

Applications for junior doctors taking up posts on January 1 next year were held from August to September.

About 1 900 medical students applied for roughly 1 400 available internship posts. Meanwhile, available community service positions were about 10 positions short of being able to accommodate the 1 342 medical interns who applied for them.

Although the deficit appears large, the majority of the unplaced applicants are foreign graduates hoping to join the South African workforce, says the health department.

The almost 200-post shortage for South African graduates was largely remedied by a recently-formed task team chaired by the director general of health, Malebona Precious Matsoso.

The department has committed to ensuring that all eligible South African graduates are placed by January 1 next year.

A nurse consults a woman during a cervical cancer screening. Training new healthcare workers may be the responsibility of the national government but the cost falls to provincial purses.

So where do we currently stand? Under immense pressure, the national health department and its task team managed to pull off a bumpy application cycle.

But next year will come. And the training of medical graduates will remain a statutory obligation of the national health department, as Motsoaledi maintained in a speech in January this year.

There need to be conditions that provide consistent funding to allow the department to fulfil the employment and training needs of medical graduates.

Now is the time to start asking some serious questions about where this funding will come from and how it can be safeguarded.

Farah Jawitz is a medical doctor and a member of the Junior Doctors Association of South Africa. You can follow her on Twitter @farahjawitz.