Healthcare spatial inequality - in South Africa

posted Oct 4, 2015, 7:04 AM by desmond Seeley

It is not a a new story that South Africa has challenges with spatial planning an service distribution, but when you read an article like this that was published in TimesLIVE by Katharine Child, you realize our the magnitude of the problem!

'Gynaes in wrong places'

Katharine Child | 07 May, 2015 00:20

"Motsoaledi said the fact that most doctors worked in the private sector and serviced about 18% of the population revealed the vast "inequality" in the country's health system. 

There is a hospital near Sandton, northern Joburg, that has more gynaecologists than all the state facilities in Mpumalanga and Limpopo combined, Health Minister Aaron Motsoaledi complained yesterday

There are six full-time gynaecologists working in the public sector in Mpumalanga and nine in Limpopo. Three also work part time for the state in Limpopo, according to Joe Maila, Motsoaledi's spokesman.

With at least 2.6 million women using state healthcare facilities in Limpopo, this means there is only one full-time gynaecologist for almost 300000 women. In Mpumalanga, the six fulltime gynaecologists each serve 297000 women.

Motsoaledi said the fact that most doctors worked in the private sector and serviced about 18% of the population revealed the vast "inequality" in the country's health system.

He was speaking at a UN meeting in Kempton Park on the East Rand on the global health plan for women, children and adolescents.

Chris Archer, a gynaecologist and head of the SA Private Practitioners' Forum, said posts for government specialists had been on and off for years.

He said this meant that when new gynaecologists qualified, they faced two choices: go overseas or work in private practice.

"The fact that gynaecologists could make a living working in private practice meant the industry had retained the doctors in the country, " Archer said.

He said many of his colleagues would love to work in the public arena if it were well-managed.

" [The public sector] has politicised management, runs out of drugs or has broken or poorly maintained equipment," he said.

Health economist Alex van den Heever agreed, saying various provinces had faced fiscal crises and had frozen posts.

But he also said when specialist posts for public hospitals were advertised, doctors applied for them.

"The state pays about R1.5-million a year for a top specialist and offers a huge pension that pays 75% a month of what one earned when working, for the rest of your life."

It was hard for private doctors' savings to compete with the government's pension fund, he said.

He admitted that it was hard for rural areas to attract doctors.

Motsoaledi said better health for women and children would not be realised until the National Health Insurance became a reality.

NHI would need more gynaecologists working in more rural areas."

According to the SA Society of Obstetricians & Gynaecologists in South Africa, 400 of their members work in private practice, 98 in state hospitals and 11 part time for the government.