South Africa’s long-standing system of medical internships and community service for newly qualified doctors could be on the brink of collapse.
Under a bold new competency-based curriculum launched by the WHO Regional Office for Africa, medical students may soon be fast-tracked straight into the workforce, provided they prove they can perform safely and independently from day one.
The move promises to transform how the country trains, certifies and deploys its future medical professionals while tackling chronic shortages and unemployment in the public health sector.
The shift was highlighted on Monday in Pretoria when the WHO Regional Office for Africa unveiled the continent’s prototype competency-based curricula for Priority Health Professions.
The launch formed part of the Member States Consultation on the Draft Africa Health Workforce Agenda 2026–2035, which brought together ministers, policymakers, academics and development partners to chart a new path for Africa’s health workforce.
Integrating theory and practice from day one
Prof Christmal Dela Christmals of North-West University, a member of the Curriculum Development Advisory Committee, said the new approach integrates theory and hands-on practice from the very start of medical training.
“We begin to assess them little by little through what we call programmatic assessment. The assessment goes phase by phase from the beginning until the end so that we can track how a student is progressing that is competency-based education,” he said.
Currently, South African medical graduates complete a degree, then spend two years as interns, followed by a year of community service.
“But with competency-based education by the time students finish school they are certified to work independently because we have monitored their competence throughout their entire training,” Dela Christmals said.
The plight of junior doctors struggling to find employment after community service has become a recurring issue.
DA health spokesperson Michele Clarke said in a statement that only 60% of doctors who completed community service in 2023, or 1,187 graduates, were appointed into funded government posts. The remaining 40% either sought employment in the private sector, faced unemployment or emigrated.
Unemployment exists alongside severe staff shortages in the public sector.
Last year, deputy health minister Dr Joe Phaahla attributed the high number of unemployed medical graduates to increasing pressure on healthcare budgets, partly due to a large government salary bill.
Dela Christmals added that the issue stems from core planning.
“If you look at the strategic plan for human resources for health, you see the country has limits on the number of professionals it can employ. Clinical associates, for example, may finish training, but the department cannot place them because they weren’t planned for. Universities train them, but without government provision, these professionals remain unemployed,” he explained.
He emphasised the importance of a “plan, train and retain” strategy.
“We plan according to national needs, not what a university thinks or wants. The government must make provision for these professionals so that by the time they graduate, there is a place for them. It’s a holistic process,” Dela Christmals said.
Another challenge is the lack of fiscal space: even if trained professionals are needed, there may not be a budgetary provision to employ them.
Challenges across Africa
Africa faces multiple challenges in the health sector, beyond unemployment. Dr Adelheid Onyango, WHO’s director of Universal Health Coverage, said: “There are more than 4,000 institutions training health workers, but teaching and learning facilities have not necessarily expanded. We face shortages, uneven competence among graduates, outdated curricula and limited practical exposure, all affecting the quality of care.”
She added that the WHO Regional Office for Africa is committed to working with member states to build a capable, motivated and trusted workforce.
“Competency-based education strengthens the link between education and service delivery. It ensures the health workforce can provide safe, effective, people-centred care, the foundation for Universal Health Coverage,” Onyango said.
Dela Christmals said the new curriculum aims to set a standard across Africa. “If there is an outbreak in one country, we should be able to call on neighbouring countries for support, knowing their health workers have the necessary skills based on a shared standard,” he said.
Government response
Dr Percy Mahlathi, deputy director-general at the national department of health, acknowledged the challenges of training without corresponding employment opportunities.
“This refocus ensures we employ fit-for-purpose health professionals and create a viable environment to retain them,” he said.
He stressed the need for cross-ministerial coordination on budgeting.
“The health ministry requires support from other ministries, including finance, to ensure plans are funded. Investing in health is investing in our wealth. We must not only train but sustain health professionals to maintain national stability,” Mahlathi said.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.