Across our country, an unseen struggle unfolds daily within the walls of our public hospitals. Our health-care system — burdened by persistent challenges — stands at a critical juncture, where a collaborative, systemic approach is essential to ensure its survival for millions of South Africans.
Central to this crisis is the stark inequality in access to health care. While newly qualified doctors graduate in increasing numbers, many remain unplaced by the health department. This paradox is one of many factors contributing to the impairment of our health-care system.
One might ask: why is there a shortage of doctors in hospitals? The answer lies within a labyrinth of systemic failures — crumbling infrastructure, scarce resources and overcrowded public hospitals. The tragic irony is that while these institutions are meant to be sanctuaries for the sick, they often resemble battlegrounds, where medical personnel and patients must navigate disarray, excessive waiting times and inadequate facilities.
The pressing question is: how do we shift from crisis mode to sustainable care?
We should reimagine a South Africa where doctors are not seen as expendable workers waiting for placement, but as essential contributors to a robust health-care system. Their voices should be amplified, empowering them to advocate for both their patients and themselves.
Junior doctors are the backbone of South Africa’s health-care system, working tirelessly — often in underserved areas — to ensure patients receive the vital care they need. However, their dedication comes at a cost. Overworked and burdened by bureaucratic inefficiencies, they face an uphill battle that threatens their wellbeing, and patient safety. When our future health-care leaders are stretched beyond their limits, the entire system teeters on the brink of collapse.
The strain on medical staff, particularly junior doctors, is unsustainable. Many hospitals require them to work 30-hour shifts with little provision for illness. If a junior doctor falls sick, colleagues must cover their shifts, worsening exhaustion and burnout.
Research indicates that poor working conditions and chronic overwork drives local doctors to seek opportunities abroad, contributing to a concerning exodus of medical professionals.
The South African Medical Association (Sama) leads calls for systemic reforms that prioritise the safety and wellbeing of doctors. As an organisation, we stress the urgent need for improved working conditions, adequate staffing and fair treatment across the health-care system. Shorter overtime hours, equitable distribution of resources and systematic support are not luxuries — they are necessities. By protecting the wellbeing of doctors, we ultimately improve patient care and health-care outcomes for all.
Investing in junior doctors fortifies the core of our medical infrastructure and ensures a sustainable future
However, this is not solely a matter for the medical community. A rallying cry must emerge from all stakeholders; health-care institutions, government bodies and advocacy organisations must unite to drive change. The vision of a sustainable and safe medical practice environment requires collaborative efforts, innovative solutions and proper resource allocation to create pathways for health-care excellence.
The introduction of the National Health Insurance (NHI) has sparked fervent discussion, particularly regarding government overreach and its affect on people’s right to choose their own health coverage. Sama believes that universal health coverage in South Africa is possible only if all the six building blocks of a strong health system are addressed. These are service delivery, the health workforce, health information systems, medical products, financing, and leadership and governance.
In our view, the fundamental flaw of the NHI in its current form is its singular focus on health-care financing, while neglecting the other crucial pillars. A recent study by the Academy of Science of South Africa highlights the need for strong leadership and governance to ensure effective financial stewardship and workforce development. Without this foundation, the NHI will struggle to achieve its intended objectives.
Sama believes that health-care reform must prioritise:
- quality, access, safety and broad coverage in service delivery;
- a well-functioning health information system to ensure the production, analysis, dissemination, and use of timely and reliable data; and
- a fair and efficient procurement system for medical products that guarantees equitable access, assured quality and cost-effective use.
Our health-care system mirrors broader societal issues such as inequality, limited access to services and skewed resource allocation. To transform it, we must advocate for reforms that guarantee fair treatment for all — patients and health-care providers alike. Investing in junior doctors, for example, fortifies the core of our medical infrastructure and ensures a sustainable future.
As South Africa faces unprecedented health-care challenges, we must seize this moment for transformation. The future of our health system depends on immediate action. Government leaders, health-care institutions and advocacy groups must come together to implement urgent reforms before the system reaches total collapse.
• Dr Mvuyisi Mzukwa is chair of the South African Medical Association
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