Brain Drain or Brain Gain: The NHI will either prove to be a blessing or a curse

Since 1994, South Africa has emerged as an African economic powerhouse with a healthcare system that was once the envy of the continent. However, the country is facing a significant medical brain drain at a time when there is clear evidence that South African medical professionals possess some of the best skills in the world and will play an important role in economic growth following the implementation of the National Health Insurance (NHI).

The consequences of this brain drain are dire. As these skilled professionals leave, South Africa must grapple with challenging issues, including severe understaffing, overcrowded hospitals, and a disparity in access to quality medical care.

Added to this is the vulnerability of rural communities as medical resources become increasingly concentrated in urban centres as the brain drain intensifies. According to the Department of Health (DOH), South Africa has a vacancy rate of 18.6% for specialist medical personnel and 13.7% for nurses. Interestingly, the Democratic Nursing Organisation of South Africa (Denosa) has recently raised concerns about the shortage of nurses in public health facilities, with 20,000 nurses unemployed.

With the country’s slow economic growth and political uncertainty, the likelihood of more skilled healthcare professionals considering emigration increases, potentially harming South Africa’s economic development.

Globalisation has led to increased global demand for healthcare workers. However, without substantial investments in healthcare sectors, developing countries will continue to experience the adverse effects of healthcare worker migration. In South Africa, it is evident that this issue requires Government and civil society intervention to retain healthcare workers. If they fail to overcome this hurdle, the healthcare system in the country is at risk of collapsing.

While globalisation facilitates the movement of labour in South Africa, most of the reasons pushing healthcare workers to emigrate are rooted in structural and socio-economic factors. Further, most of these challenges are internal. The South African Government has not adequately or urgently addressed the issues undermining the country’s healthcare sector.

Public healthcare facilities are faced with overcrowding, an overt shortage of staff, low pay, and constant reduction in health budgets, which impact the procurement of medical resources and equipment. This will be a key issue in a year where South Africa faces one of its most important General Elections since 1994.

Statistics show that in 2020 emigration of professionals decreased due to the COVID-19 pandemic, however, emigration has been increasing after lockdown restrictions have eased.

The NHI has been a topic of significant discussion and debate, and its potential impact on the medical brain drain in the country is concerning.

While the NHI aims to provide universal healthcare coverage to all South Africans and improve equitable access to healthcare services, its implementation has raised specific challenges and questions regarding its effect on the migration of healthcare professionals.

The South African Medical Association (SAMA) represents approximately 17,000 doctors across South Africa. According to a survey conducted by SAMA, as many as 38% of its members intend to leave South Africa in response to the anticipated implementation of the NHI scheme. SAMA Spokesperson Dr Mvuyisi Mzukwa pointed out that the trust between Government and the profession has decreased because of current events.

According to a survey conducted by mutual financial services giant PPS, out of the 2905 medical professionals who participated (including doctors, dentists, attorneys, and medical engineers), 58% of respondents expressed pessimism about the NHI. They were especially concerned about capacity and infrastructure limitations, the potential financial burden on taxpayers, and Government’s ability to roll out the NHI effectively.

The exit of these highly skilled professionals would undoubtedly have a noticeable effect on service delivery within the healthcare sector and would be a hindrance to the NHI.

The introduction of the NHI has raised some concerns regarding the future of medical care in South Africa. Perceptions have been mixed; some view it as an opportunity to provide quality healthcare for all South Africans, which motivates some professionals to stay because they are inspired by the ability to make a difference in the country. Other professionals have expressed concerns about the uncertainty and changes in remuneration, job security, and the current state of the medical profession in South Africa, which they believe encourages emigration. For the NHI to succeed, it requires core competencies in resource allocation, funding, and human resources.

Let us not forget the two-tiered, inequitable healthcare system currently in place. South Africa’s public sector serves the majority of the population and is funded by the Government. The private sector caters to about 16% of the South African population that utilizes medical aids or out-of-pocket payments. Integrating these two sectors is crucial to addressing the disparities in South Africa and enhancing access to healthcare.

Additionally, private-sector medical professionals fear the unknown. SAMA’s Chairperson, Dr. Mzukisi Grootboom, pointed out that the reality of the brain drain is that South African doctors and nurses going to Canada and the United Kingdom are immigrating to countries that have their iteration of universal health coverage. Therefore, it may not be the fear of the concept of universal healthcare but fears regarding the makeup and implementation of the NHI that drive this crisis.

The medical brain drain has the potential to have a significant adverse impact on South Africa. How do we address this?

The brain drain is a complex challenge that requires a multifaceted approach involving Government, healthcare institutions, and civil society. Below are some considerations that our healthcare system should consider:

• improving working conditions such as workload reduction, provision of better equipment and facilities, and ensuring a safe and supportive work environment;
• the implementation of fair and competitive compensation and remuneration for healthcare professionals;
• funding should be prioritized for domestic medical education and training programs that will allow medical professionals to enhance their qualifications;
• the implementation of retention incentives such as loan forgiveness programs or scholarships that would contribute to services in underserved and rural areas; and
• developing policies that will foster the positive well-being of healthcare professionals. These can be designed to prevent burnout, harassment, and violence in the workplace. Healthcare policies should also be transparent, consistent, and supportive of the needs of healthcare professionals.

It is imperative to note that there is no one-size-fits-all solution to the medical brain drain crisis. Strategies need to be tailor-made to fit the unique circumstances and challenges faced by South Africa. For this reason, comprehensive healthcare management is pivotal for achieving equitable access to quality healthcare, improving health outcomes, and addressing the medical brain drain crisis that the nation faces.

The COVID-19 pandemic has reshaped the education and training needs of the overall healthcare workforce. Upskilling, reskilling, and continuous professional development are necessary across all healthcare functions. MANCOSA launched the School of Healthcare (SoH) to address the Continuous Professional Development needs of healthcare workers in the country. MANCOSA intends to empower the healthcare workforce to remain attuned and responsive to the needs of future healthcare systems.

Backed by MANCOSA’s 27 years of experience in distance and online higher education, the SoH will serve to meet the ever-changing demands placed on South Africa’s fragile yet resilient and complex health workforce. The school intends to meet the up-skilling needs of 21st-century South African healthcare workers.