There is very little trust that the corruption-prone government that has presided over the near-collapse of public healthcare can be trusted with the distribution of NHI funds.   

Recent medical school graduates are leaving South Africa due to the looming introduction of the National Health Insurance (NHI) system and the removal of several medical professions from the critical skills work visa list.  

According to a 24-year-old Wits alumnus (who prefers to remain anonymous), there is a network of young medical professionals on digital platforms looking to emigrate. “We have very little faith in the government,” says the class of 2022 graduate, about to start an internship. 

The system they are seeking to escape has been in the works since 2012. In a brochure the department of health explains the NHI as a healthcare financing system which gathers funds to provide “equal” and “affordable” healthcare for South Africans.  

In an additional document the department of health says these funds will be distributed to private and public healthcare facilities for their services, and it is this aspect of the NHI that has young medical professionals anxious.  

The Wits graduate says, “During the completion of my degree, I trained in public hospitals,” where she saw that “the public health system was on the brink of collapse”. She finds it difficult to trust whether the government can handle distributing the NHI funds because of “the corruption that could arise from this”.  

The Witsie and her colleagues share these anxieties and future options in a national Facebook group for medical interns with over 15 000 members. From this group she was directed to a WhatsApp group specifically for people looking to emigrate, which includes recent medical school graduates who cite the critical skills work visa list as their reason.  

Medical professionals leaving South Africa by Wits Vuvuzela

This list details the professions that South Africa needs in different sectors. In February 2022, the government released an updated version of the list which excluded several medical professionals, namely non-specialist doctors. This leaves out recent graduates who can only specialise after several years of training which start with a two-year medical internship programme. 

A 2022 University of KwaZulu-Natal medical school graduate (who also prefers to be anonymous) told Wits Vuvuzela that foreign students have to use passports to apply for internships as their main option. The alternative would be to wait out a processing period of up to 24 months for a permanent residence visa – a period when these recent graduates are unable to use the skills they have spent six years acquiring.  

However, using a passport reduces their chances of being placed in hospitals. The UKZN graduate, who is a Lesotho citizen, says this is because “you may only apply to priority one hospitals”, which are hospitals located in more remote areas and where the demand so outstrips supply that they can receive as many as 400 applicants for four posts.  She says she was hoping to complete her internship in South Africa because Lesotho’s hospitals are understaffed and interns do not get paid as much as South African interns.  

These young medical professionals join the recent trend of medical professionals emigrating overseas according to medical aid provider, Profmed, since 2015, the year the government released the White Paper with plans to introduce the NHI.   

Profmed’s records show that almost 1 000 healthcare professionals have emigrated between 2015 and 2021 and this is just the tip of the iceberg. According to a March 2022 South African Medical Association survey, the introduction of the NHI is responsible for 38% of its members planning to emigrate.  

The government acknowledges the severe need for medical skills in South Africa. In the Understanding National Health Insurance booklet, in a section titled “Do We Have Enough Health Professionals” it says, “Government has already taken action to begin increasing the numbers of health professionals graduating from colleges and universities.” However, it makes no mention of retaining these professionals once they have graduated.

Nevertheless, this has not affected the plans of those medical school graduates who want to emigrate. The Wits alumnus says she wants a career “in a health system that is more stable and organised for me and the patients I serve”.  

FEATURED IMAGE: A staff member setting up an ultraviolet sanitation device at the Wits Donald Gordon Medical Centre. Photo: Rufaro Chiswo