The migration of health professionals from public to private healthcare in South Africa.

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What measures have been put in place by the South African government to address its impacts?

The movement of skilled workers from the public sector to the private sector is not a phenomenon that is confined to a single country or a single profession; the competition for skills is one common factor between the public and private sectors. This challenge is also linked to individual needs which make it difficult for countries or governments to deal with. In my field for instance; there have been a lot of movement form small companies (Occupational Hygiene- Approved Inspection Authorities) to more big corporates that pay better salaries and offer better working conditions and incentives. It is thus not a surprise that one of the factors contributing to the movement of health care professionals from the public sector to the private sector is the issues of remuneration coupled with working conditions (Mahlathi and Dlamini, 2017:19). This movement within different health sectors of the same country cannot be viewed in isolation to the challenge of brain drain which has to do with the movement of skilled health care professionals from one country which is usually under-developed to a more developed one (Groenhout, 2012, Labonte et al., 2015:3, Pang, Lansang and Haines, 2002:499). The similarities in the factors that cause the movement of skilled healthcare professionals from the public sector to the private sector and the movement of the same skilled people out of their country to a more developed country are astounding. For, instance poor working conditions, low remuneration and corruption are common push factors that can cause a health care professional to leave the public sector for the private sector or leave their country for a more developed country.




Sub-Saharan Africa has been hit the most by the impact of brain drain, with South Africa leading the pack (Mayosi and Benattar, 2014:1348). It is thus not surprising that South Africa finds itself in a position where there are fewer doctors in public practice who are responsible for more people as compared to the situation in private practice where there are more doctors responsible for less people (Breir, 2008:11). In fact; according to Breir, (2008:11), in 2007 fifteen percent (15%) of the insured South African population was served by 59% of the doctors in private practice while conversely public practice, forty one percent (41%) of the doctors were serving 85% of the uninsured South African population. In 2004, South Africa had 7.7 medical practitioners per 10 000 population, which was better than for other neighboring countries such as Botswana, Zimbabwe and Namibia which had 4.0, 1.6 and 3.0 respectively (Breir, 2008:12). South Africa however; did not match well with other developed countries such as Canada and Belgium which had 21 and 40 practicing medical practitioners respectively (Breir, 2008:15).




When one looks at the situation in South Africa, a picture begins to form pointing to the impact of the push factors such as corruption, poor working conditions and infrastructure, poor management of funds and poor remuneration (Labonte et al., 2015:12, Mahlathi and Dlamini, 2017:19, Misau, 2010:20). The public sector is struggling with resources.


Factors that affect the movement of medical practitioners from public to private sector are individual factors such as working conditions and salary. Medical practitioners are often reluctant to work in rural areas where working conditions are said to be poor (Breir, 2008:13). The other challenge associated with the working conditions in the public sector is the long working hours and fewer incentives in comparison to the private sector (Mahlathi and Dlamini, 2017:19).


Although the situation may look drastic in South Africa; countries such as Thailand and Ireland have managed to provide better incentives for their medical practitioners resulting in a number of them returning and staying within the public sector (Pang, Lansang and Haines, 2002:500). One of the things that these countries managed to do was to increase salaries of medical practitioners in public practice and offer educational benefits for children of those medical practitioners (Pang, Lansang and Haines, 2002:500).


South Africa, has also made progress in dealing with the challenge of migration of health care practitioners form public to private sector; one of these has been the introduction of the Scarce Skills Allowance which was introduced in 2004 for doctors who work in rural areas (Breir, 2008:42 and the introduction of community service doctors which has been said to be the pillar of the system since it is evident that the provision of health care services in rural areas in South Africa is highly dependent on community service doctors (Breir, 2008:42). The Cuba incentive has also added a number of doctors in the public sector but it has also been faced with challenges and the number is not enough as South Africa needed about 6451 more doctors for it to meet the level regarded as a norm for low income countries by the World Bank (Breir, 2008). The slow progress made with regards to the National health Insurance NHI has also been noted to be a discouraging factor for many doctors in South Africa (Labonte et al., 2015:12) and this is a huge dent since the NHI is the one strategy that promotes collaboration between the public and private sector as well as better working conditions for all medical practitioners regardless of which sector they practice in.


In conclusion, the measures that the South African government has taken to deal with the disparities that occur between the public and private health sectors have not been enough (Breir, 2008:51). There needs to be more effort put into dealing with the factors that lead to the migration of health care professionals from public to private practice such as rampant corruption (not assuming that corruption only occurs in the public sector), poor working conditions and low salaries.

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