"There is sufficient production capacity. The problem is the employment capacity. We really have to look at the absorption capacity or we are training doctors to go overseas‚" Crisp said‚ challenging the perception that SA's medical schools were not producing enough specialists.
Crisp argued that the government's current fiscal constraints meant it could not increase the salary budget for healthcare workers‚ which currently stood at 72% of public health expenditure. This meant it had to use specialist more judiciously and get generalists to take on tasks that they had done in the past but now referred to specialists. "This holds true in the private sector too‚" he said.
"For example‚ a young healthy woman with an uncomplicated pregnancy did not require an obstetrician and gynaecologist for her antenatal care‚ but could be cared for by an appropriately trained nurse‚" he said. "Doing so would cost less and free up the specialist for truly complicated cases‚" he said.
Dr Crisp made his remarks during a panel discussion about medical specialists‚ in which consultant Brigid Strachan painted a picture of a country out of kilter with its middle-income counterparts.
Her presentation showed SA had 0.18 specialists per 1‚000 population‚ a quarter of the 0.8 per 1000 average of developing countries surveyed by the World Bank.
"The shortage of specialists contributes to SA's poor health status‚" said Strachan. She said that, for example‚ SA had an infant mortality rate of 34 per 1‚000‚ more than double that of Brazil (13.9) and Argentina (12.6). "These two countries spent a similar percentage of gross domestic product (GDP) on health (8.9% and 8.1%‚ respectively). SA spends 8.5% of GDP on health," she added.
According to Strachan the availability of specialists varied widely across SA and was largely concentrated in the Western Cape and Gauteng
Strachan warned that SA's specialist corps was aging and that too few young doctors were being trained in disciplines such as surgery‚ obstetrics and ophthalmology.
"One of the biggest challenges facing the public sector is its inability to retain the doctors it trained‚" she said. "10 years after graduation‚ only 20% or 30% of doctors remained in the country. We are losing what we produce to the private sector and overseas‚" she said.
A recent report to the UK's house of Lords said there were 765 South African specialists working in the UK‚ out of a total of 39‚400.
Strachan said SA needed a specialist review and better planning of the training and allocation of specialists. "They can't just be left to the forces of the market‚" she said.
The Department of Health's deputy director-general for tertiary services Terence Carter said the National Health Council agreed last week to set up a new governance structure to plan for SA's specialist needs.
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