Over one third of doctors’€™ posts (35%) and 40% of professional nurses’€™ posts were vacant in the public sector last year, according to the SA Health Review. This is significantly worse than two years ago when around 30% of doctors and nurses’€™ posts were vacant.

There is an overall vacancy rate for all health professionals of 36%, a 6% increase in two years.

Worst affected are the Free State, Eastern Cape and Mpumalanga, although the North West has the lowest number of doctors and professional nurses per capita.

Since 1994, the ratio of nurses to the population has halved, according to Professor Uta Lehmann writing in the SAHR.

There are now 1.1 nurses per 1000 people in comparison to 2.5 nurses in 1994 ‘€“ a decrease of more than 50 percent. In addition, while almost eight out of 10 nurses used to work in the public sector in 1989, only 42% do so now.

‘€œPrimary care in South Africa is overwhelmingly nurse-based,’€ says Lehmann, but the training of nurses actually dropped between 2000 and 2005. Around 2000 professional nurses graduate each year yet by 2011, the health department itself estimates that it needs to increase this to 3000 by 2011.

At the same time, research has shown that doctors and nurses were often not trained to work in primary health settings or to deal with the changing health demands.

Lehmann recommends a comprehensive audit of health science curricula to see whether health professionals, particularly nurses, ‘€œare prepared to address the changing burden of disease and to function effectively in primary and community care settings’€.

She calls for more mid-level workers and community health workers to be trained and for their training to be standardised.

Meanwhile, only one in three registered doctors are in the public sector, while less than half professional nurses are in the public sector.

Although some 6 500 psychologists are registered with the HPCSA, less than 450 work in the public sector. Over 5000 dentists are registered but fewer than 750 work in the public sector.

In the Northern Cape, there is only one psychiatrist for all five million people who depend on the public health sector.

The Eastern Cape has the fewest pharmacists, with 3 per 100 000 people.

Although the number of African doctors has more than doubled in the past eight years (to 5 564), there are still three times as many white doctors (15 744).