Theresa Smith & Di Caelers
10 October 2003
The government has come in for renewed attack by the South African Medical Association - this time over stringent rules for doctors setting up new private practices.
The association and its head, Dr Kgosi Letlape, have likened the proposed legislation - called a Certificate of Need - to the apartheid laws that governed where people could live. "This is another form of the Group Areas Act where influx control was practised, so we're back to the 'good ol' days'," Letlape said yesterday.
Doctors in existing practices will be issued with certificates which will last 20 years. If there is a change of ownership in the practice, or a new doctor wishing to practice in a specific area, there has to be an application to the department of health for a Certificate of Need to be issued.
Last month doctors from across the country launched a scathing attack on the government over the lack of hospital infrastructure, top-heavy administrations and poor salaries and working conditions.
The state countered that it was serious about retaining doctors in South Africa, and had tasked a special team with coming up with solutions.
Harry Mchunu, the department of health's director of media liaison, said the health system it had inherited from the previous government continues to be distorted by apartheid planning ideology. He said this had resulted in a "relative preponderance of health facilities and health professionals in urban areas and woeful neglect of the population living in rural areas".
The Certificate of Need was one of the ways the department is introducing to change the "inequitable distribution of health resources".
The association has turned its attention to the controversial Certificate of Need, already approved in the National Health Bill by the national assembly, saying it directly contravenes patients' constitutional right of access to health care services.
"A patient will not be able to be treated by a doctor of his or her choosing," the association charged.
The department's legislation requires that doctors apply for a certificate before establishing a practice, or joining an existing one. These certificates will be issued by its director-general, who can choose whether or not to renew or issue the certificate. Mchunu said the bill would also set out an appeals process.
"South Africa is about democracy, but the (certificate) is all about authority and infringing on the constitutional rights of doctors and patients in this country," Letlape said.
Mchunu said the association was missing the point of the department introducing the Certificate of Need as "a mechanism to redress the allocation of health resources of the past".
"Its intention is to encourage the spread of health services into underserved areas. It is also aimed at ensuring that we do not have an over-supply of health services in one area that might, in the end, contribute to over-servicing and exorbitant health costs," said Mchunu.
While the association agreed that the distribution of doctors in the country needed addressing, they said the way chosen by the health department would cause "utter chaos" in an already over-burdened health care system.
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