At many state hospitals, those on medication can wait up to four days for their medicine, while hospital authorities struggle desperately to fill vacant pharmaceutical posts, with applicants few and far between.
The head of Pharmaceutical Services in KwaZulu-Natal's Department of Health, Cyril Tshabalala, said there were 1 254 posts for pharmacists vacant in the province, but this should be seen in context.
He explained that whereas there had previously been 770 posts available to pharmacists, last year a decision was taken by the department to more than double this figure, to cope with the HIV crisis and general demand for their services.
| 'Some decide to leave the country before doing their year of community service' |
As departments of health in each province are struggling to attract applicants, the Sunday Tribune attempted to establish if there had been a decline in those wanting to enter this sector of the medical field.
According to Andy Gray, senior lecturer at the Department of Therapeutics and Medicines Management at Nelson Mandela School of Medicine, Durban, some pharmaceutical schools had seen a reduction in the number of students, but this was not a countrywide phenomenon.
At the University of KwaZulu-Natal the number of applicants far exceeded the spaces available, said Grey.
At present they were taking about 80 new applicants into the four-year programme each year. Of these, about 60 would graduate.
| 'Free State is one of the hardest hit in this field' |
"Some decide to leave the country before doing their year of community service and many students from neighbouring states go back there to do their internship and don't enter the profession in this country," said Gray.
He believes that of the 10 824 on the register of pharmaceutical practitioners, only about 9 000 are actually working here.
Of these, only 1 746 are employed in the public sector, although 80 percent of the country's population is dependent on their services.
"There's a maldistribution of pharmacists, with too few in the public sector for the number of patients they need to attend to.
"At the entry level some hospitals get no applicants. The Eastern Cape repeatedly advertises posts, but has few takers," said Gray.
Barbara Raftesath, President of the South African Association of Hospital and Institutional Pharmacists, said it had always been difficult to get health care professionals in the rural areas.
She believes the Free State is one of the hardest hit in this field.
Trying to get a precise breakdown of the salary differences between the private and the public sector had also proved almost impossible because these differed not only from province-to-province, but also at individual hospitals within a province.
"There is also no uniformity between private hospitals," said Raftesath.
She pointed out that at Level 8 (an entry grade post) the public sector received very few applicants.
At higher levels, where salaries were more on a par with the private sector, positions were easier to fill.
The department of public services is apparently restructuring health workers' salaries in the public sector to attract and retain more health workers.
No time frame had been given as to when this would come into effect, but action was not expected before mid-2007, said Gray.
The department of health's human resource plan had also not committed to specific staffing norms, so the number of pharmacists needed remained unknown at this stage, said Gray.
It has been suggested that locums could fill the void and Raftesath said in the Western ape many locums and retired pharmacists were being used effectively.
The official policy on locums also differed from province-to-province and hospital-to-hospital, with those in charge deciding what they could afford to pay them.
Gray said KwaZulu-Natal relied heavily on locums. Tshabalala said the department paid the going rate for locums - which varied from R90 to R120 an hour, depending on the area.
Obviously, a city hospital would pay more than one in a rural area.
He said pharmacists from the private sector often volunteered their services and believed that some young pharmacists also chose to act as locums, rather than take on full-time employment, finding this a more lucrative route.
The bulk of locums were, however, retired.
Durban's Vere Randles, a retired pharmacist, painted a different picture.
He said he would be happy to do locums and knew of other retired and semi-retired pharmacists willing to fill the void in the public sector, but felt the province's Department of Health was averse to using their services.
Randles did a stint of 17 months at KwaDabeka Community Health Centre, a very busy peri-urban facility.
He said he was due to fill in at a clinic in the Inchanga area, but, because there was no full-time pharmacist and policy dictated that locums may not work alone, this fell through.
"Locums are restricted to working six hours a day to ensure their earnings do not exceed those of a full-time worker," said Randles.
"Many young pharmacists also use the public health sector as a stepping stone, so do not stay long in a position."
Aisha Suleman, a research pharmacist attached to the Reproductive Health Research Unit (a Wits structure with a Durban office), cited salary discrepancies as the major reason.
"The newly qualified community service pharmacists are leaving the public sector for the private sector in droves," said Suleman.
"The public sector is offering them about R130 000 a year and the private sector about R200 000."
Another problem, she said, was the major shortage of pharmacists able to give adherence counselling to patients on anti-retrovirals.
As the struggle to fill posts continues, desperately short-staffed pharmacists in hospitals around the country try to cope with an ever-growing mountain of patients' prescriptions, often under the most trying circumstances as angry patients clamour for their medication.
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