By Myrtle Ryan & Melanie Peters
The long wait in queues for medication at public hospitals is a bitter pill to swallow for thousands of people, but there appears to be no short-term solution.
At some state hospitals the sick, the elderly and those on chronic medication can wait up to four days to have their medication dispensed, while hospital authorities struggle to fill vacant pharmaceutical posts.
The Western Cape appears to be better off than the other provinces, with around 50 of the 328 posts not filled. This compares with a shortage of 1 254 pharmacists in KwaZulu-Natal out of a total of 1 592 posts.
Miranda Anthony, spokesperson for the provincial department of health, said there were shortages throughout the country. "The main reason is the salary structure in the public service, which is not competitive with the private sector. This (sector) has grown in recent years and absorbed the majority of pharmacists."
This led to long queues in hospitals and frustrated patients. There was also a shortage of experienced pharmacists to train interns coming through the system.
The head of Pharmaceutical Services in KwaZulu-Natal's Department of Health, Cyril Tshabalala, said there were 1 254 pharmacy posts vacant in the province, but that this figure should be seen in context. Previously there had been 770 posts, but in 2006 it was decided to double the number of posts to cope with the HIV crisis and the general demand for their services. This meant there were now 1 592 positions, of which only 338 had so far been filled.
Although hospitals in all provinces are struggling to fill pharmacy posts, there does not appear to have been a reduction in the number of new pharmacy graduates. Andy Gray, senior lecturer in the department of Therapeutic and Medicines Management at Nelson Mandela School of Medicine in Durban, said while some pharmaceutical schools had seen a reduction in the number of students, this was not a countrywide phenomenon.
Between 350 and 400 pharmacists qualify in South Africa each year, but attrition of graduates had to be taken into account, said Gray. "Some decide to leave the country before doing their year of community service and many students from neighbouring states go home to do their internship and don't enter the profession in this country."
It was difficult to say how many pharmacists remained in the country, as many were registered here while working overseas, or not practising at all. He said of the 10 824 on the register of pharmaceutical practitioners, only about 9 000 were actually working here. Of these, only 1 746 were employed in the public sector, although 80 percent of the country's population was dependent on their services.
"There's a poor distribution of pharmacists, with too few in the public sector for the number of patients they need to attend to," said Gray. The allowance paid to people with scarce skills or to those prepared to work in rural areas had made a difference in some provinces, but in others this was not the case.
"At entry level some hospitals get no applicants. The Eastern Cape repeatedly advertises posts, but has few takers," said Gray.
Barbara Raftesath, president of the SA Association of Hospital and Institutional Pharmacists, said it had always been difficult to get healthcare professionals to work in the rural areas, and the Free State had been hit particularly hard.
Trying to get a precise breakdown of the salary differences between the private and the public sector had also proved almost impossible, as these differed not only from province to province, but also at individual hospitals within the province.
"There is 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 understood to be restructuring health workers' salaries in the public sector to attract and retain more health workers. No timeframe has been given as to when this will come into effect.
Aisha Suleman, a research pharmacist attached to the Reproductive Health Research Unit (a University of the Witwatersrand structure), cited salary discrepancies as the major reason for the shortage of public service pharmacists.
"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, such as Clicks, about R200 000."
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