The rights of graduate medical practitioners and reforming community service non-placements
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i6.3094Keywords:
Community service exemption, Medical graduate placement, Health Professions Act, HPCSA regulations, Constitution, Labour rights, Law, Labour law, Policy reformAbstract
South Africa’s public healthcare sector faces a severe shortage of medical practitioners, exacerbated by the failure to place newly qualified graduates in internship and community service positions. Despite the country’s urgent need for doctors, many graduates remain unplaced each year, preventing them from practising independently. This article proposes a legislative reform to address these challenges. Currently, the Health Professions Act 56 of 1974 mandates a compulsory year of community service for medical graduates before full professional registration. However, systemic placement failures result in many graduates being left in limbo, unable to work in either the public or the private sector. The article advocates a legally recognised exemption from community service for medical graduates who remain unplaced for more than 3 months after completing their internship. The proposed amendment to the Health Professions Act would enable these individuals to enter private practice or pursue further specialisation, ensuring that trained professionals are not lost to bureaucratic inefficiencies that infringe on their labour rights.
References
1. Matseke MG. Taking stock of the healthcare workforce in the public health sector of South Africa during Covid-19: Implications for future pandemics. Afr J Public Sector Dev Gov 2023;6(1):59-76. https://doi.org/10.55390/ajpsdg.2023.6.1.5
2. Yoganathan V. Junior doctors still unplaced for community service, Juta Medical Brief, 21 June 2023. https://www.medicalbrief.co.za/junior-doctors-still-unplaced-for-community-service/ (accessed 16 January 2025).
3. LudolphN,KuneneZ,MalanM.Thisiswhythehealthdepartmentcannotemploynewdoctors.Business Day, 7 February 2024. https://www.businesslive.co.za/bd/national/health/2024-02-07-this-is-why-the- health-department-cannot-employ-new-doctors/#google_vignette (accessed 15 January 2025).
4. Statistics South Africa. General Household Survey 2021. Statistical release P0318. Pretoria: Stats SA, 2022. https://www.statssa.gov.za/publications/P0318/P03182021.pdf (accessed 16 January 2025).
5. George G, Quinlan T, Reardon C, Aguilera J-F. Where are we short and who are we short of? A review of the human resources for health in South Africa. Health SA Gesondheid 2012;17(1):a622. https:// doi.org/10.4102/hsag.v17i1.622
6. World Health Organization. Global Health Observatory data repository. 2022. https://www.who.int/ data/gho/data/themes/topics/health-workforce (accessed 16 January 2025).
7. National Department of Health, South Africa. 2030 Human Resources for Health Strategy: Investing
in the health workforce for universal health coverage. October 2020. https://www.health.gov.za/wp-
content/uploads/2023/06/2030-HRH-Strategy-Final.pdf (accessed 27 May 2025).
8. Minnaar K. Severe doctor shortage in South Africa. Daily Investor, 14 January 2025. https://dailyinvestor.
com/south-africa/73722/severe-doctor-shortage-in-south-africa/ (accessed 16 January 2025).
9. South Africa. Health Professions Act 56 of 1974. https://www.gov.za/sites/default/files/gcis_
document/201505/act-56-1974.pdf (accessed 17 January 2025).
10. South Africa. Health Professions Act 56 of 1974. Regulations Relating to the Registration and Training
of Interns in Medicine. Government Gazette No. 25938, 23 January 2004. Published under government notice R.57. https://www.gov.za/sites/default/files/gcis_document/201409/259380.pdf (accessed 17 January 2025).
11. Erasmus N. Slaves of the state – medical internship and community service in South Africa. S Afr Med J 2012;102(8):655-658. https://doi.org/10.7196/SAMJ.5987
12. Bola S, Trollip E, Parkinson F. The state of South African internships: A national survey against HPCSA guidelines. S Afr Med J 2015;105(7):535-539. https://doi.org/10.7196/SAMJnew.7923
13. Reid S. 20 years of community service in South Africa: What have we learnt? In: Rispel LC, Padarath A, eds. South African Health Review 2018. Durban: Health Systems Trust, 2018:41-50. https://www. hst.org.za/publications/South%20African%20Health%20Reviews/Chap%205%2020%20Years%20 Community%20Service.pdf (accessed 18 January 2025).
14. South Africa. Basic Conditions of Employment Act 75 of 1997. https://www.gov.za/sites/default/files/ gcis_document/201409/a75-97.pdf (accessed 17 January 2025).
15. South Africa. Labour Relations Act 66 of 1995. https://www.gov.za/sites/default/files/gcis_ document/201409/act66-1995labourrelations.pdf (accessed 17 January 2025).
16. South Africa. Basic Conditions of Employment Act 75 of 1997. Determination: Earnings threshold. Government Gazette No. 52232, 7 March 2025. Published under government notice R.5970. https://www. gov.za/sites/default/files/gcis_document/202503/52232rg11806gon5970.pdf (accessed 22 May 2025).
17. South Africa. Constitution of the Republic of South Africa, 1996. http://justice.gov.za/legislation/ constitution/SAConstitution-web-eng.pdf (accessed 17 January 2025).
18. South Africa. Health Professions Act 56 of 1974. Regulations Relating to the Performance of Community Service by Persons Registering in Terms of the Health Professions Act. Government Gazette No. 18890, 15 May 1998. Published under government notice R.982. https://www.gov.za/sites/ default/files/gcis_document/201409/33691982.pdf (accessed 17 January 2025).
19. National Department of Health, South Africa. Health Professions Council of South Africa. Regulations Relating to the Registration of Students, Undergraduate Curricula and Professional Examinations in Medicine. Government Gazette No. 31886, 19 February 2009. Published under government notice R.139. https://www.gov.za/sites/default/files/gcis_document/201409/31886139.pdf (accessed 17 January 2025).
20. Purbrick GM, Morar T, Kooverjee J. Burnout among community service doctors in South Africa. Afr J Prim Health Care Fam Med 2024;16(1):4436. https://doi.org/10.4102/phcfm.v16i1.4436
21. Provincial Minister for Local Government Western Cape v Oudtshoorn Municipal Council & Others 2015 (6) SA 115 (CC) at par [14].
22. Albertyn C, Goldblatt B. Equality. In: Woolman S, Bishop M, eds. Constitutional Law of South Africa. Chapter 35. Cape Town: Juta & Co., 2018.
23. Harksen v Lane NO and Others (CCT9/97) 1998 (1) SA 300 at paras 40 & 60.
24. Affordable Medicines Trust and Others v Minister of Health and Another (CCT27/04) [2005] ZACC 3. 25. Reid SJ, Peacocke J, Kornik S, Wolvaardt G. Compulsory community service for doctors in South
Africa: A 15-year review. S Afr Med J 2018;108(9):741-747. https://doi.org/10.7196/SAMJ.2018.
v108i9.13070
26. S v Makwanyane and Another (CCT3/94) [1995] ZACC 3.
27. Sonderup M, Panieri E, Pillay S, et al. Reforming healthcare training: Ending the compulsory
community service policy. S Afr Med J 2024;114(12):e2812. https://doi.org/10.7196/SAMJ.2024.
v114i12.2812
28. International Labour Organization. ILO Forced Labour Convention, 1930 (No. 29). https://www.ilo.
org/media/21026/download (accessed 18 January 2025).
29. United Nations General Assembly. International Covenant on Economic, Social and Cultural Rights.
United Nations, Treaty Series, vol. 993, p. 3, 16 December 1966. https://www.ohchr.org/sites/default/
files/cescr.pdf (accessed 18 January 2025).
30. South Africa. Occupational Health and Safety Act 85 of 1993. https://www.gov.za/sites/default/files/
gcis_document/201409/act85of1993.pdf (accessed 18 January 2025).
31. Schütz E. In-depth: SA’s perennial problems with placing community service doctors. Spotlight,
2 August 2021. https://www.spotlightnsp.co.za/2021/08/02/in-depth-sas-perennial-problems-with-
placing-community-service-doctors/ (accessed 16 January 2025).
32. Yoganathan, V. Unplaced junior doctors freed from Gauteng government contracts. Juta Medical Brief,
22 February 2023. https://www.medicalbrief.co.za/unplaced-junior-doctors-freed-from-gauteng-
government-contracts/ (accessed 21 January 2025).
33. George A, Blaauw D, Thompson J, Green-Thompson L. Doctor retention and distribution in post-
apartheid South Africa: Tracking medical graduates (2007-2011) from one university. Hum Resour
Health 2019;17(1):100. https://doi.org/10.1186/s12960-019-0439-4
34. Frehywot S, Mullan F, Payne PW, Ross H. Compulsory service programmes for recruiting health
workers in remote and rural areas: Do they work? Bull World Health Organ 2010;88(5):364-370.
https://doi.org/10.2471/BLT.09.071605
35. Romero-Alvarez D, López-Cevallos DF, Torres I. Doctors for the people? The problematic distribution of rural service doctors in Ecuador. Health Policy Plan 2023;38(7):851-861. https://doi.org/10.1093/ heapol/czad040
36. Wiwanitkit V. Mandatory rural service for health care workers in Thailand. Rural Remote Health 2011;11(1):1583. https://doi.org/10.22605/RRH1583
Downloads
Published
Issue
Section
License
Copyright (c) 2025 D Eloff, C Eloff
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
