The KwaZulu-Natal health department expanded its registrar programme in 2019 from 314 to 414, but aimed to fill the 100 new posts with only black candidates.
Some called this discriminatory, unconstitutional and racist, but the provincial health department said it was “unapologetic about addressing these imbalances of the past”.
“South Africa, including KwaZulu-Natal, remains an unequal society with limited opportunities for self-development for those who were historically oppressed,” departmental spokesperson Ncumisa Mafunda said.
According to leaked departmental communication, the department wanted to train 366 black, 32 Indian, 12 white and four coloured registrars to meet employment equity targets. The registrar programme trains doctors to become specialists over four years.
“This means 238 posts must be filled with Africans to take the current 128 filled posts to the target of 366. This implies that the 100 new posts must go to Africans in terms of the targets, else if there are no suitable Africans, the posts must be re-advertised.”
Registar steering committee chairperson Bongani Shezi signed off the targets on September 17 2018 and alternate registrar steering committee chairperson Dr Thandeka Khanyile on September 3 2018.
The leaked communication said the provincial health department may deviate from targets, with the necessary approval, if it could not find a candidate, but “this is not recommended from the department”.
Mafunda confirmed the internal communication.
The provincial health department said on its website that doctors had to leave registrar positions after four years, “irrespective if they have completed their examinations or not”.
“This is to ensure that the new group of registrars can be appointed so that the potential pool of specialists grows.”
South African Medical Association (Sama) KwaZulu-Natal chairperson Dr Zanele Bikitsha said they were pro-transformation if it did not compromise service delivery.
“A post can’t be kept simply because there are no Africans, because that will affect service delivery directly,” Bikitsha said.
“It’s not just simply about filling the numbers. You need to identify what is the problem, what is the cause of African scholars not succeeding through colleges? You need to look at what is happening in terms of the college itself.”
Bikitsha said there were insufficient graduates to meet equity requirements and the ideal would be sufficient government funding to train all applicants.
“If the DOH (national health department) had more funding, we would be able to give more posts.”
Bikitsha was concerned about the number of registrar posts for specialists in oncology, urology and nuclear medicine.
“Those are crisis areas. Those are departments that are supposed to be resuscitated, so you need to be worried why are the recruitment numbers so low that side.”
Medical Rights Advocacy Network (Meran) member Mary de Haas said, in her personal capacity, that historical redress was necessary, but the approach was discriminatory and unconstitutional.
“I think it is a very bad way of doing it.”
De Haas blamed the DOH’s mistakes for the 2019 targets.
“It [DOH] spent money sending students to Cuba instead of building local capacity, which would have sorted this out years ago.”
She said the department should choose above-average students at postgraduate level.
“It’s not really fair to sideline people who have done extremely well.”
De Haas believed spending more on training and headhunting the best medical personnel to head up new medical schools was the solution.
“If you are training more registrars, you would be able to train more black registrars without discriminating against the other worthy ones.”
Democratic Alliance KwaZulu-Natal health spokesperson Dr Imran Keeka said a policy which “causes the domination of one race over the other by exclusion is nothing more than an aberration of our constitutional values and is racist”.
“Any form or attempt to redress the injustices of the past must ensure that we remain committed to what our constitution says… There must be no exclusion, especially based on the colour of our skin.”
Keeka said the DA would consider suing the provincial health department if it deviated from these rights.
Mafunda said historical redress was a government imperative and “the morally and socially right thing to do”.
“After difficulties were experienced in recruiting black African candidates for these posts, a deviation was sought from the accounting officer and, out of a total of 77 registrar posts, 21 posts will be offered to non-Black Africans,” Mafunda said.