Updated 10 June 2014

SA doctors need not panic over 'certificates of need'

A compulsory 'certificate of need' has been signed into law to encourage doctors to only open practices in underserved places such as rural areas and townships.


Doctors do not need to panic about being forced to work in places where they do not want to, according to the Department of Health.

This follows an outcry last week after it emerged that President Jacob Zuma had signed into law a proclamation that makes it compulsory for all health establishments to get a "certificate of need" within the next two years in order to operate.

The intention of such certificates is to encourage doctors to only open practices in underserved places such as rural areas and townships.

The importance of certificate of need

But Health Department spokesperson Joe Maila assured doctors on 3 June that "nothing is going to be unilateral", adding that it would be "unconstitutional" for government to force doctors to work in places where they did not want to.

"The regulations governing the certificates of need have still to be made, and the Director General has just started the process of consulting with all affected parties," said Maila.

"We need to find creative ways to increase people's access to health care services together, but nothing will be done without full consultation," he told Health-e News.

Read: Female doctors are better

The South African Medical Association (SAMA), which represents doctors in the private and public sectors, has raised "serious concerns" about the certificate of need, which will become compulsory in April 2016.

"It can be questioned whether the unfettered control afforded to the Director General of Health over the health industry in respect to this 'licensing requirement' for health establishments is a justified limitation on the economic and professional rights of medical professionals," said SAMA Chairperson Dr Mzukisi Grootboom.

SAMA is also concerned that the proclamation, which now forms part of the National Health Act, even requires existing health establishments to get a certificate of need. Operating without such a certificate is a criminal offence that could result in a five-year jail term.

Not enough in rural areas

However, Marije Versteeg-Mojanaga, Director of the Rural Health Advocacy Project, said both a carrot and a stick approach was needed to address the inequities in access to health services experienced between rural and urban areas.

"Under the National Health Insurance (NHI) system, it will be essential to have certificates of need, otherwise we will continue to have a mushrooming of health facilities in urban areas and not enough in rural areas," said Versteeg-Mojanaga.

Read: NHI: economic suicide for doctors?

"If doctors want to open new facilities and expect to get NHI patients (paid for by a government NHI Fund), they should prove that such facilities will reach under-served communities," she told Health-e News.

However, Versteeg-Mojanaga said aside from the "stick" approach, there should be "incentives to encourage health workers to go to rural areas".

"Research shows that graduates from rural areas are more likely to go back and serve their communities, so perhaps government should consider offering interest-free loans to such graduates to start up rural practices," she added.

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Economic downturn – fewer visits to the doctor

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