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National Assembly Debate on Registration of Foreign qualified Doctors by the HPCSA by Deputy Minister of Health Dr MJ Phaahla

13 March 2018

Thank You Honourable Speaker (Chairperson) for this opportunity to participate in the debate on the "The plight of foreign qualified medical doctors who find themselves ineligible to sit for the Health Professions Council of South Africa board exams because of section 4 of the Regulations to the Act."

Honourable Ministers , Deputy Ministers

Honourable Members .

Let me thank Honourable Narend Singh for bringing this matter for debate.

Honourable Speaker It is common knowledge that the medical profession is one of the scarce skills which is in demand all over the world even much more scarce in developing countries. Because of this medical professionals are often highly mobile with the main pattern being movement from developing , poor countries like ours to move to developed and richer countries especially Europe, New Zealand, Australia and the Americas. It gets even more complicated when you find that even developed countries of the North poach each other`s highly skilled medical doctors. A few years ago while on legislators visit to Canada I came across a young UCT graduate doctor practising in a small town there. I complained to our hosts that they were collapsing our health services by recruiting our young doctors. The host acknowledged that in that area, If it was not for South African doctors their health services would have collapsed. The host then went on to apologise for the negative effect this was having on South Africa but blamed the USA because he said Canadian doctors were being poached by USA.

It is because of this reason that while our training of doctors is in itself not enough we also need to replenish those who seek greener pastures elsewhere. It is for this reason that as South African Health and Higher Education Sectors we need to both:

a)Recruit medical doctors from other countries

b)Find opportunities for young South Africans to go and train as doctors and come back to serve in our country.

Hon. Speaker it is also common knowledge that the medical profession is a very sensitive trade as it deals with the well being of people and therefore about life and death. It therefore makes perfect sense that there should be stringent regulations to protect the population against ill-equipped or even bogus practitioners , even though some still find their way through the system.

Like almost every country in the world, South Africa has over time developed Law and Regulations and set up bodies to oversee the lincensing and supervise the quality and conduct of medical practitioners and intervene where necessary .Our system has evolved over the years, before and after democracy.

Before 1994 we had the South African Medical and Dental Council which did not escape the prejudices of apartheid .

During that period the licensing of foreign doctors to practise in the homelands was less stringent that those who were to touch white patients in the four provinces of Cape, Natal, Orange Free State and Transvaal.

Recognition of foreign qualifications was generally biased towards those from Commonwealth countries.

After 1994 the Health Professions Council of South Africa was established through amendment the previous 1974 act.

Amongst the object of the Act are:

a)To assist in the promotion of the health of the population of RSA.

b)To Protect the public in matters of rendering of health services

c)To uphold and maintain professional and ethical standards .

In terms of the HPCSA Act the council regulates registration of medical doctors through section 24 and 25 of the Act.

Section 24 deals with recognition of medical qualifications from a South African University:

"The Minister may, on recommendation of the council, prescribe the qualifications obtained by virtue of examinations conducted by an accredited University, educational institution or examining Authority in the Republic of SA". This will entitle the holder to registration. This is generally referred to as the holder of a "Prescribed Qualifications".

The problem we are debating today relates to the second category of registration in terms of section 25 of the HPCSA Act.


1)The Minister may , after consultation with the council by regulation provide that any person who holds a qualification which the council may accept by virtue of the fact that such qualification , in the opinion of the council , indicates a satisfactory standard of professional education and training ,may be registered in terms of this section in the applicable prescribed registration category, and thereupon the relevant professional board may in its discretion , but subject to any regulations and national health policy and international protocols which the Minister may make or be subject to , register such person .

2)A professional board may require the person to pass a board evaluation.

3)The Minister may , in consultation with council and relevant board make regulations for imposition of restrictions.

In line with this Section 25, subsection 4 , The Minister gazetted regulations in notice R101 in February 2009.

In terms of these regulations , a foreign qualified graduate in applying for registration must provide amongst others:

a)Certified copy of ID.

b)Copy of degree certificate ,certified by a notary.

c)Certified copy of CV with specified of courses done and practical training.

N.B(c)In case of an application for registration in a profession for which internship training is a requirement , a certificate of completed training as an intern or similar training or experience obtained elsewhere and the programme for such training.

A)Since these regulations were gazetted in February 2009 the practice by the HPCSA and the Medical and Dental Board has been as follows:

a)Doctors who have been recruited from other countries not on a government to government agreement and those who on their own initiative come to South Africa seeking employment were required all the listed documents including proof of having done internship if they claim that have done it in their countries of origin or elsewhere. If they come from a country whose curriculum content is viewed not to be at par with the South African training but otherwise the degree is assessed to be credible, they will then be offered an opportunity to write the HPCSA board exams , for which they will be entitled to three attempts. If they pass the exam then they can be employed in the Public Service for them to go into independent practice they will first need to qualify for South African Citizenship in terms of HPCSA Act.

B)Applicants for registration as medical practitioners by those foreign graduates who are fresh from graduating who in many cases would be South Africans required then to submit the documents mentioned except for proof of internship as it was acknowledged that they had not worked as interns from the countries where they graduated.

The practice of allowing graduates from foreign universities, as long as their degrees were assessed to be credible dates many years back with many graduates from India, Pakistan, Ireland, Uganda, Zimbabwe, Nigeria practising in many hospitals.

Once these fresh graduates pass the Board Exam, they would then be eligible for internship for two years and community service for one year.

The problem started on 20 February 2018 when the HPCSA issued a circular to applicants for the Board Exams which are to sit n May 2018, in which it said that at its meeting of 2 February 2018 the Examination Committee of Council decided to require applicants to posses all requirements including proof of internship completion. Based on this decision then the HPCSA wrote to all applicants who had not completed their internship indicating that their approval letters issued in August 2017 were being rescinded if they had not completed internship elsewhere.

This decision has serious implications as it prevents even South Africans who have just completed their degrees abroad from entering the South African Health Services. The only foreign graduates who will survive are those from Universities abroad which are fully accredited by HPCSA and don`t require board exams which are few.

It is for this reason that the South African Medical Association was already approaching the courts to challenge the decision.

The main problem is that in the past years there were very few South Africans graduating from foreign universities and the regulations were structured to regulate on doctors who had been in service in their countries. By invoking the internship clause the HPCSA was trying to limit the increasing number of new graduates sitting on exam.

In terms government to government agreement between South Africa and Cuba is handled differently as the students come back to complete their final year in a South African University where they go through exams and once they pass final exam with Cuban University are registerable for internship.

The Ministry and Department of Health has engaged the HPCSA on this matter and the agreement for now is that those who had already qualified to sit for the board exam should be allowed to do so. We will then jointly look at options for future which do not compromise quality control while at the same allowing especially South Africans with credible medical qualification an opportunity to be integrated into our Health Services.

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