SA’s jobs crisis is a national disgrace, and we must never normalise it.
Last week the Uber driver who fetched me from an interview with Chester Missing told me he was a medical physicist. He had studied for six years and spent three years in training. He became an Uber driver after more than a year without work, which included interviews for jobs in Australia, Thailand and Namibia. It was his first day at work and I was his eighth client. He had found a job the previous day but it only starts next year.
This heartbreaking story provides further evidence that the skills mismatch theory of unemployment is a fallacy. It illustrates the insanity of austerity and shows that the public sector is too small, not bloated. During the second quarter of the year there were 1.1-million unemployed graduates. If the problem were on the supply side there would have been millions of vacancies. Instead, Stats SA’s latest survey of large industrial companies for May shows that they had spare capacity of 22.4%.
The number one reason was that there was insufficient demand for the things they can produce. Export industries cannot be a significant or reliable substitute for inadequate domestic demand and soaring unemployment. They depend largely on the exchange rate and international demand, which together drive rand commodity prices and account for less than 10% of total employment.
There were 53, 773 doctors in SA in 2024, equivalent to 0.85 per 1 ,000 people, according to the Health Professions Council of SA. The shortfall to achieve the average EU ratio of 4.2 is 211, 000 doctors. According to the department of public service & administration, in January there were 20,000 doctors in the public service serving 53-million people who do not have medical aid cover. This was equivalent to 0.38 doctors per 1,000 people. The shortfall to achieve the EU ratio is 203,000 doctors. SA produced an annual average of almost 2,500 new doctors over the four years to 2024. It has to invest significantly in the training of new doctors and import thousands to close the shortfalls.
In budget 2.0 this year the Treasury allocated an additional R29.9bn to the health budget, part of which would be used to employ 800 post community service doctors. There are about 1 ,500-1,800 unemployed post community service doctors, according to the Bhekisisa Centre for Health Journalism. Budget 3.0 reduced the allocation to R20.8bn, a decline of R8.1bn. It is unclear how many of the 800 community service doctors will be affected by the budget cuts. It will cost an estimated R2bn to employ all post community service doctors. With such huge shortfalls to achieve acceptable doctor-to-population ratios there is no excuse for not making such an investment.
The idea that the public sector is bloated is false. The reasons for collapsing public services are soaring population-to-public sector employee ratios and collapsing public sector investment. From 1994-95 to 2023-24 the number of people per public sector employee increased to 48 from 32. If the ratio had been maintained since the end of apartheid there would have been 600,000 more public servants now.
From 2014-24 real per capita public investment collapsed by 40%. SA cannot make the transition towards National Health Insurance (NHI) in the context of austerity policies. With a strategy to grow the economy, SA can mobilise the resources to reverse the collapse of public services and infrastructure, roll out NHI and employ more public servants, including doctors and nurses.
• Gqubule is an adviser on economic development and transformation.
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