Frustrated Free State doctors face unemployment after Cuban medical training in systemic crisis

Daily Maverick

27-06-2025

A cohort of young doctors whose training was funded by the Free State government through the Nelson Mandela-Fidel Castro Bursary programme have been unable to find work in the public health sector upon completing their community service, despite a contractual obligation to serve the province that supported their studies.
More than 20 young doctors from the Free State who received training in Cuba through the Nelson Mandela-Fidel Castro (NMFC) Bursary programme, funded by the provincial health department, have been unable to find work in the public health sector due to a lack of posts.
Across South Africa, provincial health departments provide funding for individuals from their respective regions to study medicine through the NMFC Bursary programme. Upon returning from Cuba and completing their internship, beneficiaries are required to serve their local government in the health sector for the number of years for which they were funded.
However, about 24 Free State NMFC Bursary holders who completed their community service requirement over the past year have not been able to fulfil their contractual obligation to continue working in the province's public sector, according to *Thabo, a beneficiary of the programme who chose to remain anonymous out of concern for backlash.
'We've been to the [health] MEC's office. We've been to the premier's office. We've spoken with the [head of the Free State health department], and no one seems to be taking accountability. It's just one person bouncing you to the next person… and there's no real sense of urgency about what's happening on the ground in the hospitals, with the [staff] shortages, the patients or even us, as their investments,' he said.
Waiving obligations
The cohort of NMFC Bursary beneficiaries sent a memorandum of demands to the Free State premier and MEC for health in January, pushing for immediate appointments in local health facilities.
In a letter responding to this memorandum, seen by Daily Maverick, head of the Free State health department Masechaba Sesing stated: 'It is true that the bursary policy places a contractual obligation on both parties to either offer employment to bursary holders upon completion of their studies, provided that there are vacant funded posts in the department, and on the bursary holder to work back the bursary for the period of the bursary granted, should the department offer a post within three months from date of completion of the studies.
'Should the department not be in a position to offer employment within three months from date of completion, the bursary holder is released from the bursary obligation.'
Thabo claimed that the three-month limit on the state's obligation to employ post-community service bursary holders was a new development, not featured in beneficiaries' original contracts.
In a second letter from the NMFC Bursary cohort, addressed to Sesing and dated 7 March 2025, the graduates entreated the provincial health department to find a strategy to retain them in the public sector.
'For [the] Free State, each graduate costing approximately R1,137,500 to R1,750,000 is a tailored asset to address our province's dire healthcare gaps. Yet, without a robust retention strategy, we risk losing these doctors to urban centres or other provinces, undermining… the province's investment, the ANC mandate and the vision of Mandela and Castro,' stated the letter.
Thabo claimed that the Free State health department had not advertised any positions for young, post-community service doctors since January.
Driving away assets
It's not only NMFC Bursary holders who are struggling to get public sector posts, but also those from other state-funded bursary programmes that support medical training in Russia, China and South Africa, according to Thabo.
'We're adults now — some of us have families, some of us are married, some of us have kids. Even if you have savings and you're projecting that for at least three months you'll be okay… then three months pass by and there's still nothing,' he said.
'With the number of unemployed post-community service medical officers, you can only imagine how many of us are looking for work.'
The situation had taken its toll on the mental wellbeing of graduates, said Thabo, with many experiencing depression and anxiety.
'You become hopeful and it gets crushed. You reach out for help and you're treated like… a nobody, like you don't have any value… And you know the skillset you possess, you know the impact you make,' he said.
'You hear from your colleagues [in the public sector]… how overwhelmed they are, and you have the ability to help, but you can't because you're not in the system.'
Since completing his community service last year, Thabo has found work outside the Free State in the private sector. However, he noted that the large number of young doctors flocking to private facilities increased the likelihood of exploitation.
'The issue with private, now, is… they know we're unemployed, we're desperate. Instead of giving us the rate per hour that they normally give, they reduce it because they know we'll take whatever we can get. So, it's tough financially,' he said.
'I'd love to come back home [to the Free State]. There's so much potential. We're running behind on so many things — the infrastructure, the development. I'd like to be there and be able to contribute to the primary healthcare system in general… But if I'm not allowed the opportunity, then obviously self-preservation is going to come into play.'
Free State Department of Health
Mondli Mvambi, the spokesperson for the Free State Department of Health, acknowledged that there were graduates of the NMFC Bursary programme that the department hadn't been able to employ.
'The necessary human resources processes must be followed in appointing the students. Posts must be advertised and each person [has] to apply. The department does not get enough funding from the Division of Revenue to meet all its human resources and other pressing service delivery needs,' said Mvambi.
'The department has commenced the process to identify savings within the Compensation of Employees' budget to identify posts that can be filled within the [Medium-Term Expenditure Framework] period.'
If the Free State Department of Health is unable to employ bursary beneficiaries within three months of them completing their studies, the young doctors are permitted to 'ply their trade' in other provinces, the private sector, the national Department of Health or overseas, according to Mvambi.
'This [NMFC Bursary] programme contributes immensely to the human resources development strategy of the country… The role of the state is… to create an enabling environment, and training is one such enabling environment. The creation of employment opportunities is beneficial to the development needs of all our provincial citizens, South Africans, Africans and the international community,' he said.
Broader challenges
The Free State is not the only province struggling to provide posts for state-funded bursary holders who have completed their community service requirement.
Dr Percy Mahlathi, deputy director-general for hospital services and human resources in the national Department of Health, told Daily Maverick that the department was 'fully aware' of the issue.
'It is not limited to students who were studying overseas or in Cuba. Even those who are studying in our own medical schools, funded by the various provinces, are facing the same challenge,' he said.
Health officials, including the current and previous ministers of health, have engaged with the National Treasury about prioritising doctors who have just completed their community service, according to Mahlathi. However, he noted that employing these young professionals after internship and community service was not a statutory obligation.
'The moral obligation is there, but a contractual obligation is no longer there. I'm saying moral obligation because when you've got such a huge… patient load in the public health system, you would like to have… as many health professionals as possible. But the problem we then have is: When you don't have enough financial resources, what do you do?' said Mahlathi.
Processes around the budget that was tabled on 21 May have yet to be finalised in Parliament. Once complete, Mahlathi said he hoped there would be a funding allocation that would allow the health departments to employ 'most, if not all' the doctors who had recently completed their community service.
'I do know that once the provinces get funding allocations, they are going to prioritise those who they have funded to study… I know when you are a doctor out there, funded or not, you want a job, but if we look from the public value point of view, there's been an investment in those who are given bursaries, and therefore they should be prioritised,' he said.
At this stage, Mahlathi was unable to confirm when budget allocations would allow for the employment of post-community service doctors, or how many young professionals would receive opportunities. He estimated there were close to 1,300 such doctors awaiting employment.
'With all these ups and downs with the budget… it actually became a serious problem for the provinces. Very few people were able to be employed,' he said.
The national Department of Health had asked provincial health departments to work on 'various scenarios' pending the finalisation of funding allocations in the budget, according to Mahlathi.
'They must work out the scenarios so that they don't wait until the allocation lands to start doing the technical work. That's what they are busy with now,' he said.
Mahlathi said he was against any changes to the country's bursary programmes for medicine, such as a reduction in the number of beneficiaries.
'There are young, brilliant minds of all races that would not be able to study if they did not have that bursary… I don't think it would be a good idea for governments to say, 'Look, we don't have money now, we're going to stop educating South Africans', because we will feel a terrible impact in about eight to 10 years, when we've actually got less [graduates],' he said.
Dr Aslam Dasoo, the convenor of the Progressive Health Forum, said unemployed graduates of the NMFC Bursary programme were 'organising themselves', and that the forum had reached out to them.
'The bursary is underwritten by the state and the forum will support their stance on the bursary being written off, provided [the graduates] take up positions in the public service for a specified period when posts become available,' said Dasoo.
'It's really the inchoate health department and its political heads who are the obstacle here.' DM