Address by Deputy President Thabo Mbeki
at the Opening of the 48th General Assembly of the World
Medical Association (WMA) 25 October 1996
Dr Moulin, President of the WMA
Ladies and Gentlemen
It gives me great pleasure to address this important
gathering and to welcome all of you to Cape Town and
to South Africa. I hope that the weather has been kind
and that you will return to your countries as strong
advocates of Cape Town's bid for the Olympic Games in
We are delighted that you chose South Africa as the
venue for your Congress this year, and would like to
thank the Medial Association of South Africa (MASA)
for hosting this event.
I suspect that one of the reasons the WMA has chosen
to come to South Africa for its General Assembly this
year is the transformation that has taken place in this
country over the past few years. Understandably, many
people want to come and see these changes for themselves
and to celebrate with us. We ourselves are keen to share
our experiences and our new freedom with others, especially
in the light of the great contribution that the peoples
of the world made to the struggle against apartheid.
The medical profession in South Africa has been part
of the process of transformation, and many individuals
and organisations have made positive contributions to
the process, but the medical profession cannot sit back
now and think that it has done all that is required
In June 1995, the Medical Association of South Africa
(MASA) adopted a resolution of "unreserved apology
to persons - within and outside the medical profession
- who might, in the past, have been hurt or offended
by any acts of omission or commission on its part in
In his statement, the Chairperson of the Federal Council
of MASA mentioned some of the issues on which MASA has
remained silent and had been insensitive and indifferent,
and went on to commit MASA to broadening access to quality
health care for all the people of South Africa.
It was an important announcement and MASA deserves
credit for having made it.
The point was also correctly made that the motion should
be a beacon pointing the way to the completion of our
transition. Indeed, much work remain to be done merely
to deal with the legacy of the past.
UNITY IN THE MEDICAL PROFESSION
One of these is represented by the need for South African
doctors to come together to form one single association
to represent them in the World Medical Association and
other fora. We welcome the steps that have been taken
to realise this objective.
The challenge facing those of us working for unity
in the medical profession will be to create a body which,
like the World medical Association, has as one of its
prime objectives "to strive for the best possible
health care for all". The united medical association
we are working towards, should be seen by the public
as promoting the public interest, and not merely the
narrow interests of its members.
MIGRATION OF DOCTORS
Yet another challenge facing South Africa, is one that
faces many other countries, and one which the World
Medical Association is well positioned to address. This
is the issue of migration of doctors, who, as well all
know, are very expensive to produce.
South African doctors have, for many years and for
various reasons, been leaving South Africa to work in
other countries. Recently, we have suffered from the
aggressive recruiting campaigns by organisations in
relatively wealthy countries, who find it much cheaper
to buy individual doctors from South Africa than to
train sufficient of their own citizens as medical graduates.
At the same time, since we began our transition process,
many more doctors from poorer countries have sought
to come to this country. In October 1994, six months
after our first democratic election, there were 700
doctors with foreign qualifications, many of them working
in neighbouring countries, who sought registration in
However, we believe that it is not appropriate for
us to deprive out neighbours in SADC of their doctors.
We have therefore placed a moratorium on registering
doctors with foreign qualifications, unless they are
genuine political refugees, or there is a formal agreement
with their own government.
What we are saying, in essence, is that doctors are
a valuable resource in any country, and we do not wish
to plunder the resources of our neighbours, particularly
if their need is as great, or even greater, than ours.
But, of course it is difficult for a developing country
such as South Africa to maintain such a policy in the
face of very different policies in richer countries.
The World medial Association, has an avowed aim of
striving for the best possible health care for all.
The WMA also has experience of developing international
declarations on difficult ethical issues affecting doctors.
The challenge that I would like to throw to the WMA
today, is to develop an international declaration on
the issue of medical migration.
COMPETING IN THE GLOBAL VILLAGE
We recognise the fact that migration of doctors from
poorer countries to richer countries is one of the consequences
of competition within the global village. That competition
also focuses on the important question of the economy.
Effective measures that promote and protect the health
of all citizens, and good health care for those who
do fall ill, are not only desirable social goals. They
are also an important factor for economic development.
The World Development Report, published by the World
Bank in 1993, makes this point very strongly.
Although doctors are not the only players in health
provision, they nevertheless have important roles to
play, both as clinicians and managers of health services.
It is important that doctors in any country that is
competing in the global village are skilled, are able
to handle responsibly the very powerful diagnostic and
therapeutic tools and medicines that are now available,
and that they have some experience of how the different
components of the health services function.
South African is at present exploring ways of implementing
effective post graduate vocational training and continuing
medical education as two complementary ways of ensuring
that South African doctors remain in the forefront of
medical practice. If we can succeed in this regard,
this will be an important contribution reinforcing our
competitive edge on the world stage, with the necessary
longer term impact on the provision of healthy contributors
to a vibrant and modern South African economy.
The same arguments will apply to any other country.
Since the WMA and its constituent national associations
wish to fulfil their objective of "striving for
the best possible health care for all", it may
be that we should explore the economic benefits of better
health services, and which services produce the greatest
benefits. Armed with this information, you will be in
a strong position to support your Ministries of Health
and to argue for greater resources for appropriate health
In conclusion, may I wish you well in your deliberations
over the next two days, and for the implementation over
the next year of the decisions that you take.
May the people who need health care most, the poor
and the least powerful in our societies, benefit from