Doctors and nurses aren’t the only health professionals looking for work amid what experts say are cost-cutting measures at health departments. More than 40 clinical associates, the country’s newest class of health workers, are still looking for work, says the Professional Association of Clinical Associates in South Africa (Pacasa).

Clinical associates study for three years to receive a degree in clinical medical practice. During this time, students learn to perform, for instance, physical exams, take patient histories and assist in surgeries.

Countries such as Malawi, Kenya and Uganda use clinical associates to relieve the heavy workloads of doctors and nurses. South Africa began training its first class of clinical associates in 2008 to fill the gap left by a shortage of doctors and nurses in the public service.

Almost 70% of the country’s health professionals work in the private sector, according to 2013 research published in Human Resources for Health journal.

The country’s first school to train clinical associates, Walter Sisulu University, produced about 100 graduates in its first six years.

Despite this investment, Pacasa says that almost half this number of clinical associates are out of work.

Ntombi Mbovu, who chose not to use her real name, studied to be a clinical associate with a bursary from the KwaZulu-Natal department of health and qualified last year. She was due to start work in a public hospital on January 3. But she received a call in December advising her to stay home because the hospital could not afford to pay her.

Mbovu has received job offers in the private sector but her bursary requires her to work in the public sector. She says health department officials have told her she could have to wait until the new financial year to get work.

“They are threatening to sue me if I take any other jobs. How can they sue me when they cannot employ me?” she asks.

In January, Bhekisisa reported that more than 130 pharmacy graduates and almost an equal number of doctors were awaiting appointments at public health facilities. At the time, the Rural Health Advocacy Project’s Russell Rensburg said the delays could be as a result of provincial health budgets being unable to keep pace with spiralling employee costs. Employee compensation now accounts for about 65% of provincial health expenditure, according to a  2016 working paper released by the project.

Health Minister Aaron Motsoaledi later disputed the figures provided by professional associations. He said all medical graduates in need of community service positions or internships had been placed.

Mbovu says clinical associates’ qualms have largely been ignored.

She explains: “The department may be appreciative of us in the public eye but when it comes down to it we are always sidelined. We are treated like the unwanted baby of the health department.”

The national department of health did not respond to Bhekisisa’s questions.

Pacasa chairperson Zukiswa Tshabalala says the national health department has established a task team to deal with the problem but says progress has been slow. She says that clinical associates were not warned that there could be a shortage of positions for them. The scarcity of these posts is particularly bad in the provinces of KwaZulu-Natal, Gauteng and the North West, according to Tshabalala.

KwaZulu-Natal health department spokesperson Samuel Mkhwanazi says unemployed clinical associates will be offered jobs but did not give a time frame for this.

Head of Gauteng health communications Vuyo Sabani says the province is in the process of creating new clinical associate posts. The Limpopo health department maintains the issue should be dealt with by the national department of health.

No other provincial departments of health responded to requests for comment.

Clinical associate and Pacasa academic officer Nabeela Sujee says a shortage of clinical associate posts poses a real risk to patients.

As a clinical associate, Sujee, for instance, order tests for patients or refers them for specialist care. She plays an integral role in bridging the gap in understaffed district hospitals, rural hospitals and nongovernmental organisations.

Without clinical associates, Sujee warns that the waiting times for patients are likely to increase and the patient loads of health workers risk becoming unbearable.