Unemployment is a socio-political challenge worldwide and a major challenge in South Africa where the current national unemployment rate is the highest in 11 years [1–2]. Statistics South Africa (2019) reports a 29.1% official unemployment rate, which translates to approximately 6.7 million people who are able (skilled) to work and actively seeking jobs [3]. The expanded unemployment rate which would include those who are not actively seeking jobs [3] skilled or otherwise, is much higher and is up to 38.5% (10 million people) [2]. Unemployment rates are especially high (55.2%) amongst the youth aged 35 and younger [2].
More than 15 years ago, the growing unemployment crisis in South Africa was described then, as a ‘beast’, with an ‘effect on economic welfare, erosion of human capital, crime and social instability’ [4]. In response to the annual increase in unemployment, the government has shown a wide range of policy efforts and interventions to curb the crisis and impact, especially among the youth [1, 5]. One of the key interventions has been increasing access and quality of education with the aim of increasing the number skilled youth that would be more employable as per labour market skills demand/need [1, 6].
In the last 20 years in post-apartheid South Africa, increasing access, quality and levels of education has been a key focus as research has shown that educated/skilled young people stand a better chance of finding employment, and of finding employment faster than their peers with lower levels of schooling [5, 7–8]. However, there seems to still be a persistent case of unemployment even among skilled graduate professionals in South Africa to date, despite vast efforts invested in access and quality of education [5]. Graduate unemployment is problematic, because it wastes scarce human capital which is detrimental to the economy in the long run [9].
Currently, South Africa’s labour market consists of formal and informal employment. Formal employment is defined as employment created by businesses or the government where an employee is hired under established working agreements [3, 10]. In 2014, only 25% of South Africa’s workforce were skilled workers with formal employment, this is including graduate health workers [11]. In 2016, 405 000 South African citizens with tertiary level education including health professionals, were unemployed [12]. Graduate unemployment is an important area of study because the South African economy experiences severe skills shortages however simultaneously unable to generate and sustain sufficient job opportunities for skilled labour [13]. The issue of graduate unemployment therefore contradicts studies suggesting that the higher a participant’s education level, the higher the probability of finding employment, for example health professional graduates with specialized education are expected to be fully absorbed into the skills starved labour market [14–16].
The South African healthcare economy and setting is complex [17]. Research highlights that there is a rise in health human resource and service wastage through unemployment, low worker retention and low overall system efficiency as influenced by the macro socio-economic and political issues that are not unique to South Africa but are in most developing African countries [18]. The term wastage of health human resources is used by previous researchers in the field [18] to describe “the loss in utility of health workers/health professionals resulting from underuse or non-use of trained personnel, unemployment, retrenchment or the labour force’s inability to absorb skilled graduates. Some researchers argue that many of the South African healthcare challenges are rooted in distinct features of the apartheid history, which sustained health inequity through its successive segregationist policies [19]. To date, there has been a recent increase of unemployed health professionals, including audiologists [20–22].
Audiologists are the primary hearing healthcare professionals involved in the identification, prevention and evaluation of auditory and balance disorders. In addition, audiologists are the single most important resources for non-medical habilitation or rehabilitation of hearing loss [23]. Audiology is a relatively young among other South African health professions and has been growing in the last half century from an adjunct to Speech Therapy to its own autonomous profession [24]. First training programs were introduced around 1937 as two-year diplomas and evolved to four-year degree programs by 1948 [24]. To date, audiology training as a singular, autonomous profession is available at some of the six higher education institutions offering the degree in South Africa with approximately 100–150 new graduates recorded annually [24–26]. It is worth noting that this is a low number of audiologists entering into healthcare system to meet the high need of hearing health services as influenced by the disease and disability burden, in South Africa [27]. Lower supplies of rehabilitation health professionals like audiologists is a common challenge in low- and middle-income countries, including many located in sub-Saharan Africa, where the need of rehabilitation professional skills tends to be greatest [28]. The Health Professions Council of South Africa 2019 register indicates approximately 845 singularly qualified audiologists and 3212 dually qualified speech therapists and audiologists, currently qualified to provide hearing healthcare services in the country of close to 60 million in population size.
Audiologists in South Africa are mostly employed and function in the public healthcare system [24, 27]. The South African public healthcare system is unfortunately marred with several challenges including well-documented lack of skilled professionals, infrastructural constraints, limited well-functioning facilities, general lack of resources for the size of the population, risk versus benefit assessments predicaments as well as challenges with translating policies into practice [27, 29–30]. These challenges affect mostly the already vulnerable parts of the population such as the poor with communication disabilities such as hearing loss [27, 30–32].
Therefore, the current study sought to investigate and describe challenges in obtaining and maintaining employment of audiologists as scarce skilled health human resources in context of the rising unemployment rates in South Africa. Anticipated impact of the current study is to inform hearing healthcare human resource policies and planning, hearing healthcare labour market needs and capacity as well as hearing healthcare context and potential for growth in the South African context [18, 20–21].