SAHR 2007 - Health Systems Trust

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Health and Related Indicators 15 Western Cape Health Services – Health facilities Category A or C Municipality Category B Municipality Mid-07 2007 2007 Number of public sector health facilities 2005 Total population Private hospitals Private hospital beds CPT City of Cape Town CPT City of Cape Town 3 179 237 24 3 289 111 52 6 9 8 2 3 13 7 501 DC1 West Coast WC011 Matzikama 50 663 4 6 4 2 84 DC2 Cape Winelands (Boland) Clinic WC012 Cederberg 39 700 3 1 6 1 2 82 WC013 Bergrivier 46 810 4 6 4 2 48 WC014 Saldanha Bay 70 858 1 44 11 2 2 1 53 WC015 Swartland 72 720 4 1 4 7 1 1 138 WCDMA01 West Coast DMA 4 348 1 5 WC022 Witzenberg 91 391 1 28 12 6 1 76 WC023 Drakenstein 200 945 1 122 13 1 4 7 1 1 340 WC024 Stellenbosch 123 259 1 90 10 1 4 2 1 95 WC025 Breede Valley 151 931 1 207 10 1 4 1 1 419 WC026 Breede River/Winelands WCDMA02 Cape Winelands DMA CHC Mobile Service Satellite Clinic District Hospital Regional Hospital Provincial Tertiary Hospital National Central Hospital Specialised Hospital Public sector beds 84 772 10 6 2 95 DC3 Overberg WC031 Theewaterskloof 93 682 10 1 7 1 65 WC032 Overstrand 56 093 1 45 10 1 1 37 WC033 Cape Agulhas 27 532 6 2 2 40 WC034 Swellendam 28 603 5 4 1 51 WCDMA03 Overberg DMA DC4 Eden WC041 Kannaland 24 479 3 3 1 1 35 WC042 Hessequa (Langeberg) 45 285 3 3 2 1 50 WC043 Mossel Bay 73 283 1 92 3 1 6 5 1 90 WC044 George 137 774 2 220 9 2 3 3 1 1 286 WC045 Greater Oudtshoorn 86 240 1 38 6 1 3 1 124 WC047 Bitou (Plettenberg Bay) 29 811 4 1 1 1 WC048 Knysna 52 773 1 47 4 3 2 1 98 WCDMA04 Eden DMA 14 846 1 2 1 1 20 DC5 Central Karoo WC051 Laingsburg 7 003 1 1 1 1 20 WC052 Prince Albert 11 011 1 1 1 1 29 WC053 Beaufort West 38 810 3 1 3 3 1 1 131 WCDMA05 Central Karoo DMA 6 465 1 1 1 14 Western Cape total 4 850 324 35 4 222 263 64 98 61 35 5 3 18 10 021 SA total 47 844 347 211 28 834 3 077 313 883 179 269 54 12 9 84 87 870 305
Health personnel The DoH Annual Report 2005/06 states that the “Department of Health with more than 4 100 clinics and Community Health Centres, 400 hospitals and more than 240 000 personnel is a large organisation. The role of the National Department of Health is to provide stewardship over the entire health sector (including the private sector) and provide guidance and support to provinces to manage the public health sector”. Despite this, accurately portraying the human resources picture per district, and including both public and private sector personnel, would still be a major challenge. The DoH Annual Report identifies two major priority areas – improving the human resources of the entire health sector (“improving the number of skilled health workers employed in our public hospitals and clinics and available to other health services within South Africa”) and the quality of care provided. It states that “[g]overnment recognises that the future of our national health system depends to a critical extent on our ability to train enough health professionals with the right skills and to hold on to this human gold. South Africa invests an enormous amount in producing health workers and our challenge is to create conditions that will motivate professionals to give back to the people through sustained public service”. There is, accordingly, great interest in studies of the migration of health personnel, both within and out of Africa. For example, Clemens and Pettersson looked at the number of African-born physicians and professional nurses residing in the nine principal destination countries in about 2000 [Health Professionals Abroad]. Interestingly, they included South Africa as a “receiving country”. They showed that 21% of physicians (medical practitioners) born in South Africa were, in 2000, living in another country (predominantly in the United Kingdom, United States, Canada or Australia), but also that 834 medical practitioners born in one of the developed countries were living in South Africa. Similarly, 5% of South African-born nurses were now resident in a one of the 8 “receiving” countries, but 261 born elsewhere were living in South Africa. Similarly, a study of African-trained physicians in Canada showed how the number has increased from 1993 to 2003 [Brain Drain to Canada]. In 2003, there were 1 679 South African trained medical practitioners in Canada. A study focused on nursing, while recognising the impact of international migration on the healthcare systems of low income countries, has emphasised the human rights aspects: the right to leave one’s country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality [Nursing Inquiry 14(114-24)]. The magnitude of the migration seen is also highly dependent on the metrics used [BMC Public Health 7:83]. Determining how many health professionals are currently employed in the public or private sectors is not easy. Apart from the obvious problems of high mobility, many are also employed part-time. The South African Pharmacy Council routinely asks registered practitioners to report where they are working when renewing their annual registration. Data provided for 2007 showed that, of 11 547 pharmacists on the register, 461 provided an address outside of South Africa. Of the balance, another 655 indicated that they were either retired or non-practising. Of the 10 431 pharmacists who thus reported as working either full-time or part-time or who did not provide information (and thus could be “in practice”), 7 495 (71.9%) reported working in the private sector. However, the public sector total (2 359) is greater than the total number of pharmacists recorded as employed by the PERSAL system. Closer examination of the responses also shows other inconsistencies. For example, 146 pharmacists reported that they worked in a community pharmacy in the public sector, 11 that they worked in a wholesale pharmacy in the public sector and 9 that they worked in a manufacturing pharmacy in the public sector. It is possible that these are public service pharmacists, employed in community health centres, in the provincial medical depots (which, by law, should be registered as wholesalers) or in tablet repacking and small-scale manufacturing at such sites or in hospitals. Another 7 pharmacists employed by Virtual Care Pharmacy (previously owned by Transmed) also described themselves as employed in the public sector, as did 1 working for a courier pharmacy, 102 in administrative practice and 86 in pharmacy education. Although those in administrative practice may well be public servants, even the 1 916 pharmacists who described themselves as working in a public sector institutional (hospital) pharmacy exceeded the 2007 PERSAL total (1 830). Pharmacists described themselves as working in the following areas (showing the percentage of those “in practice”): ➤ community pharmacies – 5 335 (51.1%; including 82 employed by Virtual Care); ➤ courier pharmacies – 47 (0.5%); ➤ institutional (hospital) pharmacies – 2 818 (27.0%); ➤ consultant pharmacies – 55 (0.5%); 306
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South African Health Review 2007 LI
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Foreword The 12th edition of South
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12 Traditional and Complementary Me
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Other Funders for the Health System
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This response raises a number of qu
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ucts are currently sold without reg
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The authors conclude that mandatory
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servicing and inappropriate hospita
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systems is also critical; worrying
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Authors: Laetitia Rispel i Geoffrey
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Stewardship: Protecting the Public
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Introduction The importance of the
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diseases such as tuberculosis and t
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17 of 2002). This Act entirely repl
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(d) and any other matter relating t
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Year Act No. Title Objects 1997 90
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References 1 Department of Health.
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Purchasing of Health Care 33Pooling
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Introduction This chapter presents
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Medical schemes are the largest fin
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per person dependent on the public
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An increase in hospital expenditure
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private pharmacy do so for self-tre
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References 1 McIntyre D, Thiede M,
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Policy and legislative framework In
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Medical schemes and revenue collect
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There is evidence that when faced w
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are thus contributing factors to th
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Figure 2: Historic membership of me
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Solvency of the risk pools has beco
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Figure 4: 100 Proportion of risk be
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will retain that benefit for their
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There is a general sense (but often
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From a benefit design perspective t
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and towards competition based on ef
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37 Du Preez L. Registrar wants cura
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Introduction There has long been co
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an element of cream-skimming which
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Table 1: Distribution of health car
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isk equalisation mechanism were imp
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once the cost spiral in medical sch
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Revenue collection: Collecting orga
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Current debates A key area of ongoi
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References 1 Gluckman H. The Provis
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Authors: Patrick Matshidze i Lyn Ha
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Health Information Systems in the P
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Authors: Shahieda Adams i Reno Mora
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Health and Health Care in the Workp
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Author: Bettina Taylor i 8 Rationin
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Rationing of Medicines and Health C
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Health Care Delivery 139
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Authors: Haroon Wadee i Farzana Kha
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Human Resources for Health 9 Table
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Human Resources for Health 9 Table
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Human Resources for Health 9 source
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Human Resources for Health 9 Refere
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Authors: Shadrack Shuping i Sipho K
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Public-Private Partnerships 10 Alth
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Public-Private Partnerships 10 Tabl
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Public-Private Partnerships 10 Conc
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Authors: Thulani Matsebula i Michae
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Private Hospitals 11 Table 1: Priva
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Private Hospitals 11 Table 3: Distr
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Private Hospitals 11 Human resource
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Private Hospitals 11 Figure 3: 16 T
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Private Hospitals 11 Figure 4: 2 50
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Private Hospitals 11 Monitoring qua
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Private Hospitals 11 Recommendation
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Authors: Nceba Gqaleni i Indres Moo
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Traditional and Complementary Medic
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Authors: Myles Mander i Lungile Ntu
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Economics of the Traditional Medici
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Authors: Marion Stevens i Edina Sin
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HIV and AIDS, STI and TB in the Pri
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Indicators 213
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Authors: Candy Day i Andy Gray ii 1
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Page 364 and 365: Glossary AFA AIDS ALP AMA ANC ART A
Page 366 and 367: Glossary KZN LFS LIMS LP LPP MAR MC
Page 368 and 369: Glossary SAPC SARS SASIM SASSA SEP
Page 370 and 371: Index A Acts (Legislation and Bills
Page 372 and 373: Index N and O National Health Refer
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SAHR 2007 - Health Systems Trust

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