sector skills plan for the health sector in south africa

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organisations, to veterinary services. In the 2009/2010 financial year a total of 4 321 organisations paid skills development levies to the HWSETA. In 2010, an estimated 460 000 people are employed in the health sector, of which 179 000 (39%) are employed in private health and 281 000 (61%) in public health departments. A large portion of the workers in the health sector are registered with statutory professional councils that regulate the various professions. These councils are the Health Professions Council of South Africa (HPCSA), the South African Nursing Council (SANC), the South African Pharmacy Council (SAPC), the Allied Health Professions Council of South Africa (AHPCSA) and the South African Dental Technicians Council (SADTC). Members of the veterinary and para-veterinary professions are registered with the South African Veterinary Council (SAVC) and practitioners using indigenous African healthcare techniques and medicines will soon be required to register with the Interim Traditional Health Practitioners Council of South Africa (ITHPCSA). In many instances these councils determine the scope of practice for various health professions and enforce rules of ethical and professional conduct. The professional councils are actively involved in skills development through the setting and controlling of standards for education and training, the registration of professionals, and continuous professional development. In both the Public Service and in the private sector managers constitute approximately 4% of total employment. Almost half (47%) of employees in the private sector are employed as professionals and 28% in the Public Service. Professionals include medical and dental practitioners, registered nurses, pharmacists, and other health-related occupations such as occupational therapists and psychologists. Community and personal service workers in the Public Service constitute 42% of total employment. This category mainly comprises enrolled and auxiliary nurses, emergency service and ambulance workers and food and auxiliary hospital workers and aides. In 2010, the majority (87%) of the people working in the sector are black, while white workers constitute only 13% of the total workforce. Most (63%) of the professionals employed in the total sector are African, 21% are white, 9% coloured and 7% are Indian. Among community workers and personal service workers, 80% in the private sector and 86% in the Public Service are Africans. Women constitute 75% of the health workforce and the professionals in the public sector. The majority of medical doctors/practitioners (80%), dentists (77%) and pharmacists (74%) in public health are younger than 45. More than 50% of professional nurses are 45 and older. Of the medical practitioners and specialists in the private sector, 42% are younger than 45. A number of institutions conducting research in human and animal health and the socio-economic impact of disease play a prominent role in the health sector. In addition to their research activities, the Medical Research Council (MRC), National Health Laboratory Service (NHLS), Human Sciences Research Council (HSRC) and the Onderstepoort Veterinary Institute (OVI) are specifically mandated to advance the training and development of researchers, health professionals and technicians for the health sector. xi
Health professionals and practitioners are organised in numerous voluntary organisations that generally promote the interests of specific fields of medical practice and their members, including their educational and economic interests. The Hospital Association of South Africa (HASA) represents 90% of the private hospital groups and is a leading employer organisation in the sector. Labour and trade unions are well organised and mobilised within the health sector. Trade unions play a formative role in shaping labour market policies, labour relations practices and human resources management in the sector. Non-governmental organisations play an essential part in the delivery of healthcare to disadvantaged and marginalised communities, even though they fall outside the sector’s formal structures. FACTORS INFLUENCING THE HEALTH SECTOR LABOUR MARKET South Africans access medical care either through the public health system or through their own health insurance arrangements with medical schemes, or incur out-of-pocket expenses. More than 41 million people rely on the public health system and 7.9 million people are covered by medical insurance. About 28% of the uninsured population consult private practitioners, but use public hospital services. An estimated 64% to 68% of the population is entirely dependent on public sector care. Many inequalities are entrenched in South Africa’s public-private healthcare mix. In 2009, the per capita expenditure on healthcare in the public sector was about R2,058, but it was six times higher in the private sector. In 2010 total healthcare expenditure in South Africa was estimated to be above R227 billion, with more than 53% of this attributable to private sector spending. Significantly higher numbers of health professionals serve healthcare users in the private sector than the public sector population. For example, more than three times the number of doctors and seven times the number of medical specialists are available to private sector users, compared to the public sector. The ratio of nurses per private sector population is almost double that of the public sector. From 1995 onwards the public sector moved from a hospital-based approach to a primary healthcare (PHC) approach. This is also reflected in public sector spending, with about 41% of public health funds allocated to district health services, which include primary healthcare clinics and community health centres, district hospitals and AIDS interventions. In contrast, private sector spending has moved away from PHC towards funding major medical benefits such as hospitals, specialists and chronic diseases. Payroll expenses comprise 56% of provincial health expenditure and escalated by 19% per annum over the four years from 2005/06 to 2008/09. Both the public and private health sectors are experiencing increased demand for services. At the same time South Africa is also affected by the worldwide shortages of health workers. As highly mobile health professionals migrate to more developed economies, valuable skills are lost and local health services are adversely impacted. Similar experiences in the veterinary profession continue to cause skills shortages in the public sector where the vacancy rate at national, provincial and laboratory levels remains high. The 2008 global economic crisis and economic downturn impacted the health sector on several levels. As tax revenues decline due to economic contraction, health budgets, allocations for human resources xii
Page 1 and 2: SECTOR SKILLS PLAN FOR THE HEALTH S
Page 3 and 4: 2.4.6 LABOUR UNIONS ...............
Page 5 and 6: 5.2 THE SOUTH AFRICAN SECONDARY SCH
Page 7 and 8: LIST OF TABLES Table 2-1 Total empl
Page 9 and 10: ABBREVIATIONS AND ACRONYMS ABET Agr
Page 11: EXECUTIVE SUMMARY INTRODUCTION The
Page 15 and 16: Implementation of these policies dr
Page 17 and 18: statistics are for 2008 when the Ne
Page 19 and 20: In collaboration with the professio
Page 21 and 22: Information submitted by the depart
Page 23 and 24: 2 PROFILE OF THE SECTOR 2.1 INTRODU
Page 25 and 26: 2.3 EMPLOYERS IN THE SECTOR The hea
Page 27 and 28: ) The South African Nursing Council
Page 29 and 30: several institutions are specifical
Page 31 and 32: development and care in areas such
Page 33 and 34: PERSAL database The PERSAL system k
Page 35 and 36: African Coloured Indian White Total
Page 38 and 39: In 2010, 460 000 people are employe
Page 40 and 41: Table 3-1 Health expenditure in pub
Page 42 and 43: According to the Development Bank o
Page 44 and 45: Table 3-3 Primary healthcare visits
Page 46 and 47: 3.4 THE MOBILITY OF LABOUR In 2006
Page 48 and 49: Arguably, many of the driving facto
Page 50 and 51: 3.8 MANAGEMENT OF THE HEALTH SYSTEM
Page 52 and 53: 3.9.2 REGULATION OF QUALITY Strict
Page 54 and 55: service are not well defined. 113 S
Page 56 and 57: ) Challenges These proposals aim to
Page 58 and 59: 3.10.5 STRATEGY TO FIGHT TUBERCULOS
Page 60 and 61: Veterinary skills are in demand glo
Page 62 and 63:
4 THE DEMAND FOR SKILLS 4.1 INTRODU
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Table 4-2 Total professional positi
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Organisations are also required to
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4.4 FUTURE DEMAND 4.4.1 SKILLS DEVE
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4.5.3 MATERNAL, CHILD AND WOMEN’S
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4.6 CONCLUSIONS The growing demand
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5 THE SUPPLY OF SKILLS 5.1 INTRODUC
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Table 5-3 shows that the total numb
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5.3 INSTITUTIONAL ARRANGEMENTS AND
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5.3.4 PRIVATE HOSPITALS Private hos
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Table 5-5 shows the registration fi
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5.4.3 REGISTRATIONS WITH THE SOUTH
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Table 5-10 Number of health-related
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The HWSETA has also registered seve
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5.7.3 INTERNSHIPS The HWSETA has su
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5.8 FACTORS INFLUENCING THE SUPPLY
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d) The introduction of mid-level sk
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of legally enforceable nurse/patien
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annual growth rate in professional
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Therefore, the HWSETA’s skills de
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In Chapter 5 it was mentioned that
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Cape Peninsula University of Techno
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http://www.hwseta.org.za/upload/sec
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National Treasury. 2009. “Health
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assistants”. Published at http://
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APPENDIX A SCARCE SKILLS LIST - PRI
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OFO Code OFO description Private he
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