sector skills plan for the health sector in south africa

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
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