sector skills plan for the health sector in south africa

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and training are directly affected. Demand for public health services is likely to increase due to job losses (and loss of employment-linked medical insurance cover). This will add further pressure on health professionals and workers in the public sector. South Africa is encumbered by a quadruple burden of disease attributable to diseases of poverty, the HIV and AIDS pandemic, high incidence of communicable diseases and tuberculosis infection, as well as high levels of chronic diseases and inter-personal violence. This disease burden is four times larger than in developed countries and is generally double that of other developing countries. The public sector bears the brunt of the problems. It is widely recognised that care levels, outcomes and management of the public health system are under strain partly because of significant staff shortages, a mal-distribution of skills between urban and rural areas, and an inadequate skills base. Management of the health system is under strain at almost all levels. Wide-spread inefficiencies result in services that are unresponsive to health and patient needs, and a lack of accountability exists on a large scale. Almost every aspect of the health system is regulated by the national Department of Health (DoH), while the professional councils regulate the quality of the country’s health workers. Responsibility for developing human resources in the public sector are split between the national and provincial levels. The national DoH has to promote adherence to norms and standards for the training of human resources, while the nine provincial departments of health are responsible to plan, manage and develop human resources to render health services. A key priority for the national DoH is the introduction of a national health insurance (NHI) system offering universal coverage and free health services to all South Africans by 2014; i.e. within the planning horizon of this SSP. Although the proposals are still under development and subject to change, the HWSETA should take into account the implications for human resources needs and skills requirements, especially considering the long lead-time required to train healthcare professionals. Although the details of the scheme are not yet known, it will extend access to private care and some analysts expect an increase in the demand for services of general medical practitioners and specialists as patients will move away from public clinics and hospitals. In the NHI system itself, considerable managerial, financial and information technology management skills will be required to monitor usage and benefits offered, as well as the distribution of resources and the costs of the scheme. Current national health policies focus on the provision of primary care and community-based health services; expanded HIV and AIDS and TB treatment; improving the health of mothers, babies and children; improving management and governance of the health system; and improving human resources planning. On the animal health side, there are increasing calls to make veterinary services more accessible to low-income communities at local government level and to introduce mid-level veterinary workers such as primary animal healthcare workers and community animal health workers to serve animal health needs in impoverished communities. xiii
Implementation of these policies drive the need for more professional and technical healthcare, leadership and management skills, as well as skills development interventions to enhance the skills content. DEMAND FOR SKILLS The health sector is a personal services industry where services are both resource- and time-intensive. Effective delivery of health services depends upon the availability of skilled human resources with the appropriate skills. A growing demand for healthcare and the introduction of changes in the way health services are delivered to the public, drive the demand for skills. Such demand continues to outstrip supply. In 2010 there were approximately 281 000 filled positions in the Public Service Health Departments. At the time the total number of funded vacancies was not known, and the total number of positions available in the Public Service could not be calculated. However, the scarce skills information obtained through the Public Service Departments’ WSPs indicate that vacancy rates are quite high and that the Public Service total establishment is considerably larger than what is reflected in the current employment figures. The number of current posts is only slightly higher than that of 1997/98 and has not increased to allow for population growth or the impact of AIDS. Calculations by health economists using the 1997/98 staffing levels as a baseline showed that the public sector required a staff complement of 315,087 by 2008, just to keep up with population growth and the expanding disease burden. Clearly current post levels are inadequate to meet demand for healthcare services in the public sector. A conservative estimate for the number of employees in the private sector is 178 921 during June 2010. The vacancy rate in the private sector is estimated at 2.3%. By contrast, the public sector experiences a high vacancy rate of up to 60% in certain professional categories. One-third of the vacancies that are difficult to fill in private health organisations are for professional positions, while 47% of the scarce skills reported in the Public Service are for professionals. Vacancies in professional positions that both the public and private sectors find most difficult to fill exist for doctors, medical specialists, professional nurses and pharmacists. Other scarce and critical skills needs in the public sector are for managers in finance and information technology and in the healthcare fields of dietetics and physiotherapy. Employment of doctors and nurses in the public sector falls short of international benchmarks for inhospital care and WHO minimum guidelines. According to the WHO, countries with fewer than 230 doctors, nurses and midwives per 100 000 population generally fail to achieve adequate coverage rates of care to attain the health-related Millennium Development Goals (MDGs). Those goals relate to reducing child mortality, improving maternal health and combating HIV and AIDS and other diseases. In 2008 the public sector had 152 doctors and professional nurses per 100 000 of the population and, if staff nurses are also included, the ratio improves to 209. xiv
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 and 12: EXECUTIVE SUMMARY INTRODUCTION The
Page 13: Health professionals and practition
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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