sector skills plan for the health sector in south africa

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In public health, shortages were mostly related to growth in demand, difficulties to retain or replace qualified staff, geographic location, new technology, and migration of employees. Skills development targets for the health sector set by the DoH in 2006 indicate the scope of demand for skills, but failed to acknowledge supply-side constraints to a sufficient degree. Some of these constraints are considered in Chapter 5 of this SSP. Programmes to accelerate HIV testing and increase the number of patients on anti-retroviral treatment (ART) by almost three times will have a major impact on the demand for skills. More specifically, the public sector will need additional doctors, medical specialists, nurses, administrative support staff (to order, collect and distribute drugs) and skilled health managers to implement and oversee operations. Demand for similar skills is triggered when key programmes to fight TB and improve the health of mothers, children and women are rolled out. More lower-level skills and community health workers are needed to monitor adherence to treatment regimes for AIDS and TB. Skills interventions should also target PHC nurses involved in health monitoring programmes for children. Specialised training on a large scale is required in TB management and infection control, and staff nurses require targeted training in midwifery, antenatal, obstetric and post-natal care. In the public sector, and in the district health system in particular, leadership skills and professional management skills are required to manage complex systems and to improve operational efficiency. Skills in the planning and implementation of programmes, as well as the monitoring and evaluation of service and quality of care, are required. On the people side, skills are needed to manage human resources and their performance. More particularly, managers require skills to lead and guide subordinates, improve their productivity and instill accountability for service to patients. Other areas for managerial development include planning and time utilisation, use of information technology, as well as financial and capital resources management. Extensive, intensive and purposive skills development is needed in all these areas. Finally, the introduction of a national health insurance system will drive demand for higher levels of care offered by doctors and medical specialists and is expected to turn utilisation of health services away from nurse-based primary care. SUPPLY OF SKILLS This section describes the different elements of supply and highlights the supply-side constraints that contribute to the current shortages. The supply of skills can be correlated directly with outputs from the school system, graduation trends, professional registration and the role that the HWSETA plays in skills development. A combination of complex factors influences the supply of skills to the health sector. At the heart of the problem is the quantity and quality of learners who complete high school. The secondary school system is producing fewer candidates with the combination of mathematics, physical sciences and/or life sciences required to enter tertiary level studies in the health sciences. The latest available matriculation xv
statistics are for 2008 when the New Curriculum Statement was introduced. A total of 554 664 candidates wrote the Grade 12 examination in 2008. Of those, a total of300 008 wrote mathematics and 89 186 (16%) achieved 40% and above in mathematics, while 61 480 candidates passed physical sciences (or 11% of candidates who wrote Grade 12). A total of 29 8210 candidates wrote the life sciences examination and 117 483 achieved 40% and above. Quality standards of education in mathematics, physical sciences and life sciences are major supply-side constraints impacting on the skills of the health sector. Sub-standard levels of literacy and numeracy skills of school leavers and their poor level of readiness for tertiary studies further reduce the supply pool. Existing institutional arrangements and regulatory provisions regarding the training of health professionals also restrict the supply of skills to the sector. Most of the health professionals who are required to register with the HPCSA, the SANC, the SACP and the SAVC are trained by universities and universities of technology, and undergo practical training in state-owned academic health complexes. Production levels at these institutions are limited due to capacity and budget constraints. Regulatory requirements prevent private sector training providers from training many categories of health professionals. With the exception of basic healthcare sciences, the growth in supply of new graduates from the higher education system has been moderate, and even low over the last decade. If all the health-related fields of study are considered, the total output from the Higher Education and Training (HET)sector grew on average by 3.4% at National Diploma level, at 6.3% at the first three-year BDegree level and at 5.1% at the first four-year degree level. The field with the highest growth was Basic Health Care Sciences. Clinical Health Sciences (which more or less represents the output of entry-level medical degrees) grew only moderately – by 3.1% per year. This trend is carried through to the registration of health professionals with their respective professional councils. The average annual growth rate in professional registrations across key occupational categories has been low, and in some instances lower than the growth rates in graduates produced for the particular professional category. Nursing colleges play an important role in the training of nurses. Total output from nursing colleges grew on average by 10% per year over the period 2000 to 2009. The largest growth was at the level of pupil nurses and pupil auxiliaries. The HWSETA also contributes to skills formation in the health sector. Since 2002 more than 25 000 learners enrolled on health-related learnerships. More than 7 000 have completed learnerships at the time of writing this SSP, and were recorded on the HWSETA’s electronic system. Many more completed learnership that are quality assured by professional councils and their achievements are recorded by the councils and not by the HWSETA. The SETA also support skills development through internships and workplace training programmes, skills programmes, ABET and small enterprise development. xvi
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 and 14: Health professionals and practition
Page 15: Implementation of these policies dr
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
Page 64 and 65: 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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sector skills plan for the health sector in south africa

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