sector skills plan for the health sector in south africa

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) Challenges These proposals aim to solve South Africa’s pervasive healthcare problems by introducing a financing mechanism to enable delivery of national health priorities. 124 Over a period of almost two decades a range of policy proposals for social or national health insurance have been put forward, but little progress has been made. The introduction of such reforms is complex and will have to deal with the massive disparities in the private-public sector mix referred to earlier in this chapter. 125 Observers have commented that before any NHI system can be introduced, significant improvements will be required in public hospital services, public perceptions of such institutions, management and governance, as well as greater operational autonomy. 126 It will also be necessary to fill the large numbers of vacant public sector posts and to provide additional nursing skills. 127 c) Planning The Minister of Health has appointed an advisory committee on NHI, which is mandated to explore a range of policy proposals. An inter-ministerial committee established by Cabinet is discussing and reviewing the proposals and public consultations are planned for 2011. 128 Current research is focused on identifying measures to support a feasible transition to an NHI model over a period of five years. 129 Timeframes for implementation are still uncertain, but the DoH is aiming for 2014; i.e. within the planning horizon of this SSP. d) Implications for human resources and skills 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, specialists, clinicians and mid-level workers. 130 The draft policy recommends that a quality improvement plan covering hospitals, clinics, ambulance services and primary healthcare facilities in both the public and private sector be implemented. It also suggests that individual institutions prepare human resources improvement plans and that those plans should feed into the HWSETA’s sector skills plans. 131 124 Van der Berg, S., Burger, R., Theron, N. et al. 2010. Financial Implications of a National Health Insurance Plan for South Africa; Harrison, D. 2009. An Overview of Health and Health care in South Africa 1994-2010: Priorities, Progress and Prospects for New Gains. Published at www.doh.gov.za (Accessed February 2010). 125 ANC. 2009. National Health Insurance Policy Proposal. Published at http://www.healthe.org.za/documents/5b5e24462cdf6e214072c2e3f92ab1b9.pdf (Accessed August 2010). 126 McIntyre, D. and Van den Heever, A. 2007. “Social or National Health Insurance” in South African Health Review 2007. Health Systems Trust. Published at www.hst.org.za/uploads/files/chap5_07.pdf (Accessed August 2010). 127 Van Niekerk, J. P. de V. 2010. “National Health Insurance Exposed”. South African Medical Journal. January 2010. 100 (1). Published at http://www.scielo.org.za/pdf/samj/V100n1. (Accessed August 2010). 128 National Treasury. 2010. “Vote 15: Health”. Estimates of National Expenditure 2010. 129 National Treasury. Budget Review 2010. 130 As a minimum, it takes 14 years to train a medical specialist, 8 to 9 years to train a medical doctor, 6 years to train a dentist, 5 years to train a pharmacist, 5 years to train a professional nurse, and 5 years to train an occupational therapist, 4 years to train a clinical (medical) assistant. The periods include one year of community service required before the practitioners acquire full registration status at their respective professional councils. 131 ANC. 2009. National Health Insurance Policy Proposal. Published at http://www.healthe.org.za/documents/5b5e24462cdf6e214072c2e3f92ab1b9.pdf (Accessed August 2010). 37
Recent research has projected an increase in demand for service and a concomitant increase in human resources required to meet the demand. The scheme will extend access to private care free of charge and will increase demand for services of GPs and specialists. 132 More patients will be attracted to medical practitioners and hospitals in the private sector and away from public clinics and public hospitals. 133 It has been mooted that norms and standards for care will be set to enhance quality of service and care in the public sector. Further, packages of care containing standard lists of services to be delivered at each level of care will be designed. Implementation of these policies may have an impact on the present skills base, in that there may be gaps or shortages of skills to meet the standards to be introduced. Training and skills development interventions will be required to deal with such skills gaps and shortages. In the NHI system itself, considerable managerial, financial and information technology management skills will be required to monitor usage and benefits offered, the distribution of resources, and the costs of the scheme. 134 3.10.4 HIV AND AIDS POLICIES By 2010 the number of hospital or clinic visits associated with HIV and AIDS approached 30 million per annum. 135 An estimated 740 000 patients were on anti-retroviral treatment (ART) by 2009. In April 2010 government announced the accelerated implementation of HIV testing and ART programmes to include more people on treatment. President Zuma announced that 15 million South Africans will be HIV tested by June 2011 and be granted access to AIDS medication if they require it. Estimates are that 2 million people may require ART within the next few years. 136 Clearly, additional human resources will be required if the ART population is to increase almost three-fold. Health economists predict that more than 25% of current public health resources will be required for ART over the next 10 years, and by 2020 the resource needs will be 40% of resources currently available. 137 It is reported that the DoH plans to equip more than 4300 sites to administer the treatment (or almost four times the number of police stations in South Africa) and to train 4800 nurses and lay counsellors to initiate and manage the AIDS treatment. 138 The scale of the programme will require the appointment of more administrative support staff (to order, collect and distribute drugs) and more skilled health managers to implement and oversee operations. 132 Van der Berg, S., Burger, R., Theron, N. et al. 2010. Econex. Financial Implications of a National Health Insurance Plan for South Africa. 133 Van der Berg, S., Burger, R., Theron, N. et al. 2010. Econex. Financial Implications of a National Health Insurance Plan for South Africa. 134 Macheke, C. 2010. HWSETA Health Sector Baseline Study. 135 National Treasury. Budget Review 2010. 136 Steinberg, J. “The state wants our blood, to stop the three-letter plague”. Sunday Times 2 May 2010, p. 9. 137 HEU Information Sheet 1. 2009. “Public sector health care spending in South Africa”. Health Economics Unit, University of Cape Town. Published at http://www.heu-uct.org.za (Accessed August 2010). 138 Steinberg, J. “The state wants our blood, to stop the three-letter plague”. Sunday Times 2 May 2010, p. 9. 38
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SECTOR SKILLS PLAN FOR THE HEALTH S
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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 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 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
Page 66 and 67: Organisations are also required to
Page 68 and 69: 4.4 FUTURE DEMAND 4.4.1 SKILLS DEVE
Page 70 and 71: 4.5.3 MATERNAL, CHILD AND WOMEN’S
Page 72 and 73: 4.6 CONCLUSIONS The growing demand
Page 74 and 75: 5 THE SUPPLY OF SKILLS 5.1 INTRODUC
Page 76 and 77: Table 5-3 shows that the total numb
Page 78 and 79: 5.3 INSTITUTIONAL ARRANGEMENTS AND
Page 80 and 81: 5.3.4 PRIVATE HOSPITALS Private hos
Page 82 and 83: Table 5-5 shows the registration fi
Page 84 and 85: 5.4.3 REGISTRATIONS WITH THE SOUTH
Page 86 and 87: Table 5-10 Number of health-related
Page 88 and 89: The HWSETA has also registered seve
Page 90 and 91: 5.7.3 INTERNSHIPS The HWSETA has su
Page 92 and 93: 5.8 FACTORS INFLUENCING THE SUPPLY
Page 94 and 95: d) The introduction of mid-level sk
Page 96 and 97: of legally enforceable nurse/patien
Page 98 and 99: annual growth rate in professional
Page 100 and 101: Therefore, the HWSETA’s skills de
Page 102 and 103: In Chapter 5 it was mentioned that
Page 104 and 105: 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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