sector skills plan for the health sector in south africa

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4.4 FUTURE DEMAND 4.4.1 SKILLS DEVELOPMENT TARGETS SET BY THE NATIONAL DEPARTMENT OF HEALTH In 2006, as part of a document entitled Human Resources for Health: A Strategic Plan, the national DoH set targets for the production of human resources by health sciences education and training institutions to primarily address public sector needs. At the time those targets were developed with reference to public sector vacancies, outputs at education institutions and the potential for increased outputs, estimated replacement needs and limited financial resources. The DoH acknowledged that the targets should have been influenced by actual healthcare needs identified in provincial health service plans, rather than by the affordability of services in a resource-constrained environment. 161 Further studies were required, especially on capacity at academic institutions to meet the proposed targets. One of the targets the DoH set was to increase the number of medical practitioners that would qualify each year from the approximately 1 200 per year to 2 400 per year. The production of professional nurses had to increase from 1 900 to 3 000 per year and enrolled (staff) nurses had to increase from 5 000 to 8 000 per year. Experts warned in 2008 that South Africa has no system in place to ensure that the production of health professionals occurs in relation to their need and that decisions on skills development for health are made independently of national policy. 162 Others remarked that the above targets were set, without an implementation plan to achieve them. 163 At the time of writing this SSP, the DoH was in the process of revisiting its Strategic Plan. 4.5 FACTORS THAT IMPACT ON THE DEMAND FOR HEALTHCARE WORKERS In Chapter 3 several changes and challenges were discussed that will have an impact on the number of healthcare workers needed in the country, the occupational mix needed and the actual skills required of people within specific occupations. The most important of these are summarised below: 4.5.1 HIV AND AIDS TREATMENT POLICIES Expanding the access to ART will impact largely at the district level. Patients will have to be introduced to ART, advised of the risks of non-compliance with the treatment regime, followed up for risks, and monitored for side-effects. Since there are not enough doctors to do so, the bulk of the work is expected to shift to nurses – a professional group already in short supply and under pressure in the 161 Department of Health. 2006. “Chapter 5: Priority Areas for Implementation”. Human Resources for Health: A Strategic Plan. Published at http://www.doh.gov.za/docs/discuss/2006/hrh_plan/. (Accessed August 2010). 162 Development Bank of South Africa. 2008. A Roadmap for the Reform of the South African Health System. 163 Wolvaardt, G., Van Niftnik, J., Beira, B. et. Al. 2008. “The Role of Private and Other Non-Governmental Organisations in Primary Health Care”. South African Health Review 2008. Health Systems Trust. Published at www.hst.org.za/publications/841. (Accessed August 2010). 49
public sector. 164 This may necessitate the fast-tracking of changes to the legal and regulatory frameworks governing the nursing profession, as nurses may be required to prescribe the ART drugs. Because the delivery of ART is regarded as a complex health intervention, nurses will require additional training in this area. Additional higher-level skills such as those of doctors and experienced primary health care trained nurses will also be needed to support the front-line nurses and to accept referral of more complex cases. 165 As more medication will be dispensed to patients requiring daily life-long care, pharmacists may be under pressure and their ranks in the public sector may require strengthening supported by additional pharmacist assistants. Research has shown that expansion of ART will increase the number of patients who develop complications from ART-drug toxicity, side-effects, opportunistic infections and syndromes of the immune system. This will potentially increase the demand for medical and specialist care at secondary level hospitals. 166 4.5.2 POLICIES TO CONTROL TUBERCULOSIS Preventing the development of MDR-TB and XDR-TB requires a heightened response from nursing professionals to detect signs of these diseases and from medical practitioners to correctly diagnose patients at an earlier stage. 167 By implication, more appropriately trained and skilled professional nurses and doctors are required at district level to ensure that more patients are screened sooner. Health workers experience a high TB infection rate themselves, are six times more likely to develop drug-resistant TB, and may inadvertently be spreading the disease. 168 To combat the risk of infection the DoH has identified the need to train 3500 health professionals per annum in TB management control. 169 In addition, more lower-level health workers such as nursing auxiliaries and community health workers are needed to support and monitor patient adherence to treatment regimes and to increase treatment completion rates. The development of mid-level environmental health practitioners such as infection control officers who are needed to prevent the risks of infectious outbreaks in hospitals and clinics is needed. 164 Colvin, C. J., Fairall, L., Lewin, S. et al. 2010. “Expanding access to ART in South Africa: the role of nurse initiated treatment”. South African Medical Journal. April 2010. 100 (4). Published at http://www.scielo.org.za/pdf/samj/V100n4. (Accessed August 2009). 165 Colvin, C. J., Fairall, L., Lewin, S. et al. 2010. “Expanding access to ART in South Africa: the role of nurse initiated treatment”. South African Medical Journal. April 2010. 100 (4). Published at http://www.scielo.org.za/pdf/samj/V100n4. (Accessed August 2009). 166 Kevany, S. Meintjes, G. Rebe et al. 2009. “Clinical and financial burdens of secondary level care in a public sector antiretroviral roll-out setting (GF Jooste Hospital). South African Medical Journal. August 2009. 99 (8). Published at http://www.scielo.org.za/pdf/samj/V99n5 (Accessed August 2009). 167 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). 168 Jordan, B. 2010. “Health workers besieged with drug-resistant TB”. Sunday Times, 12 September 2010. Published at http://www.timeslive.co.za/sundaytimes/article653446.ece/Health-workers-besieged-by-drug-resistant-TB. (Accessed September 2010). 169 Department of Health. 2010. National Department of Health Strategic Plan 2010/11-2012/13. Published at http://www.doh.gov.za. (Accessed August 2010). 50
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SECTOR SKILLS PLAN FOR THE HEALTH S
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2.4.6 LABOUR UNIONS ...............
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5.2 THE SOUTH AFRICAN SECONDARY SCH
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LIST OF TABLES Table 2-1 Total empl
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ABBREVIATIONS AND ACRONYMS ABET Agr
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EXECUTIVE SUMMARY INTRODUCTION The
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Health professionals and practition
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Implementation of these policies dr
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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
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Page 44 and 45: Table 3-3 Primary healthcare visits
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