sector skills plan for the health sector in south africa

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4.5.3 MATERNAL, CHILD AND WOMEN’S HEALTH PROGRAMMES The national programme to improve the health of mothers, children and women (which is linked to South Africa’s commitment to achieve its MDGs aims to avert maternal deaths, stillbirths and improve infant mortality rates. This programme involves improvements to the coverage and quality of care of mothers, babies and children in the antenatal-, post-natal- and early childhood development stages. Specialised skills are needed. It is estimated that 2445 professional nurses, 250 enrolled nurses and 134 enrolled nursing assistants with training in midwifery, antenatal-, obstetric- and post-natal care will be needed. 170 The aim to test 100% of pregnant women for HIV at hospitals, community clinics and PHC facilities 171 will drive the demand for nurses and community health workers with counselling skills. Efforts to prevent, improve the diagnosis, monitoring and management of birth defects require the skills of nurses and medical practitioners trained in human genetics care. 172 More nursing skills are required at primary care level where immunisation and vaccination coverage of babies, infants and young children will be increased. At that level more healthcare workers also require skills in managing childhood illnesses, and many primary-level care facilities will require healthcare providers trained in the integrated management of childhood illnesses. 173 Expansion of school health services requires the skills of nurses to provide health education, impart life skills, screen children for diseases, disabilities, immunisation status and other healthcare needs. At the tertiary level of care, the demand for nursing skills in neo-natal care and intensive care is high. A 2008 study by the Critical Care Society of South Africa found that only 3.8% of nurses had neo-natal intensive care training. 174 4.5.4 MANAGEMENT OF HEALTH OPERATIONS AND PEOPLE In the public sector, and in the district health system in particular, leadership skills and professional management skills are required for managing complex systems and improving operational efficiency. 175 Skills in the planning and implementation of programmes, as well as the monitoring and evaluation of service and quality of care, are required to strengthen management of health operations. On the people side, skills are needed in the management of human resources and their performance. More 170 Chopra, M., Daviaud, E., Pattinson, R. et al. 2009. “Saving the lives of South Africa’s mothers, babies, and children: can the health system deliver?” Lancet. September 2009. Vol. 374. Published at http://thelancet.com. (Accessed August 2010); Department of Health. 2010. National Department of Health Strategic Plan 2010/11-2012/13. Published at http://www.doh.gov.za. (Accessed August 2010). 171 Department of Health. 2010. National Department of Health Strategic Plan 2010/11-2012/13. Published at http://www.doh.gov.za. (Accessed August 2010). 172 Department of Health. 2010. National Department of Health Strategic Plan 2010/11-2012/13. Published at http://www.doh.gov.za. (Accessed August 2010). 173 Department of Health. 2010. National Department of Health Strategic Plan 2010/11-2012/13. Published at http://www.doh.gov.za. (Accessed August 2010). 174 Bateman, C. 2009. “Legislating for nurse/patient ratios ‘clumsy and costly’ – experts”. South African Medical Journal. August 2009. 99 (8). Published at http://www.scielo.org.za/pdf/samj/V99n8. (Accessed August 2009). 175 Coovadia, H., Jewkes, R., Barron, P. et al. 2009. “The health and health system of South Africa: historical roots of current public health challenges”. Lancet. September 2009. Vol. 374. Published at http://thelancet.com. (Accessed August 2010). 51
particularly, managers require skills to lead and guide subordinates, improve their productivity and instil accountability for service to patients. Other areas for managerial development include planning and time utilisation, financial and capital resources management. 176 4.5.5 EXPANSION OF THE PUBLIC HEALTH INFRASTRUCTURE It is anticipated that health information systems in the public sector will be upgraded in the next five years to support decision-making, budgeting, monitoring and evaluation of performance. 177 Major training interventions may be required to facilitate effective application and use of such new systems, as well as the tools to extract and analyse data. The current public hospital revitalisation programme will increase the number of usable beds, leading to an increase in demand for health professionals such as doctors and nurses, as well as support staff. 4.5.6 SKILLS REQUIREMENTS FOR THE NHI The introduction of a NHI offering coverage with no co-payments to the whole population (as proposed) will impact on the demand for healthcare services and personnel. Demand for service will be driven by an increased rate of utilisation of healthcare (as there will be no co-payments) and greater demand for higher levels of care. A 2010 study by Econex, shows that, based on the assumptions used in the study, a larger proportion of the population will use higher levels of medical care offered by general practitioners and medical specialists, away from nurse-led primary care. 178 Therefore, more general practitioners and medical specialists will be required to meet the increased demand for service. It is projected that South Africa will require between 5 800 to 10 000 more GPs and another 7 000 to 17 000 medical specialists to serve healthcare demand under the NHI. On the other hand, the demand for nurses is expected to drop as the public will move away from public clinics and choose a higher level of care. 179 The study concluded that rationing of healthcare services under the NHI would be required in view of the scarcity of resources. As mentioned in Section 3.10.3 there is currently no clarity of the exact structure and provisions of the proposed NHI or the structure of the health system that will deliver the NHI. It is therefore not yet possible to project with certainty the numbers of professionals that will be needed for the implementation of the system. It is, however, an area that needs to be closely monitored and incorporated in future updates of the SSP. 176 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); Chopra, M., Lawn, J.E., Sanders, D. et al. 2009. “Achieving the health Millennium Development Goals for South Africa: challenges and priorities”. Lancet. September 2009. Vol. 374. Published at http://thelancet.com. (Accessed August 2010). 177 National Treasury. 2009. “Health”. In Provincial Budgets and Expenditure Review 2005/06 – 2011/12. Pretoria: National Treasury. 178 Van der Berg, S., Burger, R., Theron, N. et al. 2010. Financial Implications of a National Health Insurance Plan for South Africa. 179 Van der Berg, S., Burger, R., Theron, N. et al. 2010. Financial Implications of a National Health Insurance Plan for South Africa. 52
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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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statistics are for 2008 when the Ne
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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
Page 46 and 47: 3.4 THE MOBILITY OF LABOUR In 2006
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Page 112 and 113: APPENDIX A SCARCE SKILLS LIST - PRI
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