sector skills plan for the health sector in south africa

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5.8 FACTORS INFLUENCING THE SUPPLY OF SKILLS Apart from the institutional strengths and constraints described earlier in this chapter, a number of other factors also impact, or are set to impact, on the supply of skills in the future. These include government strategies and policy interventions, the management of public sector health facilities, the migration of South African health professionals, the recruitment of foreign professionals, and the socioeconomic realities faced by many potential professionals. 5.8.1 GOVERNMENT STRATEGIES AND POLICY INTERVENTIONS Over the last few years government has introduced a number of strategies and plans to improve the supply of health workers. A few of these interventions are discussed below: a) Nursing Healthcare provision in South Africa is affected by the global shortage of nurses. Both the public and private sectors have suffered losses of experienced nursing professionals who are regarded as essential components in the overall healthcare delivery system. In response to these losses the SANC and the national DoH developed the Nursing Strategy for South Africa to “achieve and maintain an adequate supply of nursing professionals who are appropriately educated, distributed and deployed to meet the health needs of all South Africans”. 196 This strategy was published in 2008. Important elements of this strategy are to provide sufficient numbers and appropriate categories of nursing skills through goodquality education and training and to maintain high standards, professionalism and quality in nursing practice. In 2004 the SANC revised the scope of practice of nurses into new categories: professional nurse, professional midwife, staff nurse, and auxiliary nurse. 197 New educational qualifications were developed which are aligned to the revised scope of practice. The SANC planned to phase out several nursing qualifications that had existed prior to the NQF by 30 June 2010. However, this deadline was extended due to delays in the publication of regulations to facilitate the implementation of the new scopes of practice for the different categories of nurses and their respective qualifications. 198 The implementation of the revised scope of practice and the new qualifications will follow in the near future and the success of implementation will depend in part on the availability of sufficient and suitably qualified educators with appropriate academic and clinical skills. 199 196 DoH. 2008. Nursing Strategy for South Africa. Published at http://www.sanc.co.za/pdf/nursing-strategy.pdf. (Accessed August 2010). 197 The previous categories were registered nurse, registered midwife, enrolled nurse and enrolled midwife. 198 South African Nursing Council. 2009. “Implementation of the new Nursing Qualifications registered on the National Qualifications Framework (NQF)”. SANC Circular 3/2009. Published at http://www.sanc.co.za/newsc903.htm. (Accessed August 2010). 199 DoH. 2008. Nursing Strategy for South Africa. Published at http://www.sanc.co.za/pdf/nursing-strategy.pdf. (Accessed August 2010). 73
Cuts in provincial health budgets for training, the rationalisation of public nursing colleges (and the subsequent closure and merger of many) have had an adverse effect on the supply of nurses. 200 b) Community service for health professionals The national DoH introduced community service in the public sector for 11 health professions between 1998 and 2007. Newly qualified health professionals serve one year of community service in underresourced areas to enhance access to healthcare and also to develop their own clinical skills independently from the lecturers at their institutions of training. 201 Each year a number of these health professionals are allocated to the SA Military Health Services and the Department of Correctional Services. The introduction of community service has alleviated shortages of health personnel in the public sector, especially in the rural areas. 202 In 2006 and 2007 the number of GPs increased by 20% (but declined again in 2008 when the two-year internship was introduced). The number of occupational therapists and physiotherapists in the public sector increased by at least 33% and 40% respectively, based on comparisons of the number of public sector posts available and the number of community service professionals. 203 Although community service helped to alleviate skills shortages in the public sector, the public health services still experience challenges in retaining professionals – especially in the rural areas. c) Salary adjustments A few years ago the DoH introduced rural and scarce skill allowances to attract and retain healthcare professionals in areas of greatest need. 204 The introduction of the occupational-specific dispensation for nurses in the public sector from March 2008 is also aimed at eliminating salary differentials between the private and public sectors and retaining scarce skills. Similar arrangements to retain doctors and midlevel category doctors in the public sector have been hampered by incapacity in provincial health departments. 205 The national DoH also agreed to implement occupational-specific remuneration for dentists, medical and dental specialists, pharmacist assistants, pharmacist and emergency medical services personnel, and a proposal was made for occupational-specific remuneration for therapeutic and related allied health professionals. 206 200 Breier, M., Wildschut, A. and Mgqolozana, T. 2009. Nursing in a New Era – The Professional Education of Nurses in South Africa. 201 National Department of Health. 2006. “Community service to improve access to quality health care to all South Africans”. Published at http://www.doh.gov.za (Accessed August 2010). 202 Lehmann, U. 2008. “Strengthening Human Resources for Primary Health Care” South African Health Review. 203 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). 204 Lehmann, U. 2008. “Strengthening Human Resources for Primary Health Care”. South African Health Review 2008. Health Systems Trust. Published at www.hst.org.za/publications/841 (Accessed August 2010). 205 Bateman, C. 2010. “Occupation-specific dispensation – a hapless tale”. South African Medical Journal. May 2010. 100 (5). Published at http://www.scielo.org.za/pdf/samj/V100n5. (Accessed August 2010). 206 National Treasury. 2010. “Vote 15: Health”. Estimates of National Expenditure 2010. 74
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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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In collaboration with the professio
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Information submitted by the depart
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2 PROFILE OF THE SECTOR 2.1 INTRODU
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2.3 EMPLOYERS IN THE SECTOR The hea
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) The South African Nursing Council
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several institutions are specifical
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development and care in areas such
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PERSAL database The PERSAL system k
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African Coloured Indian White Total
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In 2010, 460 000 people are employe
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Table 3-1 Health expenditure in pub
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Page 86 and 87: Table 5-10 Number of health-related
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Page 98 and 99: annual growth rate in professional
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Page 102 and 103: In Chapter 5 it was mentioned that
Page 104 and 105: Cape Peninsula University of Techno
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Page 108 and 109: National Treasury. 2009. “Health
Page 110 and 111: assistants”. Published at http://
Page 112 and 113: APPENDIX A SCARCE SKILLS LIST - PRI
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