sector skills plan for the health sector in south africa

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d) The introduction of mid-level skills A new category of mid-level health workers, so-called “clinical associates”, was introduced in 2004 to improve coverage of PHC and service delivery in under-resourced areas. 207 Clinical associates are required to work under the supervision of doctors and assist them with emergency care, procedures and in-patient care in district hospitals. 208 They enter practice after completing a three-year Bachelor of Medical Clinical Practice degree offered at the Walter Sisulu University, the University of Pretoria and the University of the Witwatersrand and after serving one year of community service. Analysts have commented that progress with the development of these mid-level skills has been slow and that the graduation numbers are too low to offset the shortage of professionals. 209 A further constraint is that the public sector may not have created the posts in which to accommodate these mid-level health workers. According to certain authors there still appears to be uncertainty about their roles. 210 In order to improve access to emergency medical services, the national DoH intends to increase output of emergency care technicians from training colleges from 127 in 2009/10 to 160 in 2012/13. 211 Health authorities are considering the introduction of mid-level workers in the field of nutrition, but a final decision has not been made. 212 Other training programmes aimed at developing mid-level workers may include new pharmacist technicians, forensic officer technicians, radiation technicians and dental assistant technicians. 213 During 2010 to 2013 specific measures will also be taken to develop and train more emergency care technicians, nurses and health managers. 214 5.8.2 MANAGEMENT OF THE PUBLIC SECTOR HEALTH FACILITIES The DBSA Roadmap process found that many of the human resource problems in the public sector arise from institutional problems in the public sector itself. 215 Institutional factors such as poor planning, substandard clinical care, poor governance, inadequate management systems, lack of effective controls, low levels of organisational responsibility for actions and failures, and inadequate devolution of authority to make effective operational decisions about patient care all have an impact on how effective skills are deployed. The effectiveness of skills development and training programmes for middle and senior 207 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). 208 Faculty of Health Sciences. 2010. Faculty of Health Sciences Prospectus 2010. Mthatha: Walter Sisulu University. Published at http://www.wsu.ac.za/academic/images/resources (Accessed August 2010); University of the Witwatersrand. Published at http://web.wits.ac.za/Prospective/...../Health/UndergraduateDegreesAndDiplomas.htm. (Accessed September 2010) 209 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). 210 Hugo, J. 2005. “Midlevel health workers in South Africa – not an easy option” in Ijumba, P. and Barron, P. (eds). South African Health Review 2005. Durban: Health Systems Trust. Published at http://www.hst.org.za/uploads/files/sahr05_chapter11.pdf (Accessed August 2010); 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). 211 National Treasury. 2010. “Vote 15: Health”. Estimates of National Expenditure 2010 212 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). 213 HWSETA. 2009. HWSETA Sector Skills Plan 2005-2010: Annual Update August 2009. 214 National Treasury. 2010. “Vote 15: Health”. Estimates of National Expenditure 2010. 215 Development Bank of South Africa. 2008. A Roadmap for the Reform of the South African Health System. 75
managers is compromised as working environments are not conducive to change and innovation. 216 Other research found that poor treatment of doctors and other health professionals in the public sector was the major reason for them leaving the public sector and the country. 217 If this situation does not improve quite drastically, other interventions to retain staff and to increase the supply of skills may prove to be ineffective. 5.8.3 MIGRATION OF PROFESSIONALS Emigration of professionals and their migration from the public sector to the private sector directly impact healthcare delivery and outcomes. Research has identified a number of factors that contribute to increased emigration in the healthcare sector – including remuneration, working conditions, job satisfaction, medical infrastructure, safety and risk of disease, along with more general concerns regarding political stability, crime, and standards of service delivery. 218 South African health professionals are a sought-after resource. 219 By 2007 more than 20 foreign commercial recruitment agencies were working locally to recruit and place South African health professionals overseas. 220 Public sector health services in South Africa have been particularly hard hit by emigration and migration. Migration inside South Africa takes place on two levels: from the public to the private sector and from rural to urban public sector facilities. 221 Recent calculations estimated that up to 50% of the almost 2400 medical graduates for 2006 and 2007 would leave the country. Of the remaining 1200 approximately 75% would work in the private sector, leaving about 230 to work in urban public facilities and perhaps 70 or 2.9% of the graduates to work in rural public facilities. 222 Burnout due to a combination of workload, under-staffing, lack of resources, high-risk working conditions, poor local hospital management and dysfunctional administration is another factor contributing to public-private sector migration. 223 Doctors and nurses are often ill-prepared to work in PHC facilities and complain of poor support while they work there. 224 In an attempt to address the difficult working conditions, two trade unions – DENOSA and Solidarity – are calling for the introduction 216 Lehmann, U. 2008. “Strengthening Human Resources for Primary Health Care”. South African Health Review. Published at www.hst.org.za/publications/841. (Accessed August 2010). 217 Wolvaardt, G., Van Niftnik, J., Beira, B. et al. T. 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). 218 Macheke, C. 2010. HWSETA Health Sector Baseline Study. 219 Macheke, C. 2010. HWSETA Health Sector Baseline Study. 220 Bateman, C. 2007. “Slim Pickings as 2008 Health Staff Crisis Looms”. South African Medical Journal. November 2007. 97 (11). 221 Macheke, C. 2010. HWSETA Health Sector Baseline Study. 222 Bateman, C. 2007. “Slim Pickings as 2008 Health Staff Crisis Looms”. South African Medical Journal. November 2007. 97(11). (Accessed August 2010). 223 Bateman, C. 2007. “Slim Pickings as 2008 Health Staff Crisis Looms”. South African Medical Journal. November 2007. 97(11). (Accessed August 2010). 224 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); Day, C. and Gray, A. 2008. “Health and Related Indicators”. South African Health Review. Health Systems Trust. Published at http://www.hst.org.za/uploads/files/chap16_08.pdf. (Accessed August 2010). 76
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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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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
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 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
Page 106 and 107: http://www.hwseta.org.za/upload/sec
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
Page 114: OFO Code OFO description Private he
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