sector skills plan for the health sector in south africa

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of legally enforceable nurse/patient ratios to bring nurses back to practise and to boost training outputs. The implications are that if the nurse/patient ratio is reached, patients will either wait to be admitted, or be refused treatment, or wards in under-staffed hospitals and facilities will have to close in order to reach the prescribed nurse/patient the ratios. 225 5.8.4 THE IMPACT OF HIVAND AIDS Workers in the health sector are required to treat, counsel and care for patients infected with HIV and AIDS. Unlike workers in other sectors who risk HIV infection due to human and social behaviour, health workers are exposed to additional infection risks in the workplace on a daily basis. The nature of their work makes them more vulnerable to infection risks from HIV and tuberculosis. Surveys have found that as many as 46% of in-hospital patients in the public sector may be HIV positive, while more than 36% of private sector patients were infected. Exposure to these conditions increases the risks of illness and premature death among staff and adversely affects worker morale. 226 In turn, service delivery in the health system is affected by absenteeism, loss of skills due to preventable deaths, and the risk of neglect as a result of increased patient load. 227 By 2002 an estimated 15.7% of health workers employed in the public and private sectors were living with HIV and AIDS. Among younger health workers in the age group 18 to 35 years, the risk of infection was higher and the estimated HIV prevalence was 20%. Non-professionals had a higher HIV prevalence of 20.3% compared to professionals at 13.7%. Studies have recorded a high HIV prevalence among nurses at 16%. Of the total number of health workers who died from 1997 to 2001, it was estimated that 13% died from HIV and AIDS-related illnesses. 228,229 5.8.5 RECRUITMENT OF FOREIGN HEALTH WORKERS Since 1994 the national DoH has entered into agreements with foreign governments (including Cuba, Iran and Tunisia) to recruit and employ foreign doctors in the public health sector. The DoH also recruits in the UK, where the number of medical graduates exceeds the number of registrar posts available. 230 An estimated 15% of the country’s public sector health posts are filled by foreign-qualified doctors, well below the 25% norm applied in the UK and United States. Concerns were raised recently that a 225 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/V2009n8. (Accessed August 2009). 226 Lehmann, U. 2008. “Strengthening Human Resources for Primary Health Care”.South African Health Review. Health Systems Trust. Published at www.hst.org.za/publications/841. (Accessed August 2010). 227 Shisana, O., Hall, E., Maluleke, J. et al. 2004. The Impact of HIV/AIDS on the Health Sector – National Survey of Health Personnel, Ambulatory Patients and Health Facilities, 2002. 228 Shisana, O., Hall, E., Maluleke, K.R. et al. 2004. The Impact of HIV/AIDS on the Health Sector – National Survey of Health Personnel, Ambulatory Patients and Health Facilities, 2002; Shisana, O. Hall, E., Maluleke R. et al. 2004. “HIV/AIDS prevalence among South African health workers. South African Medical Journal October 2004. Vol. 94 (10). Published at http://ajol.info/index.php/samj/article/view/13643. (Accessed August 2010). 229 Macheke, C. 2010. HWSETA Health Sector Baseline Study. 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). 230 Bateman, C. 2007. “Slim Pickings as 2008 Health Staff Crisis Looms”. South African Medical Journal. November 2007. 97(11), pp 1020-1024. 77
substantial number of foreign doctors (an estimated 300) are qualified, skilled and available in South Africa to serve in the public sector, but that bureaucratic delays (specifically in the registration with the respective professional councils) are preventing their deployment. 231 The DoH will continue to cooperate with countries that have an over-supply of healthcare professionals and recruit foreigners to be deployed in the public sector and adopted a new policy in 2009, which is aligned to international recruitment protocols. 232 5.8.6 SOCIO-ECONOMIC REALITIES OF POTENTIAL LEARNERS Lastly, prevailing socio-economic realities and the lack of equal educational opportunities for different population groups continue to impact the number of African black learners who enter the health professions. Long training periods mean that aspiring health professionals forego earning an income for many years and this deters people especially persons from lower socio-economic positions from entering the professions. The relatively high costs of education in the health sciences, compared with other tertiary programmes, may also affect the supply of skills. 5.9 CONCLUSIONS A combination of complex factors influences the supply of skills to the health sector. At the heart of the problem are the number and quality of learners who complete high school. The secondary school system is producing fewer candidates with the combination of mathematics, physical sciences and/or life sciences required to enter tertiary-level studies in the health sciences. Quality standards of education in mathematics, physical sciences and life sciences are major supply-side constraints impacting on the skills of the health sector. Sub-standard levels of literacy and numeracy skills of school leavers and their poor level of readiness for tertiary studies further reduce the supply pool. Existing institutional arrangements and regulatory provisions regarding the training of health professionals also restrict the supply of skills to the sector. Most of the health professionals who are required to register with the HPCSA, the SANC, the SACP and the SAVC are trained by universities and universities of technology, and undergo practical training in state-owned academic health complexes. Production levels at these institutions are limited because of capacity and budget constraints. Opportunities to train healthcare professionals in the private sector are limited as private HEIs appear to be challenged in meeting the extensive accreditation requirements for the training of health professionals set by the professional councils and the HEQC. With the exception of basic health care sciences, the growth in supply of new graduates from the higher education system has been moderate, and even low over the last decade. This trend is carried through to the registration of health professionals with their respective professional councils. The average 231 Bateman, C. 2010. “Ham-fisted policies, overworked officials put foreign doctors ‘on ice’”. South African Medical Journal. March 2010. 100 (3). Published at http://www.scielo.org.za/pdf/samj/V100n3. (Accessed August 2010). 232 Department of Health. 2010. “Health Sector Strategic Framework: The 10 Point Plan” in the Strategic Plan 2010/11-2012/13. Published at http://www.doh.gov.za. (Accessed August 2010); National Treasury. 2010. “Vote 15: Health”. Estimates of National Expenditure 2010. 78
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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
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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
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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 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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