MAXIMIZING POSITIVE SYNERGIES - World Health Organization

NDOH to disburse external funds in the timeframe required by donors, in particular for HIV‐related
activities. In December 2008, the NDOH failed to channel a received Global Fund disbursement to
NGO recipients, with the Global Fund citing lack of required development around disbursement
capacity within the department.
Health Workforce
While GHIs do not provide direct funding for human resources, this study’s preliminary results
show that their interventions have significant impact on human resources for health at all levels.
South Africa, like many other African countries, is currently experiencing a general shortage of
skilled personnel in the public health sector, which is exacerbated by the problem of a high staff
turnover. The scale‐up of services associated with HIV‐related programmes has in general led to
increased workloads for existing health care workers. A GHI’s offer of technical assistance may
often exacerbate existing capacity issues by drawing away staff for training or concentrating
facility efforts on one set of health issues at the expense of others (ND2). It was noted by one donor
that scale‐up had been further hampered by government backtracking on the agreement that
nurses would be able to initiative ARV treatment, particularly in areas with few physicians (D2).
Both government and some GHI representatives acknowledge the problem of insufficient health
workers. For example, six out of nine TB/HIV coordinators trained by the NDOH in 2006 were
reported to have left the department by February 2009. Such turnover usually disrupts the
management and implementation of projects, with additional time needed to orient and train new
staff. Some donors have also seconded and trained staff on TB and HIV management who later
leave and join the private sector.
Informants linked mobility from government to GHI or donor‐funded programmes, especially ART‐
related projects, to remuneration differences and frustration with government’s HIV/AIDS policies.
Though GHI‐funded projects pay the same salaries as the public sector, there are fewer deductions
and therefore the take‐home amount “looks” higher (GHI1, ND2). Poor working conditions have
contributed to dissent in the public sector.
To address high staff turnover, the NDOH has developed staff retention strategies that encourage
staff to stay and also make working in the public sector more attractive, especially in rural areas.
However, these are targeted at clinical workers and have failed to increase supervision capacity
(ND2). Some donors work closely with government to identify gaps and second staff to
government projects for a specific period of time. Government public sector policy allows for GHI
funds to be used for short-term consultants, but such funds cannot support public sector salaries
(ND2). GHIs will occasionally negotiate with state structures to ensure higher salaries for staff
within the government salary structure (D2).
Donor funding has also been used to provide community health workers to CSOs, either
independently of government or through state health structures (GHI1, ND6). Overall, the
provision of specific training by GHI‐funded projects is regarded by the NDOH as having had
positive effects on HIV/AIDS service delivery (ND3). However, GHI-provided training tends to focus
on specific topics and fails to contribute towards an integrated approach to health care (ND3).
In these circumstances, human resource (HR) planning becomes a critical requirement, with
forward planning a crucial skill in the context of ever increasing numbers of TB and HIV/AIDS
patients. The NDOH acknowledges that there is minimal ability in the department to plan and
forecast HR needs. One respondent described HR managers under NDOH jurisdiction as generally
personnel managers who are only interested in personnel issues such as salaries and leave days
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