MAXIMIZING POSITIVE SYNERGIES - World Health Organization

It appears there is limited progress in translating global commitments on aid effectiveness into
concrete action at country level – principally in relation to reducing aid fragmentation, in line with
the Paris Declaration on harmonization and aid effectiveness. Even though South Africa has policy
guidelines on donor harmonization and alignment, the level of coordination among GHIs and
other donors is still low. Some do not work closely with government in planning, setting priorities,
implementing, monitoring and evaluating their programmes. Little attention has been paid to the
administrative and programme costs of either coordination or non-coordination. Parallel reporting
systems still exist, with duplication in the reporting systems of different stakeholders at district
level.
That said, there have been noted improvements of late in efforts at harmonization, alignment and
health system strengthening. These latest developments should be commended and encouraged,
with more support given to those spearheading the process. Bigger GHIs such as PEPFAR and
Global Fund should be encouraged to lead by example, by considering joint activities at country
level and examining how to supplement each other’s efforts. The prioritization of coordination by
government might be better served by integrating it as a line function of senior officials in the
NDOH.
One common concern amongst GHIs, other donors and government is the lack of sufficient health
care workers in South Africa, particularly in the public sector. Lack of health workers has been
recognized as a major constraint in the scale-up of HIV/AIDS programmes in both this study and
others [23, 24]. Competition for available labour by the public sector and the private sector,
including GHIs and other donors, as well as by overseas recruitment agents, increases high
mobility among more experienced, skilled labour in focal areas such as TB and HIV management.
The number of vacant posts in the public sector is still very high [17], though lack of HR forward
planning means this calculation is often based on out-of-date projections.
Despite severe staff shortages and migration of skilled labour in the health sector, there is no
available evidence of increased investment in overall human resources development from
government, GHIs or other donors, with HR efforts concentrated in specific focal areas. There has
been little support given to developing and producing more skilled labour, except for short-term
training in specific areas such as information systems, monitoring and evaluation and
management of TB and HIV/AIDS, among others. Evidence shows that the health workforce drives
a health system’s performance, and the production of more skilled labour as well as better
distribution and retention of existing workers are necessities [24].
GHIs and donors should aim to strengthen training institutions over the long-term, with shortterm
efforts concentrated on means of improving capacity without increasing workloads. Training
should include non-focal issues that indirectly impact on areas of concern, such as financial
management, HR forward planning, and the importance of monitoring or evaluation activities at
facility-level. Government should interact with such efforts to ensure comprehensive skills building
within facilities and in training institutions. Means of improving and sustaining effective
supervision should be investigated by the NDOH.
Weak information on the health workforce in South Africa hampers planning, policy and
programme development, and implementation [24]. Participants in this study acknowledged that
health workforce‐related information is still sparse and fragmented in South Africa and
emphasized the need for forward planning to develop HR plans that will accommodate contextual
challenges experienced by the country. The problems experienced by all parties demonstrate the
importance of partnership by government with all stakeholders involved in HR issues, including
GHIs and donors implementing different programmes across the country, as well as labour unions
and research institutions that collect significant amounts of data on HR. Therefore, a reliable and
regularly updated HR database for South Africa should be developed.
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