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HUMAN RESOURCES FOR HEALTH
SOUTH AFRICA HRH Strategy for the Health Sector:
2012/13 – 2016/17
National Health Consultative Forum Presentation Context
• On 11th October 2011 the Minister of Health launched the HRH Strategy at Wits University
• Phase 1 of Implementation has been led by the DG for Health, Ms M P Matsoso
• The HRH Strategy has received a positive response from people in the health services, the professions, donors, Faculties of Health Sciences and provincial departments of health
• The challenge is ensuring action and sufficient resources
• The role of stakeholders is essential – stakeholders need to take what is relevant for their sector or role – and act on it
• At the launch it was noted that the culture and character of HRH for the future in SA (next 30 years) will be determined by what we did going forward from the launch of the strategy
• Have we optimally risen to the challenge?
Presentation
• Problem statement as stated in Human Resources for Health Strategy in 2012
• Strategic Priorities
• And progress made
We need to critically assess what we have achieved and what needs to be done
Suggestions in this meeting and after are welcome.
HRH Strategy - Problem Statement3 Themes
The strategy aimed to address the problem statement
HRH Strategy - Problem Statement3 Themes
The strategy aimed to address the problem statement3 Themes identified:
Equity and access to health professionals Education and training – production of the health workforce The working environment of the health workforce
Equity and access to health professionals Stagnation in growth and mal-distribution (urban/rural and public/private) SA – very poor health professional to population ratios for level of
development Lack of data quality on human resources Lack of retention of graduates Attrition and Migration (25% CS professionals) Issues with the supply and the recruitment of foreign health professionals
HRH Strategy - Problem Statement3 Themes (slide 2)
The strategy aimed to address the problem statement Education and training – production of the health workforce
Lack of growth in the professions – no growth of doctor output Freezing of registrar posts and academic clinicians Problems in nursing education especially quality and appropriate numbers by type Decline in output of research, especially clinical research Almost minimal training in 4 out of 9 provinces which affects access to health
professionals with many professions not being trained in E Cape AHC organisational infrastructure, financing flows and accountability
The working environment of the health workforce HR management and planning Performance and motivation RWOPS and moonlighting The quality of professional care
HRH SA Vision Mission and Values
HRH SA Vision Mission and Values
VISION
A workforce developed through innovative education and training strategies and fit for purpose to meet the needs of the re engineered health system and measurably improve access to quality health care for all by 2030
MISSIONTo ensure a workforce fit for purpose to meet health needs by:Ensuring necessary and equitable staffing of the health systemDeveloping health professionals and cadres to meet health and health care needsEnsuring the health workforce has an optimal working environment and rewarding careersEnsuring innovative and efficient recruitment and retention of the health workforceEnabling clinical research which enhances clinical and service developmentProvide professional quality care which is effective and evidence basedProviding the organization and infrastructure for health workforce developmentEnsuring the regulatory, organisational environment and leadership by NDoH to support HRH
VALUES Patient Centred Quality Care Universal Access Innovation Caring
HRH for South Africa is informed by the need to:provide patient centred quality health careensure universal coverage and universal access to health care and to enable an innovative and caring environment for health professional development and patient care
HR Strategy HRH SA 8 Thematic Areas for Strategic Priority
HR Strategy HRH SA 8 Thematic Areas for Strategic Priority
Leadership, governance and accountability
Health workforce information and health workforce planning
Reengineering of the workforce to meet service needs
Upscale and revitalise education, training and research
Create the infrastructure for workforce and service development - Academic Health Complexes and nursing colleges
Strengthen/professionalise the management of HR and prioritise health workforce needs
Provide professional quality care – skills and motivation of health professionals
Improve access in rural and remote areas
Growth in public sector expenditure 2006/7 – 2010/11
In 2010/11 doctors and specialists cost R16bn of the R58,9bn
Growth in public sector expenditure 2006/7 – 2010/11
In 2010/11 doctors and specialists cost R16bn of the R58,9bnTable 1: Growth in public sector expenditure on the health workforce, 2006/07–2010/11 (R million)
Province 2006/07 2007/08 2008/09 2009/10 2010/11 Average annual growth
Eastern Cape 3,860 4,563 6,085 7,397 8,392 29.5%
Free State 2,012 2,352 2,881 3,144 3,777 23.4%
Gauteng 5,347 6,519 8,158 9,877 12,225 31.7%
KZN 6,629 8,644 10,077 12,126 12,940 25.0%
Limpopo 3,311 4,044 4,692 5,594 6,617 26.0%
Mpumalanga 1,628 1,992 2,603 3,073 3,614 30.5%
Northern Cape 621 786 891 1,034 1,278 27.2%
North West 1,914 1,983 2,537 2,877 3,269 19.5%
Western Cape 3,419 4,139 4,876 5,780 6,805 25.8%
Total 28,740 35,022 42,801 50,903 58,919 27.0%
Disturbing drop in specialist numbers
YEAR .08/09 .09/10 .10/11 .11/12 .12/13EASTERN CAPE 7.70% 10.70% 31.70% -5.30% -5.60%FREE STATE 3.20% -3.60% -5.60% 0.30% 4.00%GAUTENG 6.00% 8.00% 3.20% 1.50% 0.70%KWA-ZULU NATAL -3.20% 4.90% 6.60% 14.20% 9.40%LIMPOPO 14.10% 17.50% -11.40% -5.90% -3.20%MPUMALANGA -3.60% -9.30% 24.50% 13.10% 0.00%NORTHERN CAPE 0.00% 10.00% -13.60% 0.00% 0.00%NORTH WEST -5.90% 50.00% 11.10% 7.50% 19.80%WESTERN CAPE 6.00% 3.10% -4.60% -0.20% 9.70%Total 4.40% 5.60% 1.60% 2.40% 4.70%National Treasury 2012
Table 2 Specialists percentage increase & decrease
The health sector has to seek greater efficiency andimprove financial management -
Mid Term Budget Statement 2012 Page 29• No increase in MTEF for the public sector
• There is no expansion in personnel budget over three years (after compensation increase)
• In fact there is a slight decline
• BUT planning training of doctors and health professionals is a medium – long term issue and must be managed in times of financial constraint
• We cannot afford a repeat of the 1996 – 2000 squeeze on academic clinician appointments, AHCs and health professional development
• Need to plan carefully and have good information on HRH – we do not have this
Table 3: Expansion on Intake for MBChB for 2012 and 2013
University Approved June 2012 Actual 2012 increase 2013 approved by
NDoH
Stellenbosch 20 40 60
Cape Town 20 20 40
Wits 45 45 90
Medunsa 20 95 95
Walter Sisulu 20 20 40
UKZN - - 40
Free State - - -
Pretoria 20 - 60
TOTAL 145 220 425
Table 4 Number Implications of 5% Expansion to 2025
Table 4 Number Implications of 5% Expansion to 2025
Profession Enrolled 2010
Graduates2010
Enrolled 2025
Graduates 2025
Graduates 2035
MBChB 8589 1298 15549 1954(inc 656)
2351(inc 1053)
Dentistry 1137 214 2144 309 376
Pharmacy 1966 405 3893 686 794
Physiotherapy 1373 326 2718 558 645
Occ Therapy 1032 203 2043 347 402
SLP & Audio 659 157 1305 236 273
Table 5 Implications of 5% expansion for ratio per 1000 popn
Brazil Chile Costa Rica Colombia Thailand Argentina
DOCTORS 1.8 1.7 2.5 1 0.9 3.2 0.54
Graduate increase and result per 1000 populationYear 2012 2015 2020 2025 2030Graduates 5% inc 1298 1298 1488 1818 2239no attritionDoctors per 1000 popn 0.52 0.59 0.69 0.82 0.97
International benchmarks per 1000 populationSA current
Options to consider in MBChB & health professionals expansion –
requires close co-operation with DHET• Ensure existing faculties of health sciences, especially medical schools are
operating at full capacity (intake in some faculties for all the professions is low )
• Ensure quality of output for all faculties and efficiency of throughput
• Expand existing medical schools which have capacity
• Expand existing medical schools through extending the service training platform to rural & peri-urban areas (Eastern Cape, Limpopo, North West, Kimberly, and Mpumalanga)
• Establish one or more new undergraduate medical schools and/or faculties of health sciences
• Extend postgraduate training to private sector service sites, and teaching arrangements by private academic clinicians in the public sector
• Explore the feasibility of the development of Public Private Partnerships for a service platform for undergraduate training in areas of need, for example the Eastern Cape and even in urban areas (reduce cost of training on the public sector)
Programme 5
2011/12 2012/13 2013/14
Sub Prog Medium - term estimates
Nurse c olleges 1,930,748 1,956,757 2,047,846
EMS c olleges 118,225 138,307 144,970
Bursaries 394,472 422,827 448,905
P HC t raining 390,322 411,304 430,920
Training other 859,169 915,847 971,043
Total 3,692,936 3,845,042 4,043,683
Other related
HPTDG 1,977,310 2,076,176 2,190,366
HEIs 2,653,225 2,812,418 2,981,164
Source: National Treasury 2011 .
Table 6 Health Science Education & Training
Way Ahead
• Stakeholder comment and involvement• Priorities the same
Leadership and managementInformationGrowth in the professionsQuality of professional careManagement and planning of HRHRural access and development
COMMENT AND SUGGESTIONSTHANK YOU
Sa doctores
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