South African Health Review: Strengthening Human Resources

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South African Health Review Strengthening Human
Resources

• Presenter Dr. O. Shisana CEO HSRS
• Rapporteur Mr. G. Pillay
• Resource Department of Health

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Introduction Background

• Post-apartheid legislation and policies on health
  systems transformation
• Policies to improve human resource for health
• rural and scarce skills allowances
• Increased nurses and doctors salaries-OSD
• scholarships/bursaries for rural school leavers
  proviso return to these areas to work
• community service
• Importation of doctors to serve in rural areas
• Hospital rehabilitation

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Challenges 1

• Mal-distribution between public and private
  sectors
• 60 of nurses and 40 of doctors work in the
  public sector serving about 85 (41 million) of
  the population.
• 40 of nurses and 60 of doctors serve 15 of
  the population (7.4 million) with medical
  schemes
• Private sector also serves some of the uninsured
  people
• Challenges for health workers
• Poor physical infrastructure despite some
  improvements,
• The location of many public facilities in rural
  or inhospitable areas that are often difficult
  and dangerous to access,
• Staff shortages,
• The extent of the disease burden fear of
  contracting HIV or TB,
• Heavy work load, and
• Low salaries.

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Challenges 2

• Decrease in Medical doctor graduates from all
  eight medical schools
• Under-production of doctors (2007 1122) coupled
  with a loss of 1 000 p.a.
• The increase in registrations of nurses each year
  falls far short of the number trained. Attrition
  rates over a ten year period ranged from 66 per
  cent for professional nurses to 72 per cent for
  Enrolled Nurses (EN) and Enrolled Nurse
  Assistants (ENA).

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Challenges 3

• Poor physical infrastructure despite some
  improvements,
• The location of many public facilities in rural
  or inhospitable areas that are often difficult
  and dangerous to access,
• Staff shortages,
• The extent of the disease burden fear of
  contracting HIV or TB,
• Heavy work load, and
• Low salaries.

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Leadership Strategies

• Focus on and improve Targets proposed by the NHRH
  Planning Framework (DOH, 2006) vs. actual
  production, 2002 to 2007
• Define norms and standards for Health Service
  delivery
• Address decline in production of doctors
• Re-assessment of public sector nurse training -
  continue opening nursing colleges
• Reprioritisation in provincial and hospital
  budgets so that public sector resumes its role in
  the production of enrolled nurses and enrolled
  nurse assistants.
• Re-assess projected health professional
  production totals in the light of the HIV, AIDS
  and TB epidemics
• Address career progression of community and
  mid-level cadres particularly the need for
  HIV/AIDS lay counsellors.
• Address training of emergency care practitioners
  with attention to the implications of stopping
  modular training.
• Allocation of more resources to public
  institutions of higher education including
  strengthening responsive institutions such as
  Medunsa.

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Management Strategies

• Managers of health facilities must have formal
  management skills and knowledge of health
• Managers manage- medical prof. treat
• Changes in management culture towards
  decentralised and empowered management and a
  renewed focus on the building of a multi-skilled
  and multi-facetted team within districts and
  institutions
• Focus on Information management and
  administration systems

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Collaboration

• Production Training professional
  registration- employment- cpd - retention
• Improve information systems for HR planning
• The HPCSA public/private in-country or out of
  country
• PERSAL inaccurate for research
• Labour Force Surveys conducted by StatsSA not
  occupation specific
• Staff who moonlight in public or private sector
  are not captured
• Policy developers, implementors, social partners
  must work in a cohesive framework

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Public Private Partnerships

• End outsourcing of support services Reduce
  outsourcing poor salaries, quality and detracts
  from medical professionals core work.
• Outsourcing of support services has a detrimental
  impact on morale of staff because the wages and
  benefits of those affected have been cut an
  estimated 40
• Short of support service staff, leads to nursing
  staff performing that function---undermining
  quality care for patients
• Solution
• Ending outsourcing and the reintegration of the
  support service staff into the public service.
• Addressing the wage-gap particularly in relation
  to the support service staff and
• developing a career-pathing programme as part of
  the human resource development plan.

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Capacity Building 1
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Capacity Building 2
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Recommendations

• Public sector assume its training role
• Training mid-level workers
• Focus on Models of excellence
• Retention strategies and International Pacts on
  management of foreign recruitment