Health care provider

PRESS RELEASE: EMBARGOED UNTIL 19H00, WEDNESDAY 7 SEPTEMBER 2005

Most sections of the National Health Act, which lays the foundation for efficient delivery of Primary Health Care to all citizens, have now come into effect. In addition a draft strategic framework for Human Resources, which sets the basis for a long term Human Resources for Health plan and priority areas for immediate action, has been released by the Department of Health to address HR challenges in the country.

The worldwide shortage of health workers means that rich countries are not likely to stop poaching health workers from poorer countries.

Education Minister Naledi Pandor said yesterday that the current funding model for the training of doctors, dentists and pharmacists was fundamentally flawed, and urged Health Minister Manto Tshabalala-Msimang to help develop a co-ordinated system.

Employers abuse and neglect the Occupational Health and Safety (OH&S) of health workers in Municipal Clinics around the country, according to research recently released by the Municipal Services Project (MSP), the Industrial Health Research Group (IHRG) and the South African Municipal Workers Union (SAMWU).

An extra four million health workers are needed if global health is going to improve over the next decade, a group of 100 health leaders says. The Joint Learning Initiative, which includes the World Health Organization, said a lack of investment is limiting the chance of tackling disease.

There is series of articles on the Brain drain in this Bulletin

STAFFING NORMS FOR PHC

It is important to remember

An estimated R500 m earmarked by the treasury to retain skilled health professionals could be withdrawn if government and unions fail to reach agreement by March next year on which category of worker is eligible for the payments. The funds, which are expected to increase to R1bn in the next two years, will be used to increase the allowances of health professionals in rural areas and those who possess scarce skills. The money was set aside after an agreement between the health department and unions in the sector in a bid to prevent health professionals from leaving the country for better paying jobs overseas. The unions include the National Education, Health and Allied Workers' Union, the Democratic Nursing Organisation of SA (Denosa) and the Public Servants' Association (PSA). It is understood, however, that the unions have so far refused to sign the agreement, claiming that government had unilaterally determined the criteria for selecting the health officials. It is believed that these unions would also like to have other categories of workers included. Currently, only professional nurses are eligible for a rural allowance. The unions have objected to this, calling on government to extend the rural and scarce skills allowances to assistant and staff nurses. The health department was not available for comment yesterday, but it is understood that Health Minister Manto Tshabalala-Msimang urged unions last week to accept the offer so that allowances could be disbursed before the end of this month. The department has only included highly trained health professionals in its list of workers who qualify for the scarce skills allowance. These are medical and dental specialists, dentists, medical doctors, pharmacists, pharmacologists, dental technicians, psychologists, dieticians and nutritionists, occupational therapists and physiotherapists, radiographers and speech therapists. The allowances will see the salaries of these workers increasing between 12% and 17%. The rural allowance ranges from 12% to 22%. Nurses in rural areas will qualify for only 12%, while doctors qualify for 22%. The exclusion of nurses in one category and the lower percentage due to them may be seen as slap in the face. Health professionals, particularly nurses, are leaving SA in large numbers. The discrepancies have annoyed Denosa, which feels that the amounts should be the same for all workers in rural areas. Denosa chief negotiator Jabu Magagula was confident yesterday that the agreement would be signed before March. PSA GM Anton Louwrens said his union was willing to sign the agreement, despite some reservations about the selection method. The allowances are to be backdated to July this year, but Denosa has proposed that they be paid from the date of implementation the saving can be used to accommodate all categories of nurses. ( Source: Business Day, 10 December 2003).

There have been reports on the number of unfilled posts and other related staffing matters within the public health sector. Health workers and professionals are the most critical resource in the delivery of health care. Their movement between rural and urban areas, public and the private health sector and across our borders is bound to impact on service delivery. Positive efforts such as the increase in access to health care on the one hand and the complex nature of the burden of diseases in the country on the other, are some of the factors that have put strain on human resources. We believe that if there is a major - and insidious - threat to our overall health effort, it is the continued outward migration of key health professionals, particularly professional nurses, with a consequent de-skilling of the professional base in both the public and private sector. The government is making efforts to mobilise resources to address these challenges within the context of competing social needs. The Department of Health in particular has taken several measures to ensure that sufficient personnel is recruited and retained to enable us to provide quality health care within the public sector and particularly in underserved and rural areas. We are extending community service to cover all health professions and many of the community service professionals are deployed in historically disadvantaged areas. The programme covering doctors, dentists and pharmacists is already meeting its objectives. Starting from next year, we will be phasing in radiographers, speech and hearing therapists, occupational therapists, environmental health officers, dieticians, psychologists and physiotherapists ending with the professional nurses by 2007. This should make available a pool of thousands of health professionals who can assist in providing health services mainly in historically underserved or disadvantaged areas. The 254 students we sent to study medicine in Cuba are completing their studies and the first group has already returned to South Africa. These young people will serve in the public sector for the equal number of years they have spent studying. They are students from historically disadvantaged communities who will get a wonderful opportunity to come back and serve their communities as doctors. Together with the MECs for Health, we have resolved to visit all provinces to get first hand experience of the functioning of the provincial and local health system all over the country. Where there are problems, we work together to ensure that they are addressed. The visit to the Eastern Cape, for instance, identified challenges relating to human resources, particularly staffing levels in some institutions. A massive recruitment effort has been undertaken and career progression of staff is being unblocked. A team of officials have been mobilised from the national and other provincial departments to assist the Eastern Cape in this endeavour. Together with the Health MECs, I have directed the Department of Health to work with the private sector, nursing organizations, trade unions and other relevant bodies to conclude a clear framework for attracting and retaining nurses. There are a number of incentives including the improvement of working and living conditions for our health professionals in the rural areas that are being investigated and a set of proposals is to be tabled for consideration by the MECs and myself shortly. Since migration of health professionals is an international problem facing many of the developing countries, we have also sought global solution to this challenge. At the World Summit on Sustainable Development, we spoke strongly against the recruitment of our health professionals to the developed countries. We have also developed a Code of Conduct for Recruitment of Health Professionals for the Commonwealth of Nations. This initiative should at least address the challenge of movement of personnel amongst Commonwealth member states. None of us underestimated the challenges we would face in transforming the health system. These challenges are a reminder of the task that remains before us. They require our collective efforts as government, private sector, health workers or professionals and the civil society. A commitment to improve the health of fellow South Africans should be our source of inspiration in addressing these challenges.(Source: Dr Manto Tshabalala-Msimang Minister of Health, Department of Health, Press release,23 0ctober 2002)

Scope of community service to widen The health department's controversial compulsory community service for newly qualified medical professionals would be expanded massively to include seven more categories of practitioners, Health Minister Manto Tshabalala-Msimang said yesterday. The present community service system for newly qualified doctors, dentists and pharmacists was implemented in spite of broad criticism, particularly from young doctors. It is government's mechanism to try to alleviate the drastic shortage of health practitioners in rural areas. Introducing her budget vote yesterday, Tshabalala-Msimang said the system it would be expanded next year to include physiotherapists, radiographers, occupational therapists, speech and hearing therapists, clinical psychologists, dieticians and environmental health officers. One of the reasons for community service is that government pays significant amounts for the training of each doctor, dentist and pharmacist, and student fees do not cover this. The minister did not explain how this applies to the new categories. Tshabalala-Msimang said in the National Assembly that the system of community service was providing significant relief when it came to the shortages in rural areas. It was estimated that 26% of public sector dental posts and 31% of pharmacy posts were filled through community service in 2001. This year the programme will put no fewer than 1742 young doctors, dentists and pharmacists into the field. She said the department was also working hard to improve the quality of supervision for new practitioners in the rural areas. We harvest our first crop of nine graduates in our Cuban medical training programme in September. Candidates were recruited largely from rural provinces and are contracted to work in (those provinces) for 10 years. At present we have 252 students in Cuba and a further 71 will depart this year, said Tshabalala-Msimang. Democratic Alliance health spokesman Mike Ellis said public hospitals had experienced enormous problems in retaining staff as a result of slashed budgets and a moratorium on recruitment. At the same time many doctors and nurses continue to leave for the private sector and overseas. The 2002 SA health review identified various problems as contributing to low morale amongst healthcare providers, including huge demands, difficulties in prioritising, inadequate management skills, lack of rewards for competence or sanctions for incompetence and hierarchies that are too rigid. Ellis said that community service had failed to alleviate the crisis in rural hospitals, with 83% of those doing community service going to urban hospitals. New National Party (NNP) MP Kobus Gous said the brain drain was of concern because recent figures showed that 33% of all newly qualified doctors were leaving the country.(Source: Business Day, 5 June 2002)