For some categories of health professionals, including medical practitioners, pharmacists and allied health professionals, the numbers working in the public sector have increased. However, there is still a critical shortage of health professionals in the public sector in South Africa, and for some categories, such as medical specialists and enrolled nurses, there has been a decline in the numbers employed. Over the past decade there has also been a decline in the production of professional nurses, although in 2004 there was a reversal of this trend. In addition the selected targeting of the rural and scarce skills allowance has created dissatisfaction among categories of health workers, especially professional nurses, who are excluded.
These are some of the findings of the 2005 South African Health Review.
The 10th edition of the widely acclaimed South African Health Review (SAHR) was launched in Durban today (7 September 2005). This edition of the SAHR Review focuses on human resources for health and underscores the many challenges faced by the Department of Health (DoH) in implementing transformation in the health sector. The focus on Human Resources brings home the magnitude of the challenge as chapter after chapter reiterates that the critical block to policy implementation is both an absolute shortage, as well as a skewed distribution, of personnel in the public sector.
By 2009, South Africa will need approximately 3 200 doctors, 2 400 nurses, 765 social workers, 765 dieticians, 112 pharmacists and 2000 data capturers to implement full roll out of the antiretroviral component of the Operational Plan for Comprehensive HIV and AIDS Care Management and Treatment, in addition to existing staff shortages in the public sector.
This years Review makes it clear that the HR crisis cannot be resolved by DoH alone the underlying causes extend far beyond the remit of one department an approach including other sectors such as education, finance, as well as the private sector, is necessary to address the challenges, said CEO of the HST, Dr Lilian Dudley.
Within the health system, factors contributing to shortages include poor working conditions, job satisfaction, low levels of pay, lack of skilled managers and the HIV/AIDS pandemic. Globalisation has created conditions that facilitate migration of health workers from SA to countries perceived to offer better pay and working conditions. The impact of the General Agreement on Trade in Services (GATS) which seeks to liberalise trade in health services is likely to exacerbate the situation and reinforce the existing maldistribution and migration of health personnel.
At a national level, one major challenge lies in the often adversarial relationship between the powerful private health sector and equity oriented policies of the DoH, with several court challenges to legislation from the private sector. This years SAHR examines the stewardship role of government in relation to the private sector and concludes that greater commitment and involvement of the private sector is required in order to create an equitable national health service.
Critical areas highlighted for urgent policy attention and implementation include development of an alternative cadre of mid level health workers, developing both corrective and protective strategies to attract and retain health care workers and focusing on soft issues such as human resource management, communication and staff development.
The release of the SAHR is timely as it is anticipated that the information contained in the Review will be instrumental in informing discussion around the development of an HR plan based on the Department of Healths Strategic Framework for Human Resources. For example, research cited in the Review shows that there has been some success in implementing a strategy for pharmacy assistants, community health workers have been shown to be a valuable and cost effective resource and initiatives to develop a comprehensive Human Resource Information System will provide much needed intelligence on various aspects of human resources management, said Dudley.
Without a foundation of skilled human resources, health care systems cannot function adequately or effectively particularly in the public sector and at the primary level of care. This years Review illustrates the importance of the health worker, concluded Dudley.
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