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