MEETING THE MEETING THE CHALLENGES OF CHALLENGES OF
HIV/AIDS IN HIV/AIDS IN SOUTH AFRICASOUTH AFRICA
CAPACITY CAPACITY CONSTRAINTS CONSTRAINTS
Gustaaf WolvaardtGustaaf Wolvaardt MBChB(Pret),M.Med(Int)(Pret),FCP(SA), MBChB(Pret),M.Med(Int)(Pret),FCP(SA),
AMP(MBS),PGCHE(Pret)AMP(MBS),PGCHE(Pret)
CLINICAL CAPACITY CLINICAL CAPACITY
PRODUCTIONPRODUCTION
Doctors Output at the 8 medical schools around 1230 doctors per
year over the past 12 years HST estimated RSA needed 3,200 dedicated
doctors and 2,400 nurses in 2009 for ART ART Programs Programs only
Nurses Massive drop in production of RN’s by Nursing Colleges
from 2300/p.a. in 1996 to 1300 in 2004 , has been increasing the last few years
Pharmacists Dropped from 450 to 320 per annum
FPD
DISTRIBUTION DISTRIBUTION
% of Doctors in Private Sector
0
1020
3040
5060
7080
90100
GP's Spesialists Pharmacists Dentists
19902004
FPD
DISTRIBUTION OF HEALTH CARE PROFESSIONALS DISTRIBUTION OF HEALTH CARE PROFESSIONALS HEALTH AND HEALTH CARE IN SA (2004)HEALTH AND HEALTH CARE IN SA (2004)
Total Public Private
GP’s 19 729 5398 (27.4%) 14331 (72.6%)
Specialists 7826 1938 (24.8%) 5888 (75.2%)
Dentists 4269 316 (7.4%) 3953 (92.6%)
Pharmacists 4410 1047 (23.7%) 3363 (76.3%)
Psychologists 3808 222 (5.8%) 3586 (94.2%)
FPD
RETENTION RETENTION
A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CUMULATIVE TOLL – WE ARE LOSING
Financial Mail April 2006
FPD
incompetent/autocratic/waste10%
Professional issues / nursing not good9%
Academic collapse/ Insufficient funds for specialities/research2%
targeted by govt/ increasing legislation2%
stress / need quality of life/fed up/insecurity6%
Other8%
abused by mgment / no recognition/lack of respect21%
State not attractive option/ disfunctional/ workload/lack future/admin load16%
Not enough salary/ no increase/ cant cope financially15%
h/care not delivered / affordable/failing/basics not there11%
Reasons for leaving the public sector SAMA Reasons for leaving the public sector SAMA Survey 2003Survey 2003
OTHER OTHER
Impact of HIV/AIDS on health professions Ageing professional population (17 000
of 22 000 doctors currently in practice qualified before 1990
FPD
MANAGEMENT CAPACITY MANAGEMENT CAPACITY
Current situation
Unpublished industry report (Univ of Pretoria SHSPH) in 2006 showed that of 148 health care managers , working in the AIDS field (76% public sector) surveyed 54% of these managers never had 54% of these managers never had any form of management trainingany form of management training
These managers in total managed 28 000 health care workers
FPD
Core qualificationsCore qualificationsFPD
Solutions – National HR Plan for Health 2006
Increase production (doubling of output) Infrastructure and resource constraints ? 10% increase Plan does not adequately explore the potential of using the
private sector Mid-level workers
Pharmacy assistants – being developed for a number of years in both public and private educational sectors
Medical assistants (new category) Training for task shifting
Nurse practitioners with salaries that compensate them for these skills
Health Charter to include replacement offerings that will support HRH
Improve conditions of service i.e. accommodation at health facilities
POTENTIAL SOLUTIONS POTENTIAL SOLUTIONS
TO INCREASES CLINICAL RESOURCES Better align patients to providers
Outsource to private sector (for and not for profit organizations)
NHI
AIDS Service Organizations
HIV 911 database 2008 – 7000 AIDS Service Organization 2009 – 12 000
FPD
Rapidly improving service Rapidly improving service delivery – The PEPFAR lesson delivery – The PEPFAR lesson 4-5 billion rand per annum budget
channeled through 250 partners predominantly from civil society
No corruption scandals
FPD
POTENTIAL SOLUTIONS – FOREIGN POTENTIAL SOLUTIONS – FOREIGN DRS:DRS:FQDs AS A SOURCE OF SKILLSFQDs AS A SOURCE OF SKILLS
FPD
POTENTIAL SOLUTIONS – FOREIGN DRS: HAVING DR’S PARK YOUR CAR IS HAVING DR’S PARK YOUR CAR IS NOTNOT A SOLUTION A SOLUTION
POLICY
FPD
Do the logical thing See stable patients less often Nurse initiation of ART Counselors do finger pricks etc.
Increase production of providers Consider private higher education
institutions
IMPROVE MANAGEMENT CAPACITY Professionalise now !! Apply current rules on management
requirements Insist that all managers get appropriate
qualifications within a 2 year period Assess if managers apply skills
“ “ The best way to predict the future is to create it “ The best way to predict the future is to create it “
Peter DruckerPeter Drucker
Peter Drucker:Peter Drucker:
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