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 Statement
3 Themes
The strategy aimed to address the problem statement
3 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 Statement
3 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
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
MISSION
To ensure a workforce fit for purpose to meet health needs by:
 Ensuring necessary and equitable staffing of the health system
 Developing health professionals and cadres to meet health and health care needs
 Ensuring the health workforce has an optimal working environment and rewarding careers
 Ensuring innovative and efficient recruitment and retention of the health workforce
 Enabling clinical research which enhances clinical and service development
 Provide professional quality care which is effective and evidence based
 Providing the organization and infrastructure for health workforce development
 Ensuring 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 care
 ensure 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
 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
STRATEGIC PRIORITY
1. Leadership and
Governance for
HRH: (page 83)
To provide proactive
leadership and an
enabling framework to
achieve the objectives
of the NDOH HRH
strategy for the health
sector
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
1.1 NDoH HRH Leadership & Governance
Structures: Secretariat, Tasks Teams linked to HR
Strategy incorporating stakeholders
1.2 HRH Strategy Implementation
1.3 Institute for Leadership & Management –
ensure/ accredit in-service and professional
management at all levels
1.4 NDoH Recruitment & Retention Unit
1.5 NDoH HRH Financing Committee
1.6 International collaboration
1.7. Communication strategy for NDoH on HRH
STRATEGIC PRIORITY
PROGRESS
1. Leadership and
Governance for
HRH:
To provide proactive
leadership and an
enabling framework to
achieve the objectives of
the NDOH HRH strategy
for the health sector
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
1.1 NDoH HRH Leadership & Governance
Structures, on-going consultation with
stakeholders on the HRH Strategy
1.2 HRH Strategy Implementation – led by DG
1.3 Minister launched Academy for leadership and
Management on 6th November 2012 and
appointed an Advisory Committee to report on
30th March 2014. Committee chaired by Prof M
Jacobs.
FOCUS
- CEOs and district management
-professionalise health care management
- accredited qualification framework
1.4 International collaboration - WHO
1.5. Communication strategy for NDoH on HRH
STRATEGIC PRIORITY
2.Intelligence &
Planning for HRH:
Establish a Centre for
Health Workforce
Intelligence which will
provide health
workforce information
and ensure oversight on
health workforce
planning across the
health care system
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
2.1.Electronic database
2.2. Data analysis & reporting and develop
HRH scenario planning models
2.3. Information for oversight & leadership
and work with provinces
2.4. Information on Academic Health
Complexes
2.5. Develop Health Workforce Committees
2.6. Develop the Centre for Health
Workforce Intelligence
STRATEGIC PRIORITY
PROGRESS
2.Intelligence &
Planning for HRH:
Establish a Centre for
Health Workforce
Intelligence which will
provide health
workforce information
and ensure oversight on
health workforce
planning across the
health care system
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
2.1.Monitoring and modelling personnel
numbers and needs
especially doctors and nurses
2.2. Much more attention needs to be given
to accurate numbers and planning need
in relation to national norms or
guidelines
Growth in public sector expenditure
2006/7 – 2010/11
In 2010/11 doctors and specialists cost R16bn of the R58,9bn
Table 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%
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%
28,740
35,022
42,801
50,903
58,919
27.0%
Northern Cape
Total
Disturbing drop in specialist numbers
Table 2 Specialists percentage increase & decrease
YEAR
EASTERN CAPE
FREE STATE
GAUTENG
KWA-ZULU NATAL
LIMPOPO
MPUMALANGA
NORTHERN CAPE
NORTH WEST
WESTERN CAPE
Total
National Treasury 2012
.08/09
7.70%
3.20%
6.00%
-3.20%
14.10%
-3.60%
0.00%
-5.90%
6.00%
4.40%
.09/10
10.70%
-3.60%
8.00%
4.90%
17.50%
-9.30%
10.00%
50.00%
3.10%
5.60%
.10/11
31.70%
-5.60%
3.20%
6.60%
-11.40%
24.50%
-13.60%
11.10%
-4.60%
1.60%
.11/12
-5.30%
0.30%
1.50%
14.20%
-5.90%
13.10%
0.00%
7.50%
-0.20%
2.40%
.12/13
-5.60%
4.00%
0.70%
9.40%
-3.20%
0.00%
0.00%
19.80%
9.70%
4.70%
The health sector has to seek greater efficiency and
improve 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
STRATEGIC PRIORITY
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
3.A Workforce for New
Service Strategies:
3.1. Workforce for re engineered PHC :
specialist teams, school health, ward
based primary health care teams
To meet workforce
requirements of new
and emerging service
strategies and thereby
ensure a health service
which promotes health
and provides value for
money
3.2. Public Health Units led by Public Health
Specialists & public health professionals
3.3. Staffing norms and planning of posts for
hospitals with adjustments for training
sites
3.4. Formulate public/private sector
contracting arrangements for PHC
3.5.Meet workforce needs for NHI
3.6. Develop workforce plans aligned to STPs
STRATEGIC PRIORITY
PROGRESS
3.A Workforce for New
Service Strategies:
To meet workforce
requirements of new
and emerging service
strategies and thereby
ensure a health service
which promotes health
and provides value for
money
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
3.1. Workforce for re engineered PHC :
specialist teams, school health, ward
based primary health care teams Dr Y Pillay to report
3.2. Public Health Units led by Public Health
Specialists & public health professionals –
established in Gauteng
3.3. Staffing norms Nursing norms as part of nursing strategy
and WISN – Ms Ravengenni
3.4. Formulate public/private sector
contracting arrangements for PHC –
GP contracting
STRATEGIC PRIORITY STRATEGIC OBJECTIVE & MILESTONE
2016/17
4.Upscale and
Revitalise
Education
Training and
Research:
To ensure the
revitalisation of the
production of a
health workforce
with the skills mix
and competencies,
education and
training, to meet
health service
demand & future
4.1.Refine and develop the model & output for HRH strategy
scenarios for all professions
4.3. Plan Growth of HEI’s in consultation, including rural campuses
4.4. Develop and implement a strategy on the nursing profession
– Nursing Professions Forum and Task Team
4.5. Audit, plan & institutionalise training for MLWs and CHWs
4.6. Revitalise clinical research & innovation
4.7. Ensure adequate financing of health professional dev
4.8.Plan and evaluate training of health professionals outside SA
4.9. Plan and enable growth of academic clinicians
4.10. Develop policy and implement collaborative arrangements
with the private sector on health professional training
STRATEGIC PRIORITY STRATEGIC OBJECTIVE & MILESTONE
2016/17
PROGRESS
4.Upscale and
Revitalise
Education
Training and
Research:
To ensure the
revitalisation of the
production of a
health workforce
with the skills mix
and competencies,
education and
training, to meet
health service
demand & future
4.1. Have done planning on growth of the professions in
consultation with DHET –
not significant development on rural campuses.
FOCUS – Joint DG Strategic Committee on Health Sciences
4.2. Developed Nursing Strategy on Education Training and
Practice for Nursing & launched 2 weeks ago – Ms Mafubelu
4.3. Audit and plan for CHWs done – Dr Y Pillay
4.4. Revitalise clinical research & innovation - Prof Mayosi of
National Health Research Committee and 1000 PHDs in ten
years
4.5. Ensure adequate financing of health professional dev
FOCUS – Public Health Enhancement Fund
National Conditional Grant Task Team - HPTDG
Review of Education and Training Expenditure
4.6. Have not planned expansion of academic clinicians
STRATEGIC PRIORITY STRATEGIC OBJECTIVE & MILESTONE
2016/17
PROGRESS 2
4.Upscale and
Revitalise
Education
Training and
Research:
To ensure the
revitalisation of the
production of a
health workforce
with the skills mix
and competencies,
education and
training, to meet
health service
demand & future
Expansion of MBChB
1.
In 2011 , 2012 and 2013 8 faculties of health sciences have
expanded intake of medical students
2. Not an easy process –
Issues:
Capital development for DHET and university budget
Service platform development by NDoH
Budget availability from National Treasury
Only expanded 1,2 % - need to expand 3 – 5%
DHET target 3-5% but resources an issue
3. In 2012 - 920 medical students sent to Cuba
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
Profession
Enrolled
2010
Graduates
2010
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
International benchmarks per 1000 population
DOCTORS
Brazil
Chile
Costa Rica
Colombia Thailand
Argentina
1.8
1.7
2.5
1
3.2
Graduate increase and result per 1000 population
Year
2012 2015
2020
Graduates 5% inc
1298 1298
1488
no attrition
Doctors per 1000 popn
0.52 0.59
0.69
0.9
2025
1818
2030
2239
0.82
0.97
SA current
0.54
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)
STRATEGIC PRIORITY
5.Academic Training
and Service
Platform
Interfaces: (109)
To strengthen Academic Health
Complexes to strategically
manage both health care
and academic resources
and provide an integrated
platform for service, clinical
research, innovation and
education functions
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
5.1. Policy, financing and governance framework
for AHCs
5.2. Minister’s National Advisory Committee
5.3. Oversight regulatory and accreditation
structure on AHCs established
5.4. An Association of Academic Health Complexes
for local and international consultation
5.5. Develop the management infrastructure of
AHCs – standardised ITC, financial systems to
cost and measure performance for NHI, and
academic staffing conditions
5.6. Five Flagship Academic Central Hospitals
STRATEGIC PRIORITY
PROGRESS
5.Academic Training
and Service
Platform
Interfaces:
To strengthen Academic Health
Complexes to strategically
manage both health care
and academic resources
and provide an integrated
platform for service, clinical
research, innovation and
education functions
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
5.1. Policy, financing and governance framework
for AHCs –– issue being addressed by the
Minister
5.2. Minister’s National Standing Advisory
Committee Launch meeting 8th November
2012 with
Stakeholders for health professions and AHCs
Four task teams – meeting due in May
•
Framework for health science education
•
Financing and expenditure on Ed & Train
•
Grant Review
•
Policy of AHCs
5.3. Five Flagship Academic
5.4. Nursing Colleges: consultant group Benguela
employed on revitalisation. 3 year grant from
Table 6 Health Science Education & Training
Programme
5
2011/12
Sub Prog
2012/13
Medium
Nurse
c olleges
2013/14
- term estimates
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
training
390,322
411,304
430,920
other
859,169
915,847
971,043
3,692,936
3,845,042
4,043,683
HPTDG
1,977,310
2,076,176
2,190,366
HEIs
2,653,225
2,812,418
2,981,164
Training
Total
Other related
Source: National Treasury 2011
.
STRATEGIC PRIORITY
PROGRESS – Not enough
6.Professsional
Human
Resource
Management:
(P117 – role of HR
Depts and HRH)
To effectively manage
human resources in a
manner that attracts,
retains and motivates
the health workforce to
both the public and
private sectors in an
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
6.1. Undertake an audit of the health workforce
in each province: workforce audit and
attitudes audit on retention and work
environment
6.2. Formulate integrated HR strategic plans with
agreement on principles, structures and
performance
6.3. Clarify roles and responsibilities of the HRM
function and line managers
6.4. Improve performance management
6.5. Review and implement remuneration and
OSD - Consultant group: Benguela did
STRATEGIC PRIORITY
Progress – not enough
STRATEGIC OBJECTIVE & MILESTONE
2016/17
7.Quality
Professional
Care:
7.1. Strengthen role of Statutory Councils and
ensure funding for mandates including the
NDoH relationship - progress
(P122)
7.2. Effective accreditation of academic training
sites (undergraduate, Com Serve &
postgraduate) to ensure quality of output
To develop a health
workforce that
delivers an evidenced
based quality service,
with competence, care
and compassion
7.3. Institutionalise Continuing Professional
Development
7.4. Implement licensing of health care practices
7.5. Ensure timely response to malpractice and
develop confidential reporting
7.6. Develop a National Co-ordinating Centre for
Clinical Excellence in Health and Health Care
STRATEGIC PRIORITY
8.Integrated Strategy
for Rural and
Remote Areas:
To promote access to health
professionals in rural and
remote areas
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
8.1. Short term strategies to recruit & retain
8.2. Review policy and streamline
management of foreign recruitment
8.3. Educational strategy in for rural areas
8.4. Regulatory strategies on scopes of
practice
8.5. Financial incentive scheme
8.6. Personal and professional support
STRATEGIC PRIORITY
PROGRESS
8.Integrated Strategy
for Rural and
Remote Areas:
To promote access to health
professionals in rural and
remote areas
STRATEGIC OBJECTIVE &
MILESTONE 2016/17
8.1. Detailed project implemention plan from
Rural Advocacy Group & RUDASA
More enablement required from NDoH and
provincial departments of health to
create a clear path ahead for
implementation
Co-operation with faculties of health sciences
essential
Way Ahead
• Stakeholder comment and involvement
• Priorities the same
Leadership and management
Information
Growth in the professions
Quality of professional care
Management and planning of HRH
Rural access and development
Sa doctores
COMMENT AND SUGGESTIONS
THANK YOU