Report to the Select Committee on Social Services on Vacancies in the Public Health Sector Cape Town 6 th March 2012

Response the Auditor General on Vacancies in the Health Sector Summary of Auditor General findings Comment on data issues Trends in health workforce numbers and expenditure Strategic response to issue of vacancies: NDoH HRH Strategy 2012/13 – 2016/17 HRH workforce audit and planning 2012 – practical response to vacancies District Health PHC re-engineering Facilities management and administration vacancies Recruitment strategy for health professionals

Report by Auditor General 21 st February 2012 The AG report stated the following: – 31% of posts vacant – Vacancies by province, by programme and profession (see following 4 slides) – Issues arising according to the AG: Poor retention Overworked demoralised staff Poor training (in-service) Patient unhappiness and backlog Lack of emergency medical services Shortage of specialists and staff in academic hospitals Overspending on OSD Inadequate HR training and management resulting in lack of posts for critical skills and bursary recipients Problem of supply chain management Shortage on personnel in infrastructure unit leading to poor quality New buildings not being utilised due to shortage/ lack of staff

Table 1 Health Sector vacancies 2010/11 Source: Auditor General February 2012

Table 2 Health Sector Vacancies per province Source: Auditor General February 2012

Table 3 Vacancies per programme Source: Auditor General February 2012

Table 4 Vacancies for critical occupations Source: Auditor General February 2012

Interpretation of Data National Treasury and NDoH hold the view that the vacancies are not an accurate reflection of critical posts and affordable posts Methods used by provinces for arriving at vacancies are different and do not all reflect new service and organisational requirements Vacancies are funded and unfunded – this data is with provinces and not on PERSAL (we have requested it) It would cost R38bn to fill the vacancies of 14 of the professions (personnel expenditure was R60bn in 2010/11) - this is unaffordable – Limpopo R14bn to fill vacancies – E Cape R9bn to fill vacancies Example Limpopo – vacancy of 5000 doctors Table over page shows inconsistent ratios per 10,000 if vacancies were filled

Table 5 Total filled and vacant positions per 10,000 uninsured population for doctors in the public sector, by province, 2010 Region Uninsured population Filled (per 10,000 population) Vacant (per 10,000 population) TOTAL (per 10,000 population) Eastern Cape6,611, Free State2,594, Gauteng6,921, KwaZulu-Natal8,841, Limpopo5,314, Mpumalanga2,949, North-West3,457, Northern Cape765, Western Cape3,539, South Africa40,995,

Table 6 Health Professionals Employed in the Public Sector 1997 –2006 Source: NDoH Expenditure Review 2008 Professional category Administration & Man 28,676 27,435 27,188 25,884 27,629 27,253 26,622 28,935 32,052 37,419 Ass Health Prof 13,786 13,779 13,598 13,524 13,824 16,955 18,307 19,363 22,470 23,349 Hospital & Health Support 81,097 77,603 72,849 67,172 67,209 65,614 62,330 60,397 60,388 60,030 Management ,3141,091 Medical 15,554 15,593 14,875 14,256 14,759 14,980 13,752 14,219 14,659 16,006 Nursing 111, , ,982 99,473 99, , , , , ,153 TOTAL 250, , , , , , , , , ,048

Table 7 Growth in the Public sector health workforce 2006 – 2010 Source: National Treasury/PERSAL

Table 8 Growth in public sector expenditure on the health workforce 2006/07 – 2010/11 (R million) Source: National Treasury/PERSAL Province2006/072007/082008/092009/102010/11Average annual growth Eastern Cape3,8604,5636,0857,3978, % Free State2,0122,3522,8813,1443, % Gauteng5,3476,5198,1589,87712, % KZN6,6298,64410,07712,12612, % Limpopo3,3114,0444,6925,5946, % Mpumalanga1,6281,9922,6033,0733, % Northern Cape ,0341, % North West1,9141,9832,5372,8773, % Western Cape3,4194,1394,8765,7806, % Total28,74035,02242,80150,90358, %

Human Resources for Health Strategy for the Health sector 2012/13 – 2016/17 8 thematic strategic priorities  Leadership, governance and accountability – Leadership Institute underway for April 2012  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

HRH Information and planning Strategic Objective 2: Centre for Health Workforce Intelligence (April/May 2012) To address vacancies and develop realistic plans: – Audit of health workforce and clean up of PERSAL data – Develop database on public and private sector workforce – Service plans linked to new priorities – Strengthened workforce planning capacity in provinces guided by norms – NHI taken into consideration and contracting with private sector professionals/service providers

District Health – PHC Re-Engineering Minister’s statement in Budget Speech May 2011: PHC Re-engineering in three streams – District based model of specialists clinicians to impact on MDGs – School Health Programme – Ward based PHC model – emphasis on CHWs (training has started) Environmental health practitioners are central to the new policy of PHC re- engineering Minister’s priority on health care management – management of health care institutions and districts Overhaul of the hospital and health system HRH needs for these objectives being planned for in 2012

Review of hospital CEO positions Review by DBSA of competencies and backgrounds of hospitals CEOs New policy gazetted in August on hospital categories and requirements for CEOs Posts readvertised in Sunday papers past weekend Raining programme planned by new Institute in 2012

Administration vacancies in provinces and constraints on filling vacancies Administration expanded considerably at the expense of clinical positions (e.g. E Cape) Careful attention required before increasing administration Rather improve skills and make existing post and organistional structures better skilled efficient General limit on budgets for expansion of all posts/ filling vacancies (E Cape, Limpopo, Gauteng)

Recruitment Strategy Recruitment and retention of health professionals complex At present very poor retention due to lack of funded planned and available posts – 70% of health professionals trained do not remain in the public sector and high emigration Strategy is to: – Refine planned and funded posts – Improve work and supportive professional environment to attract health professionals – Improve HR management – Enhance continuing professional development (See HRH Strategy document)

Conclusion The AG report on vacancies gave the numbers and problems arising from ‘shortages’/unfilled posts of professionals and managers Need to develop minimum critical appropriate numbers and skills mix The Minister and DG have implemented a number of interventions over the past year which address this situation – Facility audit and improvement process – Policy on hospitals and CEOs – PHC re-engineering – HRH Strategy 2012/13 – 2016/17 – Institute for Leadership in Health – Underway: audit of workforce and workforce planning for provinces, PERSAL clean up, and Centre for Health Workforce Intelligence