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 3Themes 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

Growth in public sector expenditure 2006/7 – 2010/11 In 2010/11 doctors and specialists cost R16bn of the R58,9bn

Disturbing drop in specialist numbers

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

Table 3: Expansion on Intake for MBChB for 2012 and 2013 University Approved June 2012 Actual 2012 increase 2013 approved by NDoH Stellenbosch Cape Town20 40 Wits45 90 Medunsa2095 Walter Sisulu20 40 UKZN--40 Free State--- Pretoria20-60 TOTAL

Table 4 Number Implications of 5% Expansion to 2025 ProfessionEnrolled 2010 Graduates 2010 Enrolled 2025 Graduates 2025 Graduates 2035 MBChB (inc 656) 2351 (inc 1053) Dentistry Pharmacy Physiotherapy Occ Therapy SLP & Audio

Table 5 Implications of 5% expansion for ratio per 1000 popn

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)

Table 6 Health Science Education & Training

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

COMMENT AND SUGGESTIONS THANK YOU Sa doctores