Addressing Health Workforce Related Questions raised by the Portfolio Committee on Health in the National Assembly Dr Percy Mahlathi Deputy Director General: NDOH 02 March 2011

Q 7: OSD in Free State Proposition is that OSD has not made any impact in FS because vacancy rates are still high. Question is whether NDoH has assessed the impact in other provinces System has impacted positively - should not be judged in financial terms only. Vacancy rates in FS varying between 7 – 10% (nurses), 9 – 34% (junior to senior doctors) Currently commencing with implementation of OSD system for Allied & Medical Therapeutic groups. NDOH preparing to do comprehensive assessment of OSD for all groups

Q 27: Lack of Doctors in Free State Question is what is the department doing about lack of doctors in the FS Need to remember that FS is under severe financial strain and posts are filled according to priority Doctors aren’t in abundant supply even globally especially at specialist level Recruitment of foreign doctors remains an open option on government-to-government agreements – need guarantee for funding (salary, accommodation, transport etc)

Q 30: Assistance to potential student nurses Question is how does the department assist potential nursing students to avoid registering with bogus nursing schools Encourage them to check with SA Nursing Council where register is kept Also check with Department of Higher Education for register of institutions that offer education & training Refer cases to SANC once reported

Q 49: OSD sustainability Question is how sustainable is the OSD system Overview of OSD: – New system of holistic remuneration of health professionals in public health service – Combines 4 elements {salary, career paths, career progression and performance management} – Introduced parity across all provinces – Severely limits the power of provinces to violate regulations relating to remuneration & promotion – Places responsibility for promotion on the health professionals by rewarding good performers (no one-size fits all anymore)

Q 53: HRH Strategies to increase number of doctors & nurses Statement is that the Committee needs a detailed presentation on the Human Resource Plan focusing on strategies to increase the number of doctors and nurses. Current planning framework put forward some numbers – several hurdles experienced e.g. capacity of universities to train due to several reasons, infrastructure & educator issues relating to nursing Refurbishment or revitalisation of public nursing colleges in 2011/12 budget – to increase capacity where necessary

Q 62: Presentation on HRH Planning Framework Statement is that the Committee is still awaiting a briefing on the National Human Resource for Health Plan Various aspects of 2006 HRH Planning Framework previously presented to the Committee. Planned that revised plan be presented once it is finalised. Several areas of 2006 framework were implemented e.g. OSD system, Nursing Strategy, Clinical Associates, Policy on Recruitment of Foreign Health Professionals, Policy harmonisation across provinces, Management of Global Migration (input to development of WHO Code of Practice)

Remunerative Work Outside Public Service Public Service Act 30 (1) No employee shall perform or engage himself or herself to perform remunerative work outside his or her employment in the relevant department, except with the written permission of the executive authority of the department. Public Service Act 30 (2) For the purposes of subsection (1) the executive authority shall at least take into account whether or not the outside work could reasonably be expected to interfere with or impede the effective or efficient performance of the employee's functions in the department or constitute a contravention of the code of conduct contemplated in section 41 (1) (b) (v).

RWOPS The Act provides that RWOPS may be performed after approval by the relevant Executing Authority (MEC) based on the considerations contained in the Act Normally this function is delegated (I include the part of the Act that speaks to delegation of authority) to CEO's at facility level as part of their HRM delegations

RWOPS The performance of RWOPS has to be seen in relation to the number of hours clinicians claim for Commuted Overtime. For example, if a medical officer claims for the average of 16 hours per week commuted overtime, he/she is actually working a 56 hour week. Then the question is how many hours RWOPS are approved, as this should be clear that these work have to be performed additional to the 56 hours

RWOPS May need to consider scrapping RWOPS at higher levels of medical profession in light of high remuneration packages earned in terms of Occupation Specific Dispensation

Thank you