1. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative WHERE HAVE ALL THE DOCTORS GONE? AFRICA HEALTH PLACEMENTS

2. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative NO TEAM = NO GAME ANYONE WANT TO DISPUTE? =

3. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

4. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative (WH0, 2006) SA IN CONTEXT: HOME AND AWAY USA South Africa Public + Private South Africa Public Sector South Africa Rural Public Doctors per 100 000 Population

5. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative SA IN CONTEXT: QUADRUPLE BURDEN OF DISEASE

6. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative INEQUITIES IN HEALTHCARE DELIVERY: PUBLIC SECTOR v PRIVATE SECTOR POPULATION SERVED BY PUBLIC AND PRIVATE HEALTHCARE SECTORS PUBLIC, 34,611,781, 82% PRIVATE, 7,597,709, 18% NUMBER OF GPs SERVING PUBLIC AND PRIVATE SECTORS PUBLIC, 5,406, 27% PRIVATE, 14,323, 73% SAHR 2004

7. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative INEQUITIES IN HEALTHCARE DELIVERY: RURAL v URBAN 208 339 15 27 7 60 0 50 100 150 200 250 300 350 Gauteng Western Cape North- West Northern Cape Mpumal. KZN (Urban v Rural Provinces) SPECIALISTS PER MILLION UNINSURED POPULATION Van Rensburg & Van Rensburg, 1999

8. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative Despite having the largest health professional production capacity in Africa, we have ended up with a: – Massive shortage of clinical staff in the public sector – Massive shortage of clinical staff in rural areas This while demands on the health care system are rapidly escalating CURRENT SITUATION: IN A NUTSHELL

9. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

10. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative A GLOBAL COMPETITION FOR RESOURCES: GLOBALISATION KILLED THE MEDICAL STAR OECD 2003

11. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CUMULATIVE TOLL – WE ARE LOSING Financial Mail April 2006

12. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CAN WE ALSO EXPORT OUR INDIGENT? There are more SA qualified doctors working abroad than the total number of doctors working in the public sector in SA

13. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative NO TEAM = NO GAME: RELEGATION ZONE…

14. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative PRODUCTION: A SIMPLE TREND

15. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative PRODUCTION: A SIMPLE TREND BUT: Growing population Increasing brain drain Changing demographics impacting on number of “doctor hours” Number of final graduates is declining

16. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative SAMA Survey 2003 RETENTION: ITS HOW YOU TREAT THEM, STUPID!

17. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

18. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative 70 of 300 US citizens who won Nobel Prizes since 1901 are foreign Sun Microsystems, Intel, Google – all foreign founders 40% of US PhDs in Science and Engineering go to foreigners US planning to recruit 500 000 health professionals in next decade. LESSONS FROM A GLOBAL WINNER: USA - A SUPER-POWER BUILT ON FOREIGN SKILLS The Economist, 10 April 2008

19. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative NHS staffing crisis 2000 NHS overstaffed 2008 – Increased number of medical schools, – Opened doors to internationally qualified staff – Actively recruited former staff not working in the NHS – Improved retention – Offered flexible retirement LESSONS FROM A GLOBAL WINNER: THE UK NHS CASE STUDY 2000 - 2008

20. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

21. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – PRODUCTION: IMMEDIATE AND MEDIUM-TERM SOLUTIONS IMMEDIATE SOLUTION: What do the current 8 medical universities need? MEDIUM-TERM SOLUTION: Private Sector Medical Schools

22. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

23. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – RETENTION: I DON’T THINK THEY ARE COMING BACK…

24. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – RETENTION: SOLUTIONS THAT TAKE RESPONSIBILITY BEST PRACTICE HUMAN RESOURCE MANAGEMENT MAXIMISE USE OF BURSARY SYSTEM ACTIVE RECRUITMENT

25. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

26. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – FOREIGN DRS: FQDs AS A SOURCE OF SKILLS

27. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – FOREIGN DRS: CHEAPER THE PRICE!

28. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – FOREIGN DRS: A SOLUTION IS PARKING YOUR CAR Reconsider: This is working to SA and Africa’s detriment! POLICY

29. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative POTENTIAL SOLUTIONS – FOREIGN DRS: A GLOBAL COMPETITION FOR SCARCE RESOURCES WE HAVE A COMPETITIVE ADVANTAGE: – LIFESTYLE! – WORK EXPERIENCE! – HUMANITARIAN APPEAL! SIMPLIFY AND SPEED UP REGISTRATION PROCESS WITH REGULATORY BODIES RETHINK AFRICAN RECRUITMENT POLICY GLOBAL BEST PRACTICE IN RECRUITMENT ACCOMMODATION

30. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

31. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative A WORKING STAFFING SOLUTION MODEL FOR SOUTHERN AFRICA Operating since 2005 Nearly 700 health workers placed in South Africa since inception – doctors, nurses, allied health workers, lay health workers, clinic support staff, management – Foreign- and local-qualified professionals – In 2008: AHP will place 4 times the number of foreign qualified doctors in rural SA as all 8 SA medical schools combined (approx 140 doctors).

32. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative AHP PERFORMANCE IN PERSPECTIVE 50% 600 Drs 25% 150 Drs 8 SA Medical Schools = 1200 Graduates p.a. 50% 75% 25% 35 Drs Remain in SARemain in Public ServiceRemain in Rural Service 140 Drs in 2008

33. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative NET#WORK BBDO WORKING AS PART OF A NETWORK: PARTNERSHIPS ARE CRITICAL

34. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative AFRICA HEALTH PLACEMENTS: BECOMING MORE COMPETITIVE IN THE GLOBAL MARKET TIME TO PLACEMENT – FOREIGN-QUALIFIED DOCTORS 2005 1.5 Years 2008 - Average 4 - 6 Months 2008 - Australia 1 Month

35. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative CONTENT CURRENT SITUATION SO HOW DID WE GET HERE? SOLUTIONS POTENTIAL SOLUTION – PRODUCTION POTENTIAL SOLUTION – RETENTION POTENTIAL SOLUTIONS – FQDs AFRICA HEALTH PLACEMENTS GREAT EXPECTATIONS

36. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative GREAT EXPECTATIONS: POLICY RECONSIDERATIONS BEST PRACTICE HUMAN RESOURCE MANAGEMENT ACTIVELY PURSUE RECRUITMENT AGENCY SERVICES SIMPLIFY AND REDUCE TIME FOR REGISTRATION RETHINK AFRICAN RECRUITMENT ACCOMMODATION FOR RURAL HOSPITALS COMMISSION TO REVIEW RECRUITMENT AND RETENTION IN SA PUBLIC SECTOR RECOGNISE WE ARE COMPETING IN A GLOBAL MARKET FOR A SCARCE AND MOBILE RESOURCE

37. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative GREAT EXPECTATIONS : WHAT WE NEED TO DO

38. This project is a joint venture between the Foundation for Professional Development (Pty) Ltd and the Rural Health Initiative QUESTIONS? PREPARED BY: Saul Kornik Director, AHP saulk@ahp.org.za