1. MEETING THE CHALLENGES OF HIV/AIDS IN SOUTH AFRICA CAPACITY CONSTRAINTS Gustaaf Wolvaardt MBChB(Pret),M.Med(Int)(Pret),FCP(SA), AMP(MBS),PGCHE(Pret)

2. CLINICAL CAPACITY

3. PRODUCTION

4.  Doctors  Output at the 8 medical schools around 1230 doctors per year over the past 12 years ART Programs  HST estimated RSA needed 3,200 dedicated doctors and 2,400 nurses in 2009 for ART Programs only  Nurses  Massive drop in production of RN’s by Nursing Colleges from 2300/p.a. in 1996 to 1300 in 2004, has been increasing the last few years  Pharmacists  Dropped from 450 to 320 per annum FPD

5. DISTRIBUTION

6. % of Doctors in Private Sector FPD

7. DISTRIBUTION OF HEALTH CARE PROFESSIONALS HEALTH AND HEALTH CARE IN SA (2004) TotalPublicPrivate GP’s19 7295398 (27.4%)14331 (72.6%) Specialists78261938 (24.8%)5888 (75.2%) Dentists4269316 (7.4%)3953 (92.6%) Pharmacists44101047 (23.7%)3363 (76.3%) Psychologists3808222 (5.8%)3586 (94.2%) FPD

8. RETENTION

9. A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CUMULATIVE TOLL – WE ARE LOSING Financial Mail April 2006 FPD

10. Reasons for leaving the public sector SAMA Survey 2003

11. OTHER

12.  Impact of HIV/AIDS on health professions  Ageing professional population (17 000 of 22 000 doctors currently in practice qualified before 1990 FPD

13. MANAGEMENT CAPACITY

14. Current situation 54% of these managers never had any form of management training  Unpublished industry report (Univ of Pretoria SHSPH) in 2006 showed that of 148 health care managers, working in the AIDS field (76% public sector) surveyed 54% of these managers never had any form of management training  These managers in total managed 28 000 health care workers FPD

15. Core qualifications FPD

16. Solutions – National HR Plan for Health 2006  Increase production (doubling of output)  Infrastructure and resource constraints ? 10% increase  Plan does not adequately explore the potential of using the private sector  Mid-level workers  Pharmacy assistants – being developed for a number of years in both public and private educational sectors  Medical assistants (new category)  Training for task shifting  Nurse practitioners with salaries that compensate them for these skills  Health Charter to include replacement offerings that will support HRH  Improve conditions of service i.e. accommodation at health facilities

17. POTENTIAL SOLUTIONS

18. TO INCREASES CLINICAL RESOURCES  Better align patients to providers  Outsource to private sector (for and not for profit organizations)  NHI

19. AIDS Service Organizations  HIV 911 database  2008 – 7000 AIDS Service Organization  2009 – 12 000 FPD

20. Rapidly improving service delivery – The PEPFAR lesson  4-5 billion rand per annum budget channeled through  250 partners  predominantly from civil society  No corruption scandals FPD

21. POTENTIAL SOLUTIONS – FOREIGN DRS: FQDs AS A SOURCE OF SKILLS FPD

22. HAVING DR’S PARK YOUR CAR IS NOT A SOLUTION POTENTIAL SOLUTIONS – FOREIGN DRS: HAVING DR’S PARK YOUR CAR IS NOT A SOLUTION POLICY FPD

23.  Do the logical thing  See stable patients less often  Nurse initiation of ART  Counselors do finger pricks etc.  Increase production of providers  Consider private higher education institutions

24. IMPROVE MANAGEMENT CAPACITY  Professionalise now !!  Apply current rules on management requirements  Insist that all managers get appropriate qualifications within a 2 year period  Assess if managers apply skills

25. “ The best way to predict the future is to create it “ Peter Drucker Peter Drucker:

26. gustaafw@foundation.co.za +27833008271 www.foundation.co.za Thanks