Where are we short and who are we short of? A review of the human resources for health in South Africa

Abstract

This review showed that thinking about the shortage of health care personnel merely in terms of insufficient numbers prevents sound strategic interventions to solve the country’s human resources for health (HRH) problem. It revealed that the numbers shortage was one facet of a broader problem that included the mal distribution of HRH, production of the wrong skills in the nursing care, the attrition of staff from the public health services and, contextually, the ever-changing demands on the health services. The challenge in South Africa was furthermore to train and retain health care personnel with skills and expertise that are commensurate with the changing demands on the public health services.Uit hierdie oorsig het dit duidelik geblyk dat die tekort van gesondheidsorgpersoneel slegs in terme van ontoereikende getalle val en ’n omvattende strategiese ingryping om die land se menslike gesondheidshulpbron krisis op te los, belemmer. Dit het aangedui dat die getalletekort maar slegs een fasset van ’n groter probleem uitmaak, wat onder andere die volgende insluit: die oneweredige verspeiding van menslike gesondheidshulpbronne, ’n fokus op ontoepaslike vaardighede in die opleiding van verpleegpersoneel, die behoud van personeel in die openbare gesondheidsektor, asook die konstant-veranderlike eise van die gesondheidsdienste. Verder was die uitdaging in Suid Afrika die opleiding en behoud van gesondheidsorgpersoneel met kennis en vaardighede wat tred hou met die veranderlike eise van die openbare gesondheidsdienste.

National Health Insurance implications for rehabilitation professionals and service delivery

“…Attrition of rehabilitation staff has not been fully studied. George et al (2012) reported a 15% HIV/AIDS prevalence among professional staff and migration to be responsible for attrition (George et al 2012). Urban migration and emigration have been cited as reasons for therapist attrition but no national study could be found to support this.…”

“…The same could be said of the ratio of doctors and nurses to patients, which although better stands at 55 doctors and 361 nurses to 100000 (DoH 2011). Across all professions discrepancies exist across public and private, urban and rural and across types of service (George et al 2012). It has been pointed out that the debate around human resources should not be reduced to one of numerical shortage but should extend to appropriate use of the existing personnel (George 2012).…”

Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements

“…Application to medical officers, medical specialists, dentists, pharmacists, and emergency medical services (EMS) occurred in 2008. The existing ranges of medical cadres were collapsed into one salary package [37]. Once implemented in 2008/09, salary packages increased substantially across cadres [35].…”

A novel HIV treatment model using private practitioners in South Africa

“…However, patient reluctance to use public health facilities is well known in South Africa, where 21% of the population use the private sector on an out-of-pocket basis for primary care level care but are then dependent on the public sector for hospital care 18. Although density ratios for medical practitioners and nurses within South Africa are above minimum levels proposed by WHO (230:100 000), there are still drastic shortages in public sector and rural areas,19 and the increased strain on the public health system due to the AIDS pandemic has resulted in severe human resource shortages, with an estimated shortage of 80 000 total health workers in 2009 19…”