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This report provides a summary of the findings from the Auditor General's report on vacancies in the health sector and outlines the strategic response to address this issue, including workforce planning, district health re-engineering, and recruitment strategies. The report also discusses the challenges and issues arising from the vacancies and suggests solutions to improve the workforce situation.
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Report to the Select Committee on Social Services on Vacancies in the Public Health Sector Cape Town 6th March 2012
Response the Auditor General on Vacancies in the Health Sector • Summary of Auditor General findings • Comment on data issues • Trends in health workforce numbers and expenditure • Strategic response to issue of vacancies: NDoH HRH Strategy 2012/13 – 2016/17 • HRH workforce audit and planning 2012 – practical response to vacancies • District Health PHC re-engineering • Facilities management and administration vacancies • Recruitment strategy for health professionals
Report by Auditor General 21st February 2012 • The AG report stated the following: • 31% of posts vacant • Vacancies by province, by programme and profession (see following 4 slides) • Issues arising according to the AG: • Poor retention • Overworked demoralised staff • Poor training (in-service) • Patient unhappiness and backlog • Lack of emergency medical services • Shortage of specialists and staff in academic hospitals • Overspending on OSD • Inadequate HR training and management resulting in lack of posts for critical skills and bursary recipients • Problem of supply chain management • Shortage on personnel in infrastructure unit leading to poor quality • New buildings not being utilised due to shortage/ lack of staff
Table 1 Health Sector vacancies 2010/11Source: Auditor General February 2012
Table 2Health Sector Vacancies per provinceSource: Auditor General February 2012
Table 3 Vacancies per programmeSource: Auditor General February 2012
Table 4 Vacancies for critical occupationsSource: Auditor General February 2012
Interpretation of Data • National Treasury and NDoH hold the view that the vacancies are not an accurate reflection of critical posts and affordable posts • Methods used by provinces for arriving at vacancies are different and do not all reflect new service and organisational requirements • Vacancies are funded and unfunded – this data is with provinces and not on PERSAL (we have requested it) • It would cost R38bn to fill the vacancies of 14 of the professions (personnel expenditure was R60bn in 2010/11) - this is unaffordable • Limpopo R14bn to fill vacancies • E Cape R9bn to fill vacancies • Example Limpopo – vacancy of 5000 doctors • Table over page shows inconsistent ratios per 10,000 if vacancies were filled
Table 5 Total filled and vacant positions per 10,000 uninsured population for doctors in the public sector, by province, 2010
Table 6 Health Professionals Employed in the Public Sector 1997 –2006Source: NDoH Expenditure Review 2008
Table 7 Growth in the Public sector health workforce 2006 – 2010Source: National Treasury/PERSAL
Table 8 Growth in public sector expenditure on the health workforce 2006/07 – 2010/11 (R million)Source: National Treasury/PERSAL
Human Resources for Health Strategy for the Health sector 2012/13 – 2016/17 8 thematic strategic priorities • Leadership, governance and accountability – Leadership Institute underway for April 2012 • 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
HRH Information and planning Strategic Objective 2: Centre for Health Workforce Intelligence (April/May 2012) • To address vacancies and develop realistic plans: • Audit of health workforce and clean up of PERSAL data • Develop database on public and private sector workforce • Service plans linked to new priorities • Strengthened workforce planning capacity in provinces guided by norms • NHI taken into consideration and contracting with private sector professionals/service providers
District Health – PHC Re-Engineering Minister’s statement in Budget Speech May 2011: PHC Re-engineering in three streams • District based model of specialists clinicians to impact on MDGs • School Health Programme • Ward based PHC model – emphasis on CHWs (training has started) • Environmental health practitioners are central to the new policy of PHC re-engineering • Minister’s priority on health care management – management of health care institutions and districts • Overhaul of the hospital and health system HRH needs for these objectives being planned for in 2012
Review of hospital CEO positions • Review by DBSA of competencies and backgrounds of hospitals CEOs • New policy gazetted in 20122 August on hospital categories and requirements for CEOs • Posts readvertised in Sunday papers past weekend • Raining programme planned by new Institute in 2012
Administration vacancies in provinces and constraints on filling vacancies • Administration expanded considerably at the expense of clinical positions (e.g. E Cape) • Careful attention required before increasing administration • Rather improve skills and make existing post and organistional structures better skilled efficient • General limit on budgets for expansion of all posts/ filling vacancies (E Cape, Limpopo, Gauteng)
Recruitment Strategy • Recruitment and retention of health professionals complex • At present very poor retention due to lack of funded planned and available posts • 70% of health professionals trained do not remain in the public sector and high emigration • Strategy is to: • Refine planned and funded posts • Improve work and supportive professional environment to attract health professionals • Improve HR management • Enhance continuing professional development (See HRH Strategy document)
Conclusion • The AG report on vacancies gave the numbers and problems arising from ‘shortages’/unfilled posts of professionals and managers • Need to develop minimum critical appropriate numbers and skills mix • The Minister and DG have implemented a number of interventions over the past year which address this situation • Facility audit and improvement process • Policy on hospitals and CEOs • PHC re-engineering • HRH Strategy 2012/13 – 2016/17 • Institute for Leadership in Health • Underway: audit of workforce and workforce planning for provinces, PERSAL clean up, and Centre for Health Workforce Intelligence