KHOPOTSO: The document offers very little specifics about how many health care professionals need to be trained, recruited or deployed to fill critical positions in the health sector. Nor is it specific on how much money is needed for infrastructure development and addressing salary discrepancies ‘€“ both widely touted as means to retain our health care professionals, particularly in the public health sector. At best, the document identifies problem areas and kick-starts a consultative process between the Department of Health and stake-holders, including the unions and education and training institutions to fill the gaps.

Dr PERCY MAHLATI: The reason that we did not put any numbers to it is that in certain areas, for instance, we cannot sit as the Department and say we will train a thousand more doctors next year without having looked at the capacity of the education institutions that they can be able to train that number. That’€™s one. Number two, is that increasing the number of health professionals – it takes long to train health professionals. To train a well-qualified registered nurse takes you no less than four years’€¦ Therefore, it is important that we do not tie ourselves to targets that may not be achievable.

KHOPOTSO: Dr Percy Mahlati, Deputy Director-General of the Human Resources portfolio in the national Department of Health, explaining why the Draft Strategic Framework for Human Resources for Health shies away from committing to numbers and deadlines. The draft plan recognises the impact of relaxed international migration of health workers on the staffing solutions for the country’€™s health service.      

Dr PERCY MAHLATI: In the area of health there has to be planning at a central level, multi-lateral organisations, WHO’€¦ We’€™ve got to make sure that training is balanced so that developed countries can produce enough for their own countries, we produce enough for ours and, therefore, the exchange will actually be equitable. There will be no net-loss or net-gain, so that people can move freely all over the world. But they can’€™t move freely all over the world and not affect the developing nations as long as the developed are under-producing. The reason for that is because it’€™s expensive to train health workers. You train them for long periods of time’€¦

KHOPOTSO: A critical intervention then, is the negotiation of strong bilateral and multilateral agreements to manage the international migration of health personnel. Attention also has to be paid to why health professionals leave the public service to join the private health sector as well as the mal-distribution of health care workers in favour of urban areas.

With the Draft Strategic Framework document in hand, Health Minister Dr Manto Tshabalala-Msimang aims to launch an international recruitment drive to address the shortages in South Africa’€™s health sector.

Dr MANTO TSHABALALA-MSIMANG: We are trying to work at, very hard, not just to go out and recruit from Russia, Bulgaria, and so on ‘€“ but these South Africans who left ‘€“ I think there’€™s still a story to be told about them because it’€™s not just salaries’€¦ When you go abroad now a number of them are saying ‘€˜we want to come back home’€™’€¦ And therefore, as a government we do have a responsibility to work out mechanisms as to how we facilitate their coming back because they do want to come back’€¦ We are working very hard with DPSA now (Department of Public Service and Administration). What are those things that we must do to facilitate them coming back to South Africa?        

KHOPOTSO: A good question that needs an urgent answer. The document also takes into account that there is a low production of certain professionals in the health care sector, especially pharmacists. Nursing as a service sector will receive special attention separate from other health disciplines, more especially to review the quality of training for nursing students. Thembeka Gwagwa, General Secretary of the Democratic Nursing Organisation of South Africa, DENOSA, reacts.

THEMBEKA GWAGWA: I was quite happy when Dr Mahlati actually said that they have separated nursing, for quite a number of reasons. One of the reasons being, if you look at the health care system in South Africa, it is nurse-based and, therefore, you have to concentrate on nurses. Or if you can put it differently nurses form the largest health professionals within the health system and, therefore, they are a major, major, major stake-holder within the health services. But if you look at what is happening, there is quite a movement of nurses globally. And therefore, in South Africa we have got quite a number of nurses that are leaving to go and work in other countries. And we are not too sure as to whether in terms of producing nurses we are producing enough nurses to counter for the ones that are leaving’€¦    

KHOPOTSO: Although, this is not the final Human Resources Plan for Health, certain elements of the draft plan can be implemented immediately. Here is the Health Department’€™s Dr Percy Mahlati again.

Dr PERCY MAHLATI: One, is actually on the recruitment side, the scarce skills and rural allowance. We’€™ve spoken about firming that up. Secondly, the remuneration of health professionals. We’€™re actually talking with DPSA and Treasury about that. Looking at recruiting skills to South Africa’€¦                            

KHOPOTSO: The Department is inviting stake-holders to briefing sessions scheduled to   start next week, on August 10, to discuss various aspects of the document. One of the major discussion points is on how to market the health profession as a career of choice for South Africans, particularly the youth, and how to ensure that those who work in the sector are happy. Treasury has set aside R4.6 billion for provinces to train and develop health professionals over the next three years. The Draft Framework will work towards ensuring that the money is spent on exactly that, says Mahlati.      

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