It’€™s been described as a damp squib that is thin on practical solutions to the critical shortage of health staff ‘€“ but most stakeholders are relieved that there is finally a document on the table to kickstart discussions.

The clumsily named ‘€œstrategic framework for the human resources for health plan’€ was released last week, four months later than promised by Health Minister Manto Tshabalala-Msimang.

It recognises that human resource management in the health sector is ‘€œa major area of weakness that has not been addressed successfully’€.

The challenge of ensuring that the country has enough health staff to serve citizens properly has been complicated by the exodus of skilled staff to wealthy health systems, a ‘€œchanging disease profile’€ and a lack of a ‘€œdevelopmental approach’€ to HR planning and management, notes the plan.

By 2001, over 23 000 South African-born health staff were working in Britain, USA, Canada, Australia and New Zealand, according to the plan.

By March this year, the entire public sector was left with only 42 373 professional nurses, 7 784 doctors and 1 561 pharmacists.

‘€œThe two better resourced provinces, Gauteng and Western Cape have seen substantial, and in some cases almost dramatic, declines in public sector personnel, as has KwaZulu-Natal to some extent,’€ notes the plan.

The countrywide shortage of professional nurses ‘€œthreatens the core of health service delivery and needs to be addressed as a matter of urgency’€.

The emergence of HIV, the persistence of tuberculosis (and complications such as multi-drug resistant TB), the re-emergence of diseases such as cholera and the increase in chronic ‘€œlifestyle’€ diseases such as diabetes have increased demands on the health sector.

The plan’s admission that there has been a “lack of a developmental approach’€ refers mainly to the fact that training institutions have not kept pace with the demands of the population.

Between 1998 and 2003, only 4 018 new professional nurses were trained. This did not even keep up with population growth over the period. Yet, during the same time, the public health sector shifted care from hospitals to primary health clinics, meaning there was an even greater need for more nurses.

‘€œIn the absence of a guideline on HR production, education institutions are producing health human resources based on what they perceive is needed or in many cases dictated to by financial constraints,’€ notes the plan.

While accurately pinpointing the challenges, however, the plan offers few solutions.

One key suggestion ‘€“ first mooted some years ago ‘€“ is the introduction of ‘€œnew health worker cadres’€ including ‘€œmid-level workers’€ and ‘€œpara-professionals’€ to alleviate ther shortage of professionals.

However, the plan remains vague on who exactly these would be other than noting that pharmacy assistants have already been introduced to alleviate the shortage of pharmacists.

The Democratic Nurses Organisation of SA (Denosa) has already raised concerns about the notion of ‘€œassistant doctors’€, asking where this would put professional nurses who train at university for four years.

However, Denosa’€™s general secretary, Thembeka Gwagwa, said she was encouraged that plan was not just about numbers.

‘€œWhat impressed me at the launch was that [Deputy Director General] Dr Percy Mahlati said that the plan needed to address human resource planning, development and management,’€ said Gwagwa.

‘€œThis is promising because we have long been saying that nurses are not just leaving because of the poor salaries. The environment in which nurses work, which is to do with management, is also a problem.’€

The plan itself concedes that proper management is a key problem. South Africa spends 8,5% of its GDP on healthcare, which is a very substantial portion in global terms.

Treasury has also set aside about R4.6 billion for provinces to train and develop health professionals over the next three years.

‘€œThere is a strong basis for arguing that the key challenge facing the South African health sector is not heavily one of a lack of financial resources but rather a great need to use the existing resources more efficiently and equitably,’€ says the plan.

In welcoming the plan, the SA Medical Association’€™s Dr Kgosi Letlape stressed the need to develop a national HR plan for the country ‘€“ and not just for the public health sector.

‘€œWe need to ensure that this is a HR plan for the whole nation, not just for one sector,’€ said Letlape, who has some creative ideas about how the private and public sectors to work together.

‘€œThere are many ways to get private sector staff in to help the public sector. There’€™s mentoring, contracting out services, for example. Private doctors can do sessions in hospitals,’€ said Letlape.

The Health System’€™s Trust’€™s Dr Peter Barron said it was positive that the framework ‘€œhas an action plan for the next short while with time lines’€.

For the next two weeks, the health department will be briefing stakeholders including trade unions, professional bodies and training institutions.

Stakeholders have until 15 September to make written submissions on the plan.

By January, a programme to develop national training standards for health workers is to be in place.

Other deadlines have not yet been set, but it seems that the health department has finally recognised that it has to provide leadership if our health sector is to provide an adequate service to citizens. ‘€“ Health-e News Service.

ACTION PLAN

 The framework identifies a number of priorities, including to:

* Review the capacity of health education and training institutions.

* Promote health sciences as careers of choice to students

* Mobilise resources to focus on mid-level health workers e.g. medical assistant training programme

* Remove obstacles to nurses rejoining public health service

* Harmonise and increased the production of Community Health Workers

* Finalise the review of the nursing qualifications

* Research and develop a new remuneration structure for health professionals

* Revitalise health infrastructure and improve physical environment at health facilities to improve health outcomes.

* Ensure HR information systems are able to analyse the supply and demand of staff, and where they are located.

* Accelerate the training of middle managers.

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