Creative solutions needed
Creative solutions, including employing assistants and improving allowances, are needed to get staff for over a quarter of health posts that are vacant in the country, according to the SA Health Review.
Over the past five years, a number of categories of ‘assistants’ have been introduced. These have helped eased the shortage of professionals in the public sector, particularly of pharmacists, radiographers, physiotherapists, occupational therapists and paramedics.
But the professionals that are most under pressure ‘ nurses and doctors ‘ are not getting the back-up that they need.
Although the auxiliary nurse category has existed for many years, government has been unable to train enough of these nurses.
So, while a government report recommended in 2001 that there should be two auxiliary nurses for every registered nurse, the opposite is now true. There is double the number of registered nurses as auxiliaries.
The category of assistant doctor has not been introduced, perhaps because it has been opposed by nurses organisations that want to know what this means for professional nurses, who undergo four years of training.
However, researcher Jannie Hugo says that in the USA, doctor assistants ‘are capable of giving care comparable to that of physicians’ and have ‘improved access to under-served areas such as those living in the inner city and rural areas’.
‘The most complex task of a professional is clinical reasoning, which includes assessment of the patient or a situation, and a decision about intervention. This can be regarded as a critical difference between a mid-level worker and a professional,’ argues Hugo.
Aside from the lack of support for doctors and nurses, one group of mid-level workers, counsellors, have resorted to court action as they feel they have not been given the promised opportunities.
The counsellors trained for four years of training on the understanding that, on qualifying, they would be assistants to psychologists.
But in December 2003, the health department published regulations stating that counsellors could only work in the non-governmental or public sectors, and since then it has failed to create any posts for them in the public service.
Aside from the mid-level workers, other solutions proposed by SAHR researchers focus on community service doctors, foreign doctors and improvements to the rural and scarce skill allowances.
Many doctors leave the country after doing their community service, and there is a sense that not enough is done to encourage them to stay.
According to a representative from the Senior Hospital Doctors’ Association of SA, ‘the Department of Health decides that it is not necessary to approach them to offer them jobs, while the UK does make the effort to approach them and of course they go.’
Foreign doctors still face difficulties when trying to work in this country, although in the past year the Health Professions Council of SA has made an effort to simplify registration.
While no more Cuban doctors are coming to work in the country, many district and regional hospitals relied on Cuban specialists and are now experiencing great difficulties.
An agreement has been reached with Iran to send doctors to work in Limpopo, Mpumalanga and the North West, these doctors have not yet arrived.
The health department’s opposition to employing African doctors to avoid poaching from poorer neighbours often means that African doctors simply leave the continent altogether.
The Health Review also calls for a review of the special allowances implemented in March 2004.
Rural allowances (which range from an extra 8 to 22% of salaries) had been based on outdated lists of rural hospitals and had excluded a number of rural insitutions. In addition, professional nurses received the smallest allowance (8%).
The scarce skill allowance (10-15% of salary) favours a small group of nurses and excludes nurses working in primary health clinics, yet this is where the demand for nurses is highest.
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