Public Health & Health Systems

Partnerships are crucial if health crisis is to be addressed

The World Health Day theme, ‘€œworking together for health’€, comes at a time when the South African health sector faces painful divisions.

The sharpest of these divisions is, ironically, in the area of most need: HIV and AIDS.

Government’€™s decision to block the accreditation of the Treatment Action Campaign and AIDS Law Project for the UN General Assembly Special Session on AIDS (UNGASS) in May has backfired embarrassingly.

Director General Thami Mseleku said government did so as the TAC and ALP ‘€œuse such platforms to rubbish what we are doing to tackle the problem’€.

But by barring the two organisations from the UN session, the health ministry has rubbished South Africa’€™s proud reputation as a democracy that tolerates debate and dissent.

In contrast, a few hospitals countrywide have accepted that the TAC is not going to simply disappear. They have put TAC volunteers to work in AIDS clinics, helping to prepare patients for antiretroviral (ARV) treatment.

One of these, Helen Joseph Hospital in Johannesburg, has one of the biggest and most successful ARV programmes in the country.

The sooner the health department realises that it needs the help of health sector organisations, the more likely it is to address the country’€™s health problems.

But the real focus of today is meant to be on health workers, who are in short supply worldwide.

The World Health Organisation’€™s message today is that healthworkers save lives and they need to be valued.

In a belated acknowledgement of this, our health department has been working for more than a year on a human resource plan to address the critical shortage of doctors, nurses and other health workers.

The final HR plan is due to be released today, and its more recent versions are a vast improvement on the limp first draft released last August.

Probably the most heartening improvement is the fact that important targets are now pinned to definite deadlines.

South Africa faces a range of very serious health problems, including one of the world’€™s worst HIV/AIDS and tuberculosis rates to high rates of violence, road accidents and chronic ‘€œlifestyle’€ diseases such as diabetes, hypertension and heart disease.

Yet attempts to address these serious problems are being undermined by the fact that we simply don’€™t have enough healthworkers.

Treasury has made provision for the health staff to increase by 30 000 people during the next five years.

To meet the growing need, the HR plan focuses much attention on training healthcare workers. By May, it wants a high level agreement on targets for production of healthworkers.

It has already set some of these targets. By 2009, it wants:

  • double the number of clinical psychologists to 150.
  • 3000 professional nurses (up from 1896)
  • 10 000 nursing assistants (from 7 368).

By 2010, it wants to increase the numbers of pharmacists trained in a year from 400 to 600. By 2014, it wants to double the number of doctors trained every year ‘€“ up to 2 400.

But will South Africa simply be using taxpayers’€™ money to train professionals who leave for greener pastures?

After all in 2001, 23 407 South African born health workers were working in Australia, New Zealand, Canada, Britain and the USA.

Almost 9000 of these (8,921) were doctors, yet at the same time back in South Africa the public sector only had 11 332 doctors.

To prevent a post-graduation exodus, one of the important pillars of the HR plan is a staff retention policy based on better pay, a package of incentives and improved conditions of service.

By January, the department says it wants to have developed and implemented ‘€œtargeted initiatives to promote a positive and supportive work environment’€.

These initiatives include ‘€œfinancial and non-financial incentives’€ and ‘€œa performance management system that acknowledges excellence’€.

In addition, it wants vacancies to be filled within four months to avoid overburdening staff who chose to stay in the public sector.

But government remains lukewarm about recruiting foreign healthworkers to fill the gaps. It says it will pursue foreign workers primarily through government-to-government agreements as it had with Cuba, and it will not actively recruit people from African countries.

In addition, employment contracts for foreign health professionals will be a maximum of  three years and be non-renewable.

But the provinces will have to drive much of the implementation and many ‘€“ particularly the Eastern Cape, Mpumalanga and Limpopo ‘€“ lack the capacity to do so.

This is where partnerships with a range of health sector organisations is crucial ‘€“ yet building and nurturing such partnerships is not a strong point of his health administration.

Relationships with academic and training institutions to meet the targets is particularly important, but Health Minister Dr Manto Tshabalala-Msimang has not endeared herself to the academic health establishment in the past.

Perhaps some consolation can be drawn from the fact that the HR plan is being driven by the department’€™s deputy director general for human resources, Dr Percy Mahlati.

As former CEO of the SA Medical Association, Mahlati is used to dealing with a range of health organisations and has a more inclusive style than the minister and her director general.

About the author

Kerry Cullinan

Kerry Cullinan is the Managing Editor at Health-e News Service. Follow her on Twitter @kerrycullinan11