KHOPOTSO: The national Human Resources for Health Plan is painfully aware of one fact: Almost all services in the public health system are bankrupt of health professionals.

MANTO TSHABALA-MSIMANG: Over the years, our health system has had to deal with the loss of experienced health professionals from rural to urban areas, from public to private sector and from South Africa to mainly developed countries.

KHOPOTSO: Health Minister, Dr Manto Tshabalala-Msimang, speaking at the launch of the Plan. Underpinning the Human Resources for Health Plan is the urgent need to attract and train more people in the health sciences to address the acute shortage of skills as well as counter the continued migration of health workers from the country. For example, about 1200 doctors graduate annually from the 8 medical schools in South Africa, but only a few remain in the public service after graduation. The plan proposes to double the number of doctors produced nationally by the year 2014.

Dr PERCY MAHLATI: It takes a minimum of 5 years to train doctors. So, if you are going to boost that production and get to that level you will have to start as early as 2007 to admit.

KHOPOTSO: Dr Percy Mahlati is the Deputy Director-General for Human Resources in the national Department of Health and has been instrumental in shaping up the Plan. Although Professor Max Price, the dean of health sciences at Johannesburg’€™s Wits University welcomes the plan as a recognition of the dire shortage of skills by the Department of Health, he says it brings with it some challenges for implementation purposes.      

Prof. MAX PRICE: From Wits’€™ point of view, we would need to approach that in two ways. One would be to build extra facilities because the classrooms are not big enough. There aren’€™t enough of them. But, perhaps, more critically is the human resource capacity. One of the problems that medical schools face is that their teachers are almost all clinicians who work in the health services. And in the health services, their primary responsibility is often to the patients. So, when the patient-load increases the amount of time available for teaching and for research decreases unless the staffing goes up.

KHOPOTSO: Professor Price added that most medical schools would have a great difficulty expanding their capacity to accommodate increased volumes of students. Meanwhile, consultation with medical schools and other health sciences education institutions and the national Department of Education is yet to take place to discuss their capacity for the challenge as well as time-frames for implementation of the changes necessary to support the success of the plan. Health Minister, Dr Tshabalala-Msimang.

Dr MANTO TSHABALALA-MSIMANG: The broad activities mentioned would, therefore, not at this stage have time schedules attached to them. These activities relate to the areas of function of the national and provincial Departments of Health, the various role-players including health science education institutions’€¦ Each of these bodies is expected to further identify sub-activities as part of implementation and attach time frames to these to complement national efforts to address Human Resource challenges.

KHOPOTSO: For some universities such as Wits the closing date for enrolment is almost here ‘€“ end of June. Therefore, it’€™s crucial that outstanding matters on admissions policy be addressed as a matter of urgency. But then again, would it be wise to ram these plans through in such a short period of time? Currently, Wits University admits 240 first year students per year. To meet the Department of Health’€™s target of producing 2 400 doctors a year by 2014 it would have to double that figure, if admissions are to be increased by the year 2007.  

The same goes for other health disciplines, from nursing to psychology ‘€“ enrolment figures are set to increase. For instance, the Deputy Director-General for Human Resources in the Health Department Dr Percy Mahlati, says the Plan proposes an increase in the numbers of pharmacists produced in South Africa by 2010.

Dr PERCY MAHLATI: We have proposed that we increase from about 400 that we are producing to about 600.

KHOPOTSO: Only one category of training ‘€“ dentistry ‘€“ will see the numbers decrease. Instead of increasing the number of dental practitioners trained, the report proposes that there be more dental therapists.

Dr PERCY MAHLATI: The majority of dentists are in the private health sector’€¦ We’€™ve got dental therapists who are actually doing a very good job who are within the public health sector, rural areas and, basically, what we are saying is we need to train more of that cadre because they would be able to function very well, specifically, at a primary health care level’€¦

KHOPOTSO: At present South Africa is producing 200 dentists a year. It’€™s proposed that the number decrease to 120 over the next few years. Perhaps innovative in the plan is the introduction of a new cadre of personnel to be trained at the beginning of next year ‘€“ the medical or clinical assistant ‘€“ a mid-level health worker seen as second to a doctor.

Dr PERCY MAHLATI: Some of the mid-level workers are already existing, like for instance, dental therapists. Basically’€¦ we are looking at a mid-level worker in medicine who would be able to really deal with the simple procedures that need to be done. Somebody who’€™d be able to deal with the common ailments.

KHOPOTSO: The clinical assistants will undergo a three-year training programme at varsity level – one year less than it takes to train a professional nurse. Prof. Max Price thinks that this new category of health workers is likely to generate some controversy.

Prof. MAX PRICE: The nursing community may feel that this is a group that is taking away some of the functions that they have performed. And they may also perceive that these are going to be mini-doctors and that with less training, perhaps, they will actually occupy a higher status in the medical hierarchy ladder and that they will end up giving instructions to nurses, which will, in fact, sometimes happen because their function will be to assist the doctor. When the doctor isn’€™t there they will be performing some of the roles that doctors perform. So, from the nursing side there’€™s some anxiety about whether this is necessary or whether nurses should rather have been trained to perform this function.                                          

KHOPOTSO: It is hoped that the first students for the clinical assistants’€™ course will be taken in in 2007. Yet, the training programme is still to be approved. No doubt the Human Resources Plan for Health is long-overdue. The challenge is in the finer detail of its implementation. And the pressure is on.