Released in November 2015, the 18-page paper outlines the causes, consequences and possible responses to the implementation of moratoria on the filling of posts within the health system.

It argues that human resource moratoria, also referred to as the ‘freezing of posts’ has become an increasingly common occurrence within the public health system over the last two years. The paper posits that this is largely due to cost increases that continue to outstrip both inflation as well as year-on-year increases to health budgets on average.

According to the RHAP working paper, provincial departments have managed budgetary pressures by shifting money between budget items and overspending on cost of employment in the hope that they will receive additional funding in future to account for overspending. In the absence of ‘bailouts’ from the Treasury, this overspending has contributed to growing accruals and a growing budget deficit that must be recovered from future budgets without necessary adjustments being made for this expenditure.

Meanwhile, provinces continue to ‘freeze’ posts to cut down on cost of employment. The paper makes the following main recommendations for addressing the moratoria:

1. The national departments of health and treasury should provoke policy guidance on the protection of critical posts during times of austerity;
2. Rural areas are particularly vulnerable to the impacts of frozen or vacant health posts and should thus be protected from moratoria;
3. “Critical posts” should be defined locally and include health and support staff;
4. Districts should develop costed human resource plans. The treasury should play an active role in ensure this happens and should provide some guidance on how financial aspects should be addressed;
5. Cost-cutting decisions should be made at district level by giving districts the amount to be saved and allowing the district to decide based on principles of rationality, proportionality and the over-arching Constitutional right to the progressive realization of the right to health; and
6. Corruption and unauthorised expenditures should be performance managed instead of punishing all managers and districts by withdrawing their authorities for the transgressions of others

Download the working paper: Causes, Implications and Possible Responses to Staffing Moratoria Working Paper

• Read how alleged hiring freezes are impacting patients, health workeres