Training Competent Health Professionals for the 20th Century Response National Department of Health SA Committee of Health Science Deans 3rd July 2012 UKZN
Response HRH Strategy show need for university collaboration to implement it Immediate issues undertaken this year on HRH by NDoH Priority is to work together - NDOH and DHET, universities and the academic service platform - have to create the enabling environment for health professional development in the 21 st century.
HUMAN RESOURCES FOR HEALTH SOUTH AFRICA HRH Strategy for the Health Sector: 2012/13 2016/17
Problem Statement Theme 1: Ensuring Supply of the Health Workforce & Equity of Access 3 Themes identified: Equity and access to health professionals Education and training production of the health workforce The working environment of the health workforce Theme 1: Ensuring supply and equity and access to health professionals (page 24) Stagnation in growth of health professionals in the public sector history of budget constraint Different data on total numbers of HRH (page 25) Expenditure doubled since 2006/7 Lack of retention of graduates Attrition and Migration (25% inc. CS professionals) Maldistribution urban and rural, public and private Supply and the recruitment of foreign health professionals Shortage - vacancies - Need to develop realistic assessment of shortage Benchmarking with other countries
International Comparisons per 10,000 Population International benchmarks Brazil Chile Costa Rica Colombia Thailand Argentina SA current DOCTORS 17.31 15.71 20.42 19.43 8.72 31.96 5.43 NURSES 65.59 10.45 22.19 5.83 33.21 4.87 36.1 PHARMACY 5.81 3.72 5.34 0 2.92 5.08 2.29 ORAL HEALTH 13.69 7.44 4.85 8.26 1.73 9.28 1.2 IMR (per 1,000 live births) MMR (per 100,000 live births) 17.3 7 9.6 16.2 12 13 43.1 75 18.2 26.7 75.6 12.2 40 165.5
Problem Statement Theme 2: Education, Training & Research Theme 2: Education, Training and Research (page 44) Stagnation in growth key professions and hence access e.g. MBChB not utilising full capacity and of equivalent quality output Serious decline in specialist nursing - hence service limited in tertiary centres Education and training of the nursing profession requires regulation & refinement Freezing of registrar and sub specialist medical training posts and serious gaps in specialist training in certain provinces Reduction in academic clinicians in all professions and freezing of posts Quality of clinical training in health science education and training not consistent especially in nursing Decline in output of research, especially clinical research Almost minimal training in 4 out of 9 provinces which affects access to health professionals with many professions not being trained in E Cape AHC organisational infrastructure, financing flows and accountability Nursing colleges Private sector role
Problem Statement Theme 3: The Working Environment of the of the Health Workforce Theme 3:The Working Environment of the of the Health Workforce Leadership and management Public health leadership - link to environmental health Human Resource Management Provincial HR Plans (next slide) Occupation Specific Dispensation Absenteeism and turnover of personnel Moonlighting and RWOPS Performance management and productivity Competence review and incentives Continuing Professional development Strengthening professionalism of HR function Ensuring quality care - key role of statutory councils Information for HR and workforce planning Workforce planning capability at all levels and usefulness of Service Transformation Plans
New Service Needs and requirements for New HRH Model for South Africa New service needs Minister s statement in Budget Speech May 2011: PHC Re-engineering in three streams District based model of specialists clinicians to impact on MDGs School Health Programme Ward based PHC model Need to improve quality of nursing care Minister s policy on hospital management and management of health care institutions and districts Overhaul of the hospital system and develop health professionals for higher levels of care
New Service Needs and requirements for Seven key foundations: New HRH Model for South Africa 1. CHW at community level There will be a large community based workforce with preventive & promotive competencies 2. A nurse-based system New categories of nurse will be developed for new PHC model Revised scope of work, increased clinical competencies and numbers of Professional Nurses 3. Introduce and expand mid-level workers The new cadre of Clinical Associates will be increased Others? e.g Pharmacy Assistant for the new PHC team, counsellors for the new PHC team 4. Expand general medical doctors and general health professionals There is a need for more general medical doctors at both PHC and hospital levels and other generalist health professionals pharmacists, physiotherapists, dieticians, etc.. 5. Expand selected specialists - doctors and other professionals The MCWH challenge requires an intervention to improve the numbers of selected specialists in teams and in districts to take the lead in clinical governance And ensure balanced specialist growth for clinical leadership and service development 6. Public Health Specialist leaders 7. Develop academic clinicians and clinical educators in all disciplines
VISION HRH SA Vision Mission and Values A workforce developed through innovative education and training strategies and fit for purpose to meet the needs of the re engineered health system and measurably improve access to quality health care for all by 2030 MISSION To ensure a workforce fit for purpose to meet health needs by: Ensuring necessary and equitable staffing of the health system Developing health professionals and cadres to meet health and health care needs Ensuring the health workforce has an optimal working environment and rewarding careers Ensuring innovative and efficient recruitment and retention of the health workforce Enabling clinical research which enhances clinical and service development Provide professional quality care which is effective and evidence based Providing the organization and infrastructure for health workforce development Ensuring the regulatory, organisational environment and leadership by NDoH to support HRH VALUES Patient Centred Quality Care Universal Access Innovation Caring HRH for South Africa is informed by the need to: provide patient centred quality health care ensure universal coverage and universal access to health care and to enable an innovative and caring environment for health professional development and patient care
HR Strategy HRH SA 8 Thematic Areas for Strategic Priority Leadership, governance and accountability Health workforce information and health workforce planning Reengineering of the workforce to meet service needs Upscale and revitalise education, training and research Create the infrastructure for workforce and service development - Academic Health Complexes and nursing colleges Strengthen/professionalise the management of HR and prioritise health workforce needs Provide professional quality care strengthening the role of the statutory councils skills and motivation of health professionals Improve access in rural and remote areas
Implementation Priorities for Phase 1 The issues covered today are reflected Institute for Leadership an Management under consideration by the Minister Qualification framework for health care managers Masters level and a professional body with an examination requirement Challenge for universities to provide qualifications Implies management system development for NHI and strengthened IT and Mx systems Information for workforce planning Electronic database Workforce planning skills Staffing norms
Implementation Priorities for Phase 1 Minister s Task Team on Nurse Education and Training MLWs Expansion of growth of doctors growth of other health professionals MBCHB expansion has started with 120 this year increasing to 400 increased intake 1.3% Financed this year by NDoH and then through transitional funding in the CTG Health Professions Training Task Team May 2012 DG lead DHET and NDoH Planned expansion and financing with faculties
Number Implications of 5% Expansion to 2025 (Costs not reflected) Profession Enrolled 2010 Graduates 2010 Enrolled 2025 Graduates 2025 Graduates 2035 MBChB 8589 1298 15549 1954 (inc 656) 2351 (inc 1053) Dentistry 1137 214 2144 309 376 Pharmacy 1966 405 3893 686 794 Physiotherapy 1373 326 2718 558 645 Occ Therapy 1032 203 2043 347 402 SLP & Audio 659 157 1305 236 273
Development of the Academic Service Platform Development of Academic Health Complex Infrastructure Nursing Colleges AHCs Faculties of Health Sciences, Provincial services, Central (Academic Hospitals) and other service sites
Financing and governance of AHCs Figure 1: Model for financing of academic medicine, the Health Sciences and the Academic Health Complex Direct Costs of Health Science education University Block grant Academic Health Complex Recalibrated HPTDG funds directly allocated to AHC Board Indirect Costs of Health Science Education & Service costs: Central Hospital Global Budget (with NTSG) Provincial equitable share Private sector financing Clinical Training Grant Revenue generation Other Govt & private funds Faculty of Health Sciences Academic (Central) Hospital Faculty Dept 1 Faculty Department 2 Regional Hospital and Primary Care Sites
Conclusion Need for an institutionalised process is working together Living the symbiotic relationship Annual meetings are good but not sufficient to bring about the changes and growth in health professionals as required and discussed in this forum today. Making he health services better and relevant, implementing HRH Strategy 2012/13 2016/17 - depends on this relationship.