The Minister of Health conceded that the Department of Health faced difficulties that were historical and structural. This had led to challenges in vacancy ratios and recruitment and retention of healthcare professionals which slowed the pace of service delivery efforts.
The Minister said that the findings of the Auditor-General relating to the department vacancy rates (that reflected a 31% vacancy rate) were not an accurate reflection. Methods used by provinces for identifying vacancies were different and did not reflect new service and organisational requirements. The data on funded and unfunded vacancies was with the provinces and not reflected on PERSAL (personnel salary system) which provided accurate information for the health workforce.
The Minister also reported on the functioning of district health and facilities management, administration posts in the provinces, a review of the hospital Chief Executive Officer position and a comprehensive recruitment strategy. The report noted that realistic plans should be developed that were linked to a needs analysis. The Department had developed a Human Resource Strategy 2012 - 2017 which set out eight thematic strategic priorities.
The Minister presented the department’s interventions aimed at addressing the challenges. The Department was in the process of compiling an audit of the health workforce and a clean up of PERSAL data. The development of a database on the public and private sector will be extensive and would be updated regularly. The Department also noted that service plans should be linked to new priorities and that a strengthened workforce should improve its planning capacity. Plans would be guided by minimum norms and standards. The National Health Insurance had been taken into consideration in the planning process.
Members were pleased that the Minister had provided clarity on the data presented by the Auditor-General but showed concern at staff shortages at clinics and hospitals, particularly in rural areas. They questioned the interventions put in place by the Department to deal with the findings. They asked what the Department was doing to recruit and retain the skills of healthcare professionals; what was the purpose of the moratorium on posts and if training would be provided for doctors and nurses. They were concerned that the personnel budget for
Members noted that the National Health Act came into effect on 1 March 2012 which took all services provided at a district level into account.
Minister of Health presentation
Minister Aaron Motsoaledi noted the findings of the Auditor-General on the department’s vacancy rates:
• Poor retention
• Overworked demoralised staff
• Poor training (in-service)
• Patient unhappiness and backlog
• Lack of emergency medical services
• Shortage of specialists and staff in academic hospitals
• Overspending on the Occupation Specific Dispensation (OSD)
• Inadequate HR training and management resulting in lack of posts for critical skills and bursary recipients
• Problem of supply chain management
• Shortage on personnel in infrastructure unit leading to poor quality
• New buildings not being utilised due to shortage/ lack of staff.
The Minister said that the findings of the Auditor-General on the department’s vacancy rates were not an accurate reflection of critical posts and affordable posts as methods used by provinces for identifying vacancies were different and did not reflect new service and organisational requirements. The data on funded and unfunded vacancies was with the provinces and not reflected on PERSAL which provided accurate information for the health workforce. The Minister’s report included the functioning of district health and facilities management, administration posts in the provinces, a review of the hospital Chief Executive Officer position and a comprehensive recruitment strategy.
The Minister presented a summary of the Auditor-General findings which reflected that 31% of posts were vacant within the Department of Health. He presented trends in health workforce numbers with correlated expenditure including vacancies by province, programme and profession. He stated that the data was not reliable as provinces used different methods for arriving at vacancies (see document). In addition vacancy rates were not linked to funded positions.
The Minister presented the Department Human Resource Strategy (HRH) 2012 to 2017. The strategy set out eight thematic strategic priorities which were:
▪ Leadership, governance and accountability – Leadership Institute underway for April 2012
▪ Health workforce information and health workforce planning
▪ Reengineering of the workforce to meet service needs
▪ Upscale and revitalise education, training and research
▪ Create 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 – skills and motivation of health professionals
▪ Improve access in rural and remote areas.
The Minister gave an outline of the plan to address vacancies within the department which included an audit of the health workforce, cleaning up of PERSAL data and the development of a database on the public and private sector workforce. Service plans would be linked to new priorities. In addition, strengthened workforce planning capacity would be developed in provinces guided by minimum norms and standards. The NHI would be taken into consideration and contracting with private sector professionals and service providers.
The Minister presented the department’s interventions at addressing vacancies which included re-engineering Primary Health Care (PHC) and recruitment and retention strategies for healthcare professionals.
The Minister summarised the interventions over the past year which addressed the vacancies:
– Facility audit and improvement process
– Policy on hospitals and CEOs
– Primary Health Care re-engineering
– HRH Strategy 2012/13 – 2016/17
– Institute for Leadership in Health
– Underway: audit of workforce and workforce planning for provinces, PERSAL clean up, and Centre for Health Workforce Intelligence.
The Chairperson asked if there were plans to increase the intake of nursing students at university level.
The Minister stated that the programme for training nurses was complex and not a problem created by the current ANC government. In the past people were trained on-the-job even in rural areas. In 1984 government policy changed and a primary training course at university level was established which presented various challenges such as entry requirements and fees. Nurses arrived at hospitals and clinics without any practical experience. The result over 20 years was that we have 98 000 nurses and only 35 000 enrolled at universities. Nursing colleges have deteriorated to the point of dilapidation. The National Department responded to this challenge and called a four-day national Nursing Summit much like the CODESA of nursing.
Ms M Boroto (ANC) questioned if there were strategies in place to retain critical skills.
The Minister replied that the challenge to retain health professional skills in developing countries was a global problem. There were bi-lateral and multi-lateral agreements in place. For example, a South African Development Community (SADC) agreement stated that member countries may not actively recruit doctors or nurses from each other since it may lead to collapse of the public healthcare system.
Ms M Boroto asked why there was a moratorium on management posts, but then fill the CEO posts.
The Minister said the CEO posts were not new. The Development Bank of Southern Africa (DBSA) was conducting a review of competencies and backgrounds of hospital’s CEOs. Posts were re-advertised in the Sunday newspapers (4 March 2012 edition).
Mr P Zulu (ANC) pointed out that some people have to walk up to 20km to access a clinic and wanted to know how rural development was being fast-tracked.
The Minister agreed that some rural areas were not accessible. The department had embarked on a mapping exercise to prepare for roll-out of NHI. He indicated that the Giyani district in
Mr S Plaatjie (COPE) expressed concern about the tendency to appoint “friends” who were often unqualified and asked what mechanisms the national department had implemented.
The Minister responded that oversight was best way to address the challenge of nepotism and that everyone had the responsibility to speak out about the practice.
Mr S Plaatjie asked why there appeared to be a bias toward the recruitment of administrative posts versus clinical posts which hampered the implementation of programmes
The Minister responded that the moratorium ensured that the practice of filling administrative posts was discontinued.
Ms B Mncube (ANC) expressed concern that CEOs were appointed without any health background and asked if unqualified CEOs would be retrenched.
The Minister sketched an example of when a school appointed a principal, it was looking for a qualified teacher. Likewise the hospital commander-in-chief should be qualified in health. The Minister appealed for all new appointments to be suitably qualified. The practice of hiring unqualified people was particularly evident in
Ms B Mncube asked what strategies were in place to ensure that clinical staff was sufficiently capacitated.
The Minister replied that the State of the Nation Address earmarked R1.2 billion to develop nursing homes and colleges and that the Human Resource Strategy also provided for an institute that would provide leadership training in health.
Mr W Faber (DA) invited the Minister to visit the
The Minister responded that the best doctors were in the public sector.
Mr T Mashamaite (ANC) asked what was being done about the shortages of nurses in rural areas.
The Director-General agreed that there was a shortage of doctors and nurses particularly in rural areas. Rural development was one priority while another priority area was to improve access to services in informal settlements.
Mr M De Villiers (COPE) asked how the department had included the matter of funded and unfunded positions in the new strategy.
The Director-General said the problem of unfunded positions existed across government departments. The Department of Public Service and Administration was to release a circular that would guide provinces to provide a progress report within two months. Data would be requested from provinces. The Department of Health would conduct an audit and report back on the results at the next meeting.
The meeting was adjourned.
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