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HEALTH PORTFOLIO COMMITTEE
17 June 2003
DEPARTMENT ON HUMAN RESOURCE DEVELOPMENT PLAN: BRIEFING
Chairperson: L V Ngculu (ANC)
Documents handed out:
Human Resource Issues Powerpoint Presentation
The Committee noted that the discussion it had with the Department on human resources issues helped clarify a number of critical concerns. However, some areas like incentives, equitable distribution of personnel would require a follow up. The Committee reported that it paid a visit to the Khayelitsha Hospital where there was a dire need to improve conditions for nurses and to improve health care to the people. The Committee expressed concern at the slow progress in the issue of representivity in medical schools and undertook to engage the respective deans on the matter. The Committee also concurred with the Department that Health Profession Councils should put the interests of the public before those of their members.
The Chair reminded members that during the budget hearings the issue of human resource featured prominently as one critical area that called for urgent intervention. The Department had promised to present to the Committee a comprehensive plan around the debilitating human resource issue.
Human Resource Strategy Briefing
Dr. Chetty informed the Committee that the human resource strategy was drawn from the Pick Report, which identified five key goals in dealing with this vexing issue. The first goal was to ensure that there was sufficient staff with the right skills in the right places. She continued that the second goal was the transformation of training and education, which tied in with the third key issue namely the transformation of professional regulations. In this area the focus would be on the structural reform of the professional statutory councils to ensure that these bodies serve the interests of the public and not that of their members. The fourth key goal was transformation of pay and human resource management, including improving staff morale. This area would entail the implementation of pay progression system and job evaluation and upgrading of certain categories of health professionals. In this regard both monetary and non-monetary incentive for rural and undeserved areas had been mooted. This strategy would also look at the strategy to recruit and retain scarce skills.
Ms Malumise (ANC) asked if the Department had considered introducing a special training for HIV/Aids to health professionals.
Ms Mdlalose replied that two tertiary institutions namely Medunsa and Stellenbosch have introduced courses on HIV/AIDS. Annually the Department paid regular visits to tertiary institutions to determine a number of issues on AIDS work plan and see whether these institutions were preparing competent.
Ms Malumise referred to the training centres that Dr. Chetty had alluded to and sought clarity as to whether these centres had been operationalised.
Dr. Chetty clarified that training centres had not yet been set up but that the Department was only running training courses. The Department was currently exploring the possibility of setting up such centres.
Ms Malumise also enquired on what the non-monetary incentive entailed.
Dr. Chetty explained that some of the options included in the non-monetary incentives would be long-term bursaries to the affected doctor's children, subsidized accommodation, extra leave, sabbatical, training opportunities among others.
Ms Kalyan (DP) wanted to know the doctor to patient ratio in the country's health institutions.
Dr. Chetty said the doctor-patient ratio was 70.8 doctors per 120,000 patients which she noted the Pick Report had said was an adequate ratio for the country.
Ms Kalyan inquired as to whether the Department had come up with a lasting solution to the perennial problem of malnutrition in the country.
Ms Kalyan asked about the minimum qualifications required of an assistant to a doctor.
Dr. Chetty pointed out that the Health Profession Council made recommendations pertaining to the qualifications of the medical assistants and it gives advise to the Department as to who should be registered and the applicable criteria thereof.
Ms Kalyan asked when the rural incentives programme would begin and if this facility would immediately be extended to other cadres of health professionals.
Dr. Chetty revealed that the rural incentive programme would be rolled-out on 1 July and that there were plans to immediately extent the programme to all health professionals that worked in these areas.
Ms Kalyan pointed out that most graduate doctors left for greener pastures where they were paid well in order to settle their student loan account. She asked if the Department had explored or was exploring the possibility of helping these students repay their bursaries so that they could stay on and work for the country.
Dr. Chetty confirmed that the Department had in some instances entered a contractual agreement to help some young doctors repay their bursaries as long as they agreed to work in a designated area for a certain period of time.
Dr. Luthuli (ANC) acknowledged the fact that the human resource issue was quite problematic noting that this was the root cause of the current crisis in the health sector. She welcomed the Department's effort to try and address this major concern. Was the policy of representativity in terms of selection to medical schools being implemented?
Dr. Chetty pointed out that there had been a marked improvement in the student in-take in most medical schools to comply with the criteria on representativity but regretted that the University of Stellenbosch was still problematic in that it had managed to graduate only eight doctors so far.
Dr. Luthuli pointed out that the Department suffered from an acute shortage of managerial skills. To what extent had the training scheme for managers been achieved?
Ms Mdlalose concurred that management training was identified in 1994 as a major concern and that relevant programmess had been put in place to address the issue. There was competency training at both national and regional level and that this exercise was carried out in collaboration with medical schools to improve the training of managers at an advanced stage. She added that in fact the French management model has been introduced and that plans were being made to introduce the Harvard model as well.
Dr. Luthuli faulted the Pick Report for being contradictory in that on the one hand it stated that the country had enough health professionals yet on the other hand it lamented losing professionals to other countries.
Dr. Chetty defended the Pick Report noting that it was clear that the country had enough doctors commensurate with its resources noting that the report has clarified that the problem lies in the equitable distribution of these professionals throughout the country.
Dr. Luthuli sought for an explanation as to what the report means by 'multi-skilling.
Dr. Chetty pointed out that the issue of multi-skilling had been debated at length and it talked about the possibility of , for example an enrolled nurse rendering radiography services in addition to the regular work for which she had been trained.
Dr. Jassat (ANC) concurred with Dr. Chetty that Health Professional Councils should ensure that the ethical standards were up-held at all times in order to protect the public.
The Chair indicated that a programme would be designed to meet and interact with Health Professional Councils so that a number of concerns could be discussed.
Dr. Jassat said that the overseas training programme needed to be looked at afresh noting that if one took Cuba for instance a student had to first learn Spanish which took valuable time yet might not be needed in practice.
Dr. Chetty agreed with Dr. Jassat's reasoning but noted that there were certain expertise for which certain countries were renowned like information systems in Italy which then became imperative for the student to acquire this critical skill.
Mr. Micheal Walters (DA) noted that resolution 7 dealt with human resource and skills shortages and wondered if it could help the Department resolve the question of even distribution of health personnel in the country.
Dr. Chetty pointed out that Resolution 7 applied mainly to the low-level personnel and doctors were expressly exempt from this provision.
Mr. Walters asked if the Department had considered the option of allowing medical schools to select students on the basis of provincial rather than national demographics.
Dr. Chetty emphasized that tertiary institutions were a national asset that was equipped to serve the entire country and this is the basis on which their selection criterion is assessed.
The Chair concurred with Dr. Chetty and decried the continued subtle polarization of student ratios in most medical schools. Ultimately higher education fell under the national competency rather than provincial and that to that extend these institutions must produce expertise for national duty. The Committee had planned to meet the deans of Medical Schools in June 3 but they indicated that this was an exam period and so the date was not convenient for them. The programme for meeting the deans of Medical Schools was still on and a convenient time would be set for the meeting to materialize so that issues to do with the criteria of admission and representativity could be dealt with .
Dr. Luthuli pointed out that making mathematics a compulsory subject seriously undermined the representativity targets since most black students were severely disadvantaged in this area.
Dr. Chetty pointed out that as far as the Department was concerned lack of mathematics should not be a hindrance to the study of medicines but Medical schools held a contrary view. These schools should be in a position to explain to the Committee why they thought mathematics should be retained as a compulsory subject for those intending to pursue a medical career.
Ms Kalyan asked what the 'Ethical Recruitment Agreement' that Dr. Chetty referred to entails in terms of government to government and whether Health Profession Councils were consulted in this regard.
Dr. Chetty explained that the understanding on ethical recruitment did not seek to curtail person's rights of movement but that it sought to ensure that recruitm ent was conducted on a government to government basis. This would be done with the understanding that the emigrants would benefit from outside exposure and be able to bring back the experience they would have acquired abroad for the benefit of the country. All stakeholders were duly consulted on the matter.
Dr. Chetty stated that uniform conditions of service in government was a long-standing issue and one that the President had voiced concern about. The President had indicated that the issue would be looked into soon.
The Chair suggested that when the Department looked at the various areas it should not only focus on rural and deep rural areas forgetting urban areas like Khayelitsha where there were serious problems with delivery of services.
Dr. Chetty clarified that areas of concern were categorized as hospitable and inhospitable and that therefore certain urban areas would clearly fall under the latter category.
The Chair said the discussion was fruitful in that it has helped clear a number of critical concerns although some other areas like the one on incentives, equitable distribution of personnel would require a follow-up. He pointed out that the Committee paid a visit to the Khayilitsha Hospital and it was heart breaking to listen to the tales of the nurses who work there noting that more work needs to be done to improve health care to the people.
The meeting was adjourned.