meeting the challenges of hiv/aids in south africa capacity constraints gustaaf wolvaardt...

MEETING THE MEETING THE CHALLENGES OF CHALLENGES OF

HIV/AIDS IN HIV/AIDS IN SOUTH AFRICASOUTH AFRICA

CAPACITY CAPACITY CONSTRAINTS CONSTRAINTS

Gustaaf WolvaardtGustaaf Wolvaardt MBChB(Pret),M.Med(Int)(Pret),FCP(SA), MBChB(Pret),M.Med(Int)(Pret),FCP(SA),

AMP(MBS),PGCHE(Pret)AMP(MBS),PGCHE(Pret)

CLINICAL CAPACITY CLINICAL CAPACITY

PRODUCTIONPRODUCTION

Doctors Output at the 8 medical schools around 1230 doctors per

year over the past 12 years HST estimated RSA needed 3,200 dedicated

doctors and 2,400 nurses in 2009 for ART ART Programs Programs only

Nurses Massive drop in production of RN’s by Nursing Colleges

from 2300/p.a. in 1996 to 1300 in 2004 , has been increasing the last few years

Pharmacists Dropped from 450 to 320 per annum

FPD

DISTRIBUTION DISTRIBUTION

% of Doctors in Private Sector

0

1020

3040

5060

7080

90100

GP's Spesialists Pharmacists Dentists

19902004

FPD

DISTRIBUTION OF HEALTH CARE PROFESSIONALS DISTRIBUTION OF HEALTH CARE PROFESSIONALS HEALTH AND HEALTH CARE IN SA (2004)HEALTH AND HEALTH CARE IN SA (2004)

Total Public Private

GP’s 19 729 5398 (27.4%) 14331 (72.6%)

Specialists 7826 1938 (24.8%) 5888 (75.2%)

Dentists 4269 316 (7.4%) 3953 (92.6%)

Pharmacists 4410 1047 (23.7%) 3363 (76.3%)

Psychologists 3808 222 (5.8%) 3586 (94.2%)

FPD

RETENTION RETENTION

A GLOBAL COMPETITION FOR RESOURCES: BRAIN DRAIN: CUMULATIVE TOLL – WE ARE LOSING

Financial Mail April 2006

FPD

incompetent/autocratic/waste10%

Professional issues / nursing not good9%

Academic collapse/ Insufficient funds for specialities/research2%

targeted by govt/ increasing legislation2%

stress / need quality of life/fed up/insecurity6%

Other8%

abused by mgment / no recognition/lack of respect21%

State not attractive option/ disfunctional/ workload/lack future/admin load16%

Not enough salary/ no increase/ cant cope financially15%

h/care not delivered / affordable/failing/basics not there11%

Reasons for leaving the public sector SAMA Reasons for leaving the public sector SAMA Survey 2003Survey 2003

OTHER OTHER

Impact of HIV/AIDS on health professions Ageing professional population (17 000

of 22 000 doctors currently in practice qualified before 1990

FPD

MANAGEMENT CAPACITY MANAGEMENT CAPACITY

Current situation

Unpublished industry report (Univ of Pretoria SHSPH) in 2006 showed that of 148 health care managers , working in the AIDS field (76% public sector) surveyed 54% of these managers never had 54% of these managers never had any form of management trainingany form of management training

These managers in total managed 28 000 health care workers

FPD

Core qualificationsCore qualificationsFPD

Solutions – National HR Plan for Health 2006

Increase production (doubling of output) Infrastructure and resource constraints ? 10% increase Plan does not adequately explore the potential of using the

private sector Mid-level workers

Pharmacy assistants – being developed for a number of years in both public and private educational sectors

Medical assistants (new category) Training for task shifting

Nurse practitioners with salaries that compensate them for these skills

Health Charter to include replacement offerings that will support HRH

Improve conditions of service i.e. accommodation at health facilities

POTENTIAL SOLUTIONS POTENTIAL SOLUTIONS

TO INCREASES CLINICAL RESOURCES Better align patients to providers

Outsource to private sector (for and not for profit organizations)

NHI

AIDS Service Organizations

HIV 911 database 2008 – 7000 AIDS Service Organization 2009 – 12 000

FPD

Rapidly improving service Rapidly improving service delivery – The PEPFAR lesson delivery – The PEPFAR lesson 4-5 billion rand per annum budget

channeled through 250 partners predominantly from civil society

No corruption scandals

FPD

POTENTIAL SOLUTIONS – FOREIGN POTENTIAL SOLUTIONS – FOREIGN DRS:DRS:FQDs AS A SOURCE OF SKILLSFQDs AS A SOURCE OF SKILLS

FPD

POTENTIAL SOLUTIONS – FOREIGN DRS: HAVING DR’S PARK YOUR CAR IS HAVING DR’S PARK YOUR CAR IS NOTNOT A SOLUTION A SOLUTION

POLICY

FPD

Do the logical thing See stable patients less often Nurse initiation of ART Counselors do finger pricks etc.

Increase production of providers Consider private higher education

institutions

IMPROVE MANAGEMENT CAPACITY Professionalise now !! Apply current rules on management

requirements Insist that all managers get appropriate

qualifications within a 2 year period Assess if managers apply skills

“ “ The best way to predict the future is to create it “ The best way to predict the future is to create it “

Peter DruckerPeter Drucker

Peter Drucker:Peter Drucker:

gustaafw@foundation.co.za

+27833008271

www.foundation.co.za

Thanks