Report to the Select Committee on Social Services on Vacancies in the

Public Health Sector

Cape Town6th March 2012

Response the Auditor General on Vacancies in the Health Sector

Response the Auditor General on Vacancies in the Health Sector

• Summary of Auditor General findings

• Comment on data issues

• Trends in health workforce numbers and expenditure

• Strategic response to issue of vacancies: NDoH HRH Strategy 2012/13 – 2016/17

• HRH workforce audit and planning 2012 – practical response to vacancies

• District Health PHC re-engineering

• Facilities management and administration vacancies

• Recruitment strategy for health professionals

Report by Auditor General 21st February 2012

Report by Auditor General 21st February 2012

• The AG report stated the following:– 31% of posts vacant– Vacancies by province, by programme and profession (see

following 4 slides)– Issues arising according to the AG:

• 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 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

Table 1 Health Sector vacancies 2010/11Source: Auditor General February 2012

Table 1 Health Sector vacancies 2010/11Source: Auditor General February 2012

Table 2Health Sector Vacancies per provinceSource: Auditor General February 2012

Table 2Health Sector Vacancies per provinceSource: Auditor General February 2012

Table 3 Vacancies per programmeSource: Auditor General February 2012

Table 3 Vacancies per programmeSource: Auditor General February 2012

Table 4 Vacancies for critical occupationsSource: Auditor General February 2012

Table 4 Vacancies for critical occupationsSource: Auditor General February 2012

Interpretation of DataInterpretation of Data

• National Treasury and NDoH hold the view that the vacancies are not an accurate reflection of critical posts and affordable posts

• Methods used by provinces for arriving at vacancies are different and do not all reflect new service and organisational requirements

• Vacancies are funded and unfunded – this data is with provinces and not on PERSAL (we have requested it)

• It would cost R38bn to fill the vacancies of 14 of the professions (personnel expenditure was R60bn in 2010/11) - this is unaffordable

– Limpopo R14bn to fill vacancies – E Cape R9bn to fill vacancies

• Example Limpopo – vacancy of 5000 doctors

• Table over page shows inconsistent ratios per 10,000 if vacancies were filled

Table 5 Total filled and vacant positions per 10,000 uninsured population for doctors in the public sector, by province, 2010Table 5 Total filled and vacant positions per 10,000 uninsured population for doctors in the public sector, by province, 2010

RegionUninsured population

Filled (per 10,000 population)

Vacant (per 10,000 population)

TOTAL (per 10,000 population)

Eastern Cape 6,611,246 2.43 0.88 3.30

Free State 2,594,485 3.51 1.23 4.73

Gauteng 6,921,958 5.99 0.86 6.85

KwaZulu-Natal 8,841,171 4.01 1.27 5.28

Limpopo 5,314,492 2.01 2.19 4.19

Mpumalanga 2,949,627 2.58 0.40 2.98

North-West 3,457,127 1.83 0.08 1.91

Northern Cape 765,716 4.37 0.78 5.16

Western Cape 3,539,627 7.51 1.21 8.72

South Africa 40,995,447 3.82 1.08 4.90

Table 6 Health Professionals Employed in the Public Sector 1997 –2006Source: NDoH Expenditure Review 2008

Table 6 Health Professionals Employed in the Public Sector 1997 –2006Source: NDoH Expenditure Review 2008

Professional category 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Administration & Man

28,676 27,435 27,188 25,884 27,629 27,253 26,622 28,935 32,052 37,419

Ass Health Prof 13,786 13,779 13,598 13,524 13,824 16,955 18,307 19,363 22,470 23,349

Hospital & Health Support

81,097 77,603 72,849 67,172 67,209 65,614 62,330 60,397 60,388 60,030

Management 420 381 379 342 555 620 700 800 1,314 1,091

Medical 15,554 15,593 14,875 14,256 14,759 14,980 13,752 14,219 14,659 16,006

Nursing 111,102

105,757

101,982

99,473

99,618

100,079

101,090

103,387

107,762

113,153

TOTAL 250,635

240,548

230,871

220,651

223,594

225,501

222,801

227,101

238,645

251,048

Table 7 Growth in the Public sector health workforce 2006 – 2010Source: National Treasury/PERSAL

Table 7 Growth in the Public sector health workforce 2006 – 2010Source: National Treasury/PERSAL

Table 8 Growth in public sector expenditure on the health workforce 2006/07 – 2010/11 (R million)

Source: National Treasury/PERSAL

Table 8 Growth in public sector expenditure on the health workforce 2006/07 – 2010/11 (R million)

Source: National Treasury/PERSAL

Province 2006/07 2007/08 2008/09 2009/10 2010/11 Average annual growth

Eastern Cape 3,860 4,563 6,085 7,397 8,392 29.5%

Free State 2,012 2,352 2,881 3,144 3,777 23.4%

Gauteng 5,347 6,519 8,158 9,877 12,225 31.7%

KZN 6,629 8,644 10,077 12,126 12,940 25.0%

Limpopo 3,311 4,044 4,692 5,594 6,617 26.0%

Mpumalanga 1,628 1,992 2,603 3,073 3,614 30.5%

Northern Cape 621 786 891 1,034 1,278 27.2%

North West 1,914 1,983 2,537 2,877 3,269 19.5%

Western Cape 3,419 4,139 4,876 5,780 6,805 25.8%

Total 28,740 35,022 42,801 50,903 58,919 27.0%

Human Resources for Health Strategy for the Health sector 2012/13 – 2016/17Human Resources for Health Strategy for the Health sector 2012/13 – 2016/17

8 thematic strategic priorities

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 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 – skills and motivation of health professionals

Improve access in rural and remote areas

HRH Information and planning Strategic Objective 2: Centre for Health Workforce Intelligence (April/May 2012)

HRH Information and planning Strategic Objective 2: Centre for Health Workforce Intelligence (April/May 2012)• To address vacancies and develop realistic plans:

– Audit of health workforce and clean up of PERSAL data

– Develop database on public and private sector workforce

– Service plans linked to new priorities

– Strengthened workforce planning capacity in provinces guided by norms

– NHI taken into consideration and contracting with private sector professionals/service providers

District Health – PHC Re-EngineeringDistrict Health – PHC Re-Engineering

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 – emphasis on CHWs (training has started)

•Environmental health practitioners are central to the new policy of PHC re-engineering

•Minister’s priority on health care management – management of health care institutions and districts

•Overhaul of the hospital and health system

HRH needs for these objectives being planned for in 2012

Review of hospital CEO positionsReview of hospital CEO positions

• Review by DBSA of competencies and backgrounds of hospitals CEOs

• New policy gazetted in 20122 August on hospital categories and requirements for CEOs

• Posts readvertised in Sunday papers past weekend

• Raining programme planned by new Institute in 2012

Administration vacancies in provinces and constraints on filling vacancies

Administration vacancies in provinces and constraints on filling vacancies

• Administration expanded considerably at the expense of clinical positions (e.g. E Cape)

• Careful attention required before increasing administration

• Rather improve skills and make existing post and organistional structures better skilled efficient

• General limit on budgets for expansion of all posts/ filling vacancies (E Cape, Limpopo, Gauteng)

Recruitment StrategyRecruitment Strategy

• Recruitment and retention of health professionals complex

• At present very poor retention due to lack of funded planned and available posts– 70% of health professionals trained do not remain in the public

sector and high emigration

• Strategy is to:– Refine planned and funded posts– Improve work and supportive professional environment to

attract health professionals– Improve HR management– Enhance continuing professional development

(See HRH Strategy document)

ConclusionConclusion

• The AG report on vacancies gave the numbers and problems arising from ‘shortages’/unfilled posts of professionals and managers

• Need to develop minimum critical appropriate numbers and skills mix

• The Minister and DG have implemented a number of interventions over the past year which address this situation– Facility audit and improvement process– Policy on hospitals and CEOs– PHC 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