Improving Human Resource Development And Management

This section deals with human resource development and management for the health sector as a whole. The more specific report on human resources in the Department of Health appears on pages 96 to 109, in the standard format required.

TABLE 27: COMPOSITION OF THE HEALTH SECTOR WORKFORCE IN 1999

Source: Report of the Human Resources for Health Task Team
*FTE stands for full-time equivalent. In this measure part time posts are combined to form full-time equivalents.

Five-year objectives

• Produce a human resource strategic plan.
• Create a human resource information system.
• Promote transformation of training institutions.
• Produce and implement a human resource management strategy.

Human resource development in the field of health is dependent on sound and comprehensive planning processes that embrace the needs of the sector as a whole, but pay special attention to the public component.

Even as the planning process unfolds, there is a need to develop and implement policies designed to address emerging needs.

The sound management of human resources is a prerequisite for the successful delivery of health services. As a national department, which does not have direct access to the mass of health sector personnel, the objective is to strengthen the skills for human resource management throughout the public health service and develop the systems for better management.

HUMAN RESOURCE STRATEGIC PLAN

Key objectives for 2001/2

• Finalise Human Resource Strategic Plan.
• Commence implementation of key recommendations.
• Facilitate revised scopes of practice for key professional groups.
• Develop proposals for mid-level workers' training.
• Finalise framework for post-graduate study.

TABLE 28: NUMBER OF COMMUNITY SERVICE PLACEMENTS 1999 - 2002

*Some dentists graduate mid-year and had not been placed by March

The magnitude of developing a Strategic Plan for Human Resources in health is suggested by the sheer size and complexity of the health sector - and by the inequities between the public and private systems. (See Table 27).

The Strategic Framework's "brief" for the human resource plan was that it should:

• Determine human resource needs for each level of health care.
• Determine a skills mix that is affordable.
• Audit human resources for health in all occupational classes.
• Develop norms and standards for human resources.
• Audit all training institutions in terms of student numbers and curricula.
• Assess the impact of HIV and AIDS on service providers and students.
• Determine the gap between current human resource numbers and the numbers required - and the degree to which current training can fill the gap.

The task of developing the strategy was entrusted a Human Resources for Health Task Team, appointed in 1999 by the Health Minmec and led by Professor William Pick.

• The strategy was informed by detailed research on the personnel requirements of the primary health care system, based on the package of services that has been defined for South Africa and the skills these require.
• It analysed the present gaps between supply and demand for various categories of health worker and highlighted provincial inequities.
• It projected supply and demand over a 30-year period and made recommendations for future training, in the light of present student numbers.

The report and resulting strategy were completed in July 2001 and were subsequently endorsed by the Health Minmec.

TABLE 29: PROVINCIAL DISTRIBUTION OF COMMUNITY SERVICE PLACEMENTS 2002

The Task Team contended that, when compared to other middle-income countries, South Africa does not have an overall shortage of health professionals.

However, the sharply skewed distribution of health professionals -between the public and private sectors and among provinces - creates dire shortages in rural areas.

Major recommendations related to:

• Professional scopes of practice that set the functional boundaries between health professions and between levels of worker within a profession. It was argued that a more flexible approach that extended scopes of practice - with appropriate training - could achieve better quality of care in a situation of sustained shortages in certain professional categories.
• A new, more determined approach to increase the contribution of the mid- level worker who would function as an assistant to the health professional and under the guidance of the latter.
• Differentiated training targets for the various professions, increasing output in some areas, maintaining the current numbers in others and a modest reduction in a few instances.

This was to correct the existing mismatch between the volumes and types of professional the training institutions are currently producing and the types demanded by a primary care-led system that came into being after 1994.

• A substantial growth in the number of enrolled nurses (with a two-year training, as against the professional nurse whose training takes four years) was perhaps the most significant recommendation on realigning training output with the needs of the public health system.
• The need for training institutions to recruit a body of students that is representative of the population and During the year in review, the foundation was laid for the expansion of community service to seven more professions from January 2003. The professions to be added to the programme are: Clinical psychology, dietetics, environmental health, occupational therapy, physiotherapy, radiography and speech and hearing therapy.

CUBAN TRAINING PROGRAMME

Through the government-to-government programme concluded by the South Africa and Cuba, students from disadvantaged circumstances receive fully funded bursaries for medical studies in Cuba. This programme aims to:

• Increase the number of medical students from rural and disadvantaged areas.
• Overcome some of the admission obstacles that such students face in South Africa.
• Increase the pool of practitioners with a strong primary care orientation.

In early 2002, there were 252 South Africans studying in Cuba under this scheme. Nine were due to graduate later in the year. They will be obliged, through a formal contract, to offer their services to the provincial health department that sponsored their study.

HUMAN RESOURCES INFORMATION SYSTEM

Key objectives for 2001/2

• Make maximum use of available information on PERSAL.
• Strengthen information partnership with professional councils.

A database has been established, founded on the public sector PERSAL/Vulindlela system and the registration data of the professional councils. It allows for basic comparisons across provinces and establishing basic trends in terms of equity in a variety of occupational classes or professional groups.

This is illustrated by the three graphs (Figures 13, 14 and 15) that give the racial profile of three occupational groups - professional nurses, medical doctors and medical specialists - across provinces. They indicate how complex the equity challenges in health are. Information system problems that have been identified are:

• Non-standard definitions - for instance, definition of a "vacant post".
• Lack of confidence in the accuracy of the PERSAL system.
• Limited expertise in provinces in utilising the PERSAL system for management information.

FIGURE 13: MEDICAL PRACTITIONERS: DISTRIBUTION BY RACE AS AT 31/12/2001

FIGURE 14: PROFESSIONAL NURSES: DISTRIBUTION BY RACE AS AT 31/12/2001

FIGURE 15: SPECIALISTS: DISTRIBUTION BY RACE AS AT 31/12/2001

HUMAN RESOURCE MANAGEMENT

Five-year objectives

Produce a human resource management strategy for the public health sector that encompasses policies and implementation plans on:

• Organisational structures with clear roles delineated for national, provincial and district levels.
• Management culture and systems.
• Recruitment and retention of personnel.
• Supervision and leadership.
• Training and retraining.
• Appraisal, remuneration and advancement.
• Labour relations.

Key objectives for 2001/2

• Implement new human resource management framework in the Department.
• Promote awareness of employment equity requirements.
• Align policies and procedures of Department with Employment Equity Act.
• Improve functioning of Public Health and Welfare Sector Bargaining Council.
• Negotiate collective agreements with the unions.
• Develop labour relations policies and practices of Department.

The outcomes in terms of the equityrelated objectives are covered in the Human Resource section on pages X to X.

Improved systems and capacity building for managers have been described in the sections on Hospital Revitalisation, District Health Systems and Quality of Care.

Professional councils

In human resource management in health, the systems for professional regulation play a significant role in defining the culture of work. Direct responsibility vests with the relevant statutory bodies appointed by the Minister of Health to fulfil this role.

Monitoring and evaluation of the effectiveness of the statutory framework within which the councils operate - and further development of that framework - remain important tasks of the Department.

During 2001, the Minister appointed a joint task team from the Department and various statutory councils to consider the role of statutory councils, including whether they were adequately playing their role in protecting the public. In a preliminary report:

• The Task Team affirmed that the purpose of the councils was to protect the public - not to promote the collective interests of their professions, of the pharmaceutical industry or the medical schemes.
• Members supported the position that these bodies must be constituted and appointed in a manner that guarantees that the public interest comes first. They proposed that a Charter should be drawn up to define the responsibility of council members in an unambiguous way and that this be promulgated as a regulation.

Further work will be done to apply the general principles agreed by the Task Team to individual councils and amendments may be made to the various laws that govern the statutory bodies.

Work progressed in relation to the organisation of traditional healers in preparation for self-regulation through a council with statutory powers. The drafting of the Traditional Healers Bill progressed considerably and enactment in the next year appeared likely.

Industrial relations

The Public Health and Welfare Sector Bargaining Council is one of four sectoral councils operating in the public service.

A representative of the Department of Health serves as chief negotiator for the employer parties in the council, with the Department of Social Development appointing an alternate.

The mandate of the chief negotiator derives directly from the Health Minmec and the Social Development Minmec.

During 2001/2 two collective agreements were signed with the relevant unions:

• On acting allowances.
• On needle stick injuries (mainly in the health sector).

Negotiations took place on the following issues with a view to concluding collective agreements:

• Minimum services.
• Fulltime shop stewards.

Within the Department, 16 cases of misconduct were lodged during the year.

Of these, eight were finalised. One-third of misconduct cases related to alleged fraud.

Two officials were dismissed for misconduct related to absenteeism and assault and intimidation.

In the same period, 13 grievances were lodged and nine were finalised. More than 60% of grievances related to promotion, evaluation and notch progression.