The biggest challenge facing public healthcare today is the shortage of healthcare workers. There is an estimated shortage of approximately 80 000 healthcare professionals in South Africa. Even with this massive shortage, the private sector, which serves 16% of the country’s population, enjoys 70% of the country’s doctors. The remaining 84% of South Africa’s population uses public healthcare and languishes with access to only 30% of the country’s doctors. The shortage is partly caused by medical schools not significantly increasing their graduate output. Since the 1980s, the country’s eight medical schools only produced, on average, about 1 300 doctors annually. Thousands of our doctors are also working overseas. In fact, there are more South African doctors working abroad than there are working in the public sector in South Africa. The enormous staff shortages in the public sector certainly have an impact on the care offered to patients. Doctors and nurses are overworked and burned out, impacting their retention and the quality of care they can deliver.
The quality of healthcare that patients receive in urban and rural areas is highly unequal, with urban patients generally being able to access better services. Exacerbating this inequity is the fact that access to health services is substantially more challenging and costly for rural communities. Travel can present a major challenge both in terms of travel time, requiring time away from productive work and family life, and the costs associated with such travel. These barriers can make accessing healthcare prohibitively difficult for rural communities. Some patients are so desperate to access healthcare that they even move closer to hospitals. Outside the Ganyesa District Hospital in the North West, patients have resorted to building their shacks right next to the hospital to receive treatment. The lack of quality care in rural areas also leads to growing urbanisation as people move to cities in search of better health services.
South Africa is starting to implement an ambitious National Health Insurance scheme. Many more doctors are needed for the plan to stand any chance of success. Africa Health Placements (AHP), together with the Department of Health and the Health Professions Council of South Africa, has since 2005 sourced, recruited and placed more than 2 500 foreign-qualified and local healthcare professionals at rural and underserved healthcare facilities in southern Africa. AHP has been changing the face of public health in southern Africa, creating new outcomes for healthcare facilities that might otherwise be defunct by now. We define ourselves as “social profit” because our work, while mostly donor-funded, delivers profit in terms of improved healthcare and social indicators. In 2012, AHP made great strides in achieving its vision: “Health for Africa, powered by people”. Our recruitment team placed almost 300 local and foreign-qualified healthcare professionals at rural and underserved healthcare facilities. Currently, 450 healthcare professionals placed by AHP are working in the South African healthcare system and they are reaching an estimated eight million South Africans.
As part of our health workforce support programme we conducted 110 continued professional development (CPD) sessions in rural areas in 2012. These sessions improved the knowledge and skills of healthcare professionals, reduced the feeling of professional isolation, and created a forum where they could network and interact. CPD sessions covered a range of topics relevant to healthcare professionals working in rural areas. As part of the support programme, AHP’s workforce support practitioners conducted more than 1 000 visits at healthcare facilities across the country last year. The problems addressed by workforce support practitioners are often not directly health-related, but are challenges that nonetheless have an impact on the delivery of healthcare. Practitioners have on several occasions assisted to solve road and water infrastructural problems in rural areas.
The health workforce support programme also assists hospital managers with minor equipment repairs and purchases. In 2012, AHP’s workforce support practitioner in Limpopo procured sutures to reopen a theatre which closed due to a shortage of sutures. The hospital is not allowed to purchase supplies without following long procurement processes. The practitioner found a supplier in Johannesburg and within three days the sutures were delivered at the hospital. The theatre was reopened and the clinical manager was very relieved. He said he would have had to send mothers and babies to the mortuary if the hospital did not get the sutures. AHP also offers orientation for healthcare workers which includes clinical, cultural and logistical aspects. District and facility-based induction programmes are also developed. Health workforce planning In addition to workforce support, AHP offers several services to fulfil its mission of “helping to plan for, find and keep the workforce needed to deliver health for all”. In terms of health workforce planning, AHP is developing health workforce plans, tools and systems to ensure that accurate HRH information is available so that healthcare workers are placed where they are needed the most. Workforce planning includes drafting national and district-level health workforce plans and developing national and district-level health workforce planning systems and tools. Facility profiling and HR needs assessments are performed and HR prioritisation plans are developed.
AHP’s recruitment team recruits management, clinical professionals and support staff for rural and urban government and NGO facilities and facilitates the registration of foreign-qualified healthcare professionals. AHP’s staffing model starts by making sure management can effectively handle the recruitment process, and then moves on to seeding health teams with foreign-qualified skills. Once in place, local health workers and junior doctors are recruited. Finally, facility management is supported towards self-sustainability. Health workers are sourced through creative award-winning marketing campaigns involving local and international advertising and conference attendance, as well as tapping a growing social network through online portals, alumni and a massive health worker and manager database.
AHP, as an independent organisation, is ideally placed to assist public sector staffing because we are not bound by the political and promotional protocols of government, and because we can specialise in providing the most professional recruitment services necessary to make the biggest impact possible.
Finally, AHP also conducts extensive monitoring and evaluation, as well as research on HRH aspects. This allows AHP to advise on policies to address HRH needs and draft and implement plans to execute policies around HRH. AHP also assesses and improves recruitment and registration systems. Furthermore, skills are transferred in health workforce planning, recruitment and workforce support.
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