1. HR ISSUES

2. Introduction Strategies drawn from: Pick Report on Human Resource Strategy for Health Task Team Report on Transformation of Statutory Councils Joint personnel task team report Various reports on migration, midlevel workers, foreign health professionals

3. Five Key Goals Ensure that there is sufficient staff with the right skills in the right places Transformation of training and education Transformation of professional regulation Transformation of pay and human resource management, including improving staff morale

4. Goal: Sufficient staff with the right skills in the right places Planning norms for staffing requirements Training of new categories of health workers, including mid-level workers Appropriate production of health professional Strategies for recruitment and retention Strategies to fill posts in areas of need

5. Goal: Transformation of training and education Improve representativity in undergraduate and post graduate student demography Review of training length of certain categories of health professionals Exit competencies for undergraduate students Establish Institute of Health Management Establish training centre for health managers Skills competency frameworks for hospital and DHS managers

6. Goal: Transformation of professional regulation Structural reform of professional statutory councils Improved coordination between councils Review of disciplinary processes within councils Extension of regulation for health workers not currently regulated

7. Goal: Transformation of pay and human resource management Implementation of pay progression system Job evaluations and upgrading of certain categories of health professionals Monetary and non-monetary incentives for rural and underserved areas Retention strategy to recruit and retain scarce skills

8. Key Recommendations from the Pick report Production of Health Workers No increase in the intake of medical students An increase in the intake of enrolled nursing students Revision of the nursing curriculum Modest reduction in the intake of dental students An increased intake of clinical psychology students Mid level workers

9. National Strategy on Human Resources for Health – The Pick Report Key Purpose Ensure an adequate supply of people with the requisite knowledge and skills for the health system guided by PHC approach Main findings: Shortages do exist, but main problem is mal-distribution Scopes of practice must be revised Creation of midlevel worker posts

10. Findings – Pick Report Computer simulation models Different scenarios and projected over a thirty year period Average annual population growth rate of 2% Variable net loss rates

11. Findings – Pick Report Doctors: 1 doctor: 1,290. Will decline to 1doctor: 1,320. Current production sufficient, but poor distribution Nurses: Staffing ratio of enrolled nurse: professional nurse should be revised to 2:1. Training of enrolled nurses to increase. Scopes of practice should be revised

12. Findings – Pick Report Dentists: Supply exceeding population growth. Ratio will improve from 1:9,400 to 1:7,800. Distribution between public and private sector problematic. Reduction in annual intake could be considered. Pharmacists: 1:3920 to 1:3840. Increasing numbers not justified. Problem of mal- distribution.

13. Findings – Pick Report Physiotherapists: 1:10,000. Will improve to 1:6000. Creation of extra posts and community service Radiographers: 1:8,700 to 1:9,800. Increasing rate of production or mid-level worker Dieticians, psychologists, speech therapist: Will all have worsening population ratios. Increase production

14. Other Findings Any increase in staffing unaffordable, unless financial allocation increased in real terms Key issue is shortages in underserved areas. Need to look at increasing financial allocations to recruit and retain staff. Health professionals should acquire specifically defined skills

15. Other Findings Admission criteria to be reviewed Representavity should be improved Skills audit Multi-skilling Key recommendation: Creation of mid- level workers

16. Progress: Sufficient Staff with the right skills in the right place Planning Norms for Staffing Requirement Pick report Provincial Strategic Position Statements Modernisation of tertiary services Production of Health Workers Most councils have worked on or revising scopes of practice Enrolled nursing courses Midlevel workers Pharmacy assistants Enrolled nurses Radiography assistants Physiotherapy technologist Speech, Language and Hearing Assistant

17. Progress: Sufficient Staff with the right skills in the right place Midlevel workers cont Occupational therapy assistant Phlebotomist Medical assistant Will drive as major learnership initiative with HWSETA and DoL Integrate from Level 1 to Level 6. Therefore will include CHWs

18. Progress: Sufficient Staff with the right skills in the right place Strategies for Recruitment and Retention Scarce skills and rural allowance Code of Conduct for Ethical recruitment Overseas training opportunities Cuba India Japan USA Italy Belguim Work opportunities Government to government agreements for recruitment Fast tracking of registration for underserved areas

19. Progress: Transformation of training and education Representavity Agreements reached on second year admissions within five years Admission criteria being reviewed Skills Competency Framework Done for District Health Managers Skills competency gap study done for districts Using similar framework for hospital managers

20. Progress: Transformation of training and education Health Management Institute established Training Centres for Health Managers French Programme Harvard School of Public Health MESOL Exit competencies for undergraduate students have been worked on by councils. Will be negotiated to ensure it reflects skills required Training length Agreed will have minimum five year curriculum for medical students with two year internship.

21. Progress: Transformation of professional regulation Structural reform of professional statutory councils Task Team tabled report with major achievements Legislation to enact recommendations Forum of Statutory Councils Define scopes of practice of health professionals Scopes have been defined for most councils

22. Progress: Transformation of pay and human resource management Joint Task Team reviewing salary structures and scarce skills retention strategy Incentive for rural and underserved areas Framework document on monetary and non monetary incentives approved by MinMec Task Team looking at monetary incentives

23. Transformation of pay and human resource management Non-monetary Incentives Bursaries, including dependents Improved accommodation Better leave packages Sabbaticals Training opportunities

24. Conclusions Progress has been made This year will see unfolding of major initiatives Will have major public sector learnership drive. Recruitment and retention will be a focus